Postoperative discomfort and emergence delirium in children undergoing dental rehabilitation under general anesthesia: comparison of nasal tracheal intubation and laryngeal mask airway

Abstract

Background: Several studies have identified side effects of general anesthesia with endotracheal intubation, such as laryngeal pain, dysphonia, and postoperative nausea and vomiting (PONV). The laryngeal mask airway (LMAw) is believed to decrease these side effects. The aim of this trial was to compare postoperative discomfort, emergence delirium, and recovery time of patients who received either an LMAw or nasotracheal intubation (NTI).

Patients and methods: A total of 70 children were randomly assigned to the LMAw group (n=35) or the NTI group (n=35). Both groups underwent mask induction with 8% sevoflurane. The NTI group received muscle relaxant, whereas the LMAw group did not. Postoperative laryngeal pain, dental pain, dysphonia, and PONV were assessed immediately and at 1 hour and 6 hours postoperatively. The Wong-Baker Faces Scale was used to evaluate the patients' self-reported pain. In addition, decayed, missing, and filled teeth (dft/DMFT) values, dental procedure type, number of dental procedures, duration of the dental operation, duration of anesthesia, recovery time, emergence delirium, pediatric dentist's access to the mouth, and parents' satisfaction levels were recorded. Data were analyzed using descriptive statistics, chi-square tests, and two-sample t-tests.

Results: The incidence of postoperative laryngeal pain was significantly higher in the NTI group immediately (97.2% vs. 8.5%, P=0.00), 1 hour (94.2% vs. 0%, P=0.00), and 6 hours postoperatively (25.7% vs. 0%, P=0.00). There were no statistically significant differences between the two groups in dental pain scores, dft/DMFT values, duration of anesthesia, duration of the dental operation, number of dental procedures, the incidence of PONV, or pediatric dentist's access to the mouth (P>0.05). Emergence delirium and recovery time were significantly higher in the NTI group (P<0.05).

Conclusion: The LMAw provided a more comfortable postoperative period than NTI for children who underwent full-mouth dental rehabilitation under general anesthesia.

Keywords: anesthesia; child; dysphonia; emergence delirium; intubation; pain.

Figure 1

Flowchart of the study. Abbreviations: LMAw, laryngeal mask airway; NTI, nasotracheal intubation.

Figure 2

Comparison of the dental and laryngeal pain levels of the groups immediately and at 1 hour and 6 hours postoperatively. Note: *Statistically significant difference at 0.05 level. Abbreviations: DPPO1H, dental pain postoperatively 1 hour; DPPO6H, dental pain postoperatively 6 hours; DPPOI, dental pain postoperatively immediately; LMAw, laryngeal mask airway; LPPO1H, laryngeal pain postoperatively 1 hour; LPPO6H, laryngeal pain postoperatively 6 hours; LPPOI, laryngeal pain postoperatively immediately; NTI, nasotracheal intubation.