Use of the Laryngeal Mask Airway in Children with Upper Respiratory Tract Infections

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Abstract
Several studies suggest that placement of an endotra- cheal tube (ETT) in a child with an upper respiratory infection (URI) increases the risk of complications. However, the development of the laryngeal mask air- way (LMA) has provided anesthesiologists with an al- ternative means of airway management. This study was therefore designed to evaluate the use of the LMA in children with URIS and to compare it with the ETT. The study sample consisted of 82 pediatric patients (3 mo to 16 yr of age) who presented for elective surgery with an URI. Patients with URIS were randomly allo- cated to receive either an ETT (n = 41) or a LMA (n = 41) and were followed for the appearance and severity of any perioperative complications. The two groups were similar with respect to age, gender, anesthesia and sur- gery times, number of attempts at tube placement, and presenting URI symptoms. There were no differences between groups in the incidence of cough, breath- holding, excessive secretions, or arrhythmias. Al- though one patient in the ETT group required a muscle relaxant for laryngospasm, the overall incidence of la- ryngospasm was similar between the two groups. There was, however, a significantly greater incidence of mild bronchospasm in the ETT group compared with the LMA group (12.2% vs 0%, P < 0.05). The incidence of major arterial oxygen desaturation events (Spo, <90%) during placement of the airway device was also significantly increased in the ETT group (12.5% vs 0%, P < 0.05). Furthermore, the total number of all episodes of respiratory complications, i.e., breath-holding, laryn- gospasm, bronchospasm, and major oxygen desatura- tion, was significantly greater in the ETT group (35 vs 19, P < 0.05). Despite this, all respiratory complications were easily managed, and there were no adverse se- quelae. Although the risks associated with anesthetiz- ing a child with an URI remain controversial, results from this study suggest that the LMA offers a suitable alternative to the ETT for use in children with URIS. Implications: This study compares the use of the laryn- geal mask airway with the endotracheal tube for airway management in children with upper respiratory infec- tions. Results suggest that if the decision is made to pro- ceed with anesthesia for the child with an upper respi- ratory infection, then the laryngeal mask airway provides a suitable alternative to the endotracheal tube. (Anesth Analg 1998;86:706-11)