Flexible laryngeal mask airway for cleft palate surgery in children: a randomized clinical trial on efficacy and safety

Abstract

Objective: To evaluate the efficacy of a flexible laryngeal mask airway in children undergoing palatoplasty.

Design: Prospective, randomized, single-center study.

Setting: Jawaharlal Institute of Postgraduate Medical Education and Research.

Patients: Sixty-six children (American Society of Anesthesiologists physical status 1 and 2) scheduled to undergo palatoplasty were assigned randomly to an endotracheal intubation group (RAE group, n = 33) and a flexible laryngeal mask airway group (FLMA group, n = 33).

Main outcome measures: Peak airway pressure, inspired and expired tidal volume, end-tidal carbon dioxide, lung compliance, and airway resistance were continuously measured after placement of the assigned airway. The percentage leak around the airway was quantified as the leak fraction. Parametric data between groups were analyzed using an unpaired Student's t test and within groups using a one-way analysis of variance. Nonparametric variables were analyzed using the Fisher exact test.

Results: In two children, the flexible laryngeal mask airway was displaced from its original position; whereas, one endotrachial tube advanced endobronchially. The leak fraction was significantly higher in the RAE group when compared with that in FLMA group (13.34% +/- 13.74% versus 5.96% +/- 3.78%, p < .05) until the throat pack was applied. Peak airway pressure and resistance were significantly higher in the RAE group compared with the FLMA group at all time intervals, p < .05. During emergence, frequency of coughing, desaturation, and laryngospasm were increased in the RAE group.

Conclusion: A flexible laryngeal airway mask is suitable for maintaining the airway and helps in smooth emergence in children undergoing palatoplasty.