Canadian Journal of Anaesthesia

, Volume 40, Issue 12, pp 1171–1177 | Cite as

Anaesthesia for adenotonsillectomy: A comparison between tracheal intubation and the armoured laryngeal mask airway

  • A. C. Webster
  • P. K. Morley-Forster
  • S. Dain
  • S. Ganapathy
  • R. Ruby
  • A. Au
  • Mary Jo Cook
Reports of Investigation


A prototype armoured laryngeal mask airway (LMA) was compared with tracheal intubation (ETT) for anaesthesia for adenotonsillectomy. Fifty-five children were randomised into the LMA group and 54 into the ETT group. During insertion of the LMA, peripheral oxyhaemoglobin desaturation (SpO2) < 94% occurred in ten patients (18.2%) and in seven patients (13%) during tracheal intubation (NS). After opening the Boyle-Davis gag, airway obstruction occurred in ten patients (18.2%) in the LMA group and in three patients (6%) in the ETT group (P = 0.07). In five patients (9%) the LMA was abandoned in favour of tracheal intubation. In all others (91%), when the need for adequate depth of anaesthesia was realized, a satisfactory airway was achieved more rapidly than with tracheal intubation (P < 0.001), and maintained throughout surgery. Manually assisted ventilation was required in all patients in the ETT group, mean duration 373 ± 385 sec, and in 26 patients (52%) in the LMA group, mean duration 134 ± 110 sec, P < 0.001. Mean end-tidal CO2 (PetCO2) was 45.5 ± 6.21 mmHg in the ETT group and 46.6 ± 6.09 in the LMA group (NS). The LMA did not limit surgical access. Heart rate, MAP and blood loss in the LMA group were 110 ± 21, 74 ± 9 mmHg and 1.92 ± 1.22 ml · kg−1 respectively, compared with 143 ± 13 (P < 0.001), 85 ± 12 mmHg (P < 0.001) and 2.62 ± 1.36 ml · kg−1 (P < 0.05) with tracheal intubation. Fibreoptic laryngoscopy at the end of surgery in 19 patients in the LMA group revealed no blood in the larynx. In the LMA group postintubation stridor and laryngospasm occurred in five and three patients respectively, compared with 14 (P < 0.05) and six patients respectively (NS) with tracheal intubation. SpO2 on admission to the PACU in the LMA group was 95.9 ± 2.21, and 93.5 ± 4.53 (P < 0.05) after tracheal intubation. Our study demonstrated that the LMA is a safe alternative to tracheal intubation for adenotonsillectomy. Control of airway reflexes by ensuring sufficient depth of anaesthesia is essential for successful use of the LMA in children.

Key words

Anaesthesia: paediatric Equipment: airway, laryngeal mask Surgery: otolaryngological 


Un prototype de masque larngyé armé (ML) est comparé à l’intubation trachéale (TE) pendant l’anesthésie pour adéno-amygdalectomie. Cinquante-cinq enfants sont assignés au hasard au groupe ML et 54 au groupe TE. Pendant l’insertion du ML, une désaturation périphérique inférieure à 94% survient chez dix patients (18,2%) et pendant l’intubation trachéale chez sept patients (13%) (NS). Après la mise en place de l’ouvre-bouche de Boyle-Davis, l’obstruction des voies aériennes supérieures survient chez dix patients (18,2%) dans la groupe ML et trois patients dans le groupe TE (P = 0.07). Chez cinq patients (9%), on abandonne le ML en faveur de l’intubation trachéale. Chez tous les autres (91%), après l’atteinte d’un niveau d’anesthésie adéquat, un airway satisfaisant est réalisé plus rapidement qu’avec l’intubation trachéale (P < 0,001) et maintenu pendant la chirurgie. Une ventilation assistée manuellement devient nécessaire pour tous les patients du groupe TE, avec une durée moyenne de 373 ± 385 sec, et chez 26 patients (52%) du groupe ML, avec une durée moyenne de 134 ± 110 sec (P < 0,001). Le CO2 télé-expiratoire (PetCO2) est de 45,5 ± 6,21 mmHg dans le groupe TE et de 46,6 ± 6,09 mmHg dans le groupe MLA (NS). Le MLA ne limite pas l’accès chirurgical. La fréquence cardiaque, la PAM et la perte sanguine est de 110 ± 21, 74 ± 9 mmHg et 1,92 ± 1,22 ml · kg−1 respectivement pour le groupe ML, comparativement à 143 ± 13 (P < 0,001), 85 ± 12 mmHg (P < 0,001) et 2,62 ± 1,36 ml · kg−1 (P < 0,05) pour le groupe TE. Chez 19 patients du groupe ML, la fibroscopie à la fin de la chirurgie n’a pas révélé la présence de sang dans le larynx. Dans le groupe ML après l’intubation, un stridor et un laryngospasme sont apparus chez cinq et trois patients respectivement, comparativement à 14 (P < 0,05) et six patients respectivement (NS) dans le groupe TE. Notre étude montre que le ML est une alternative sécuritaire à l’intubation trachéale pour l’adéno-amygdalectomie. Pour utiliser avec succès la LM, il est essentiel de contrôler les réflexes des voies aériennes par une anesthésie suffisamment profonde.


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Copyright information

© Canadian Anesthesiologists 1993

Authors and Affiliations

  • A. C. Webster
    • 1
  • P. K. Morley-Forster
    • 1
  • S. Dain
    • 1
  • S. Ganapathy
    • 1
  • R. Ruby
    • 1
  • A. Au
    • 1
  • Mary Jo Cook
    • 1
  1. 1.Departments of Anaesthesia and OtolaryngologyUniversity of Western Ontario, St. Joseph’s Health CentreCanada

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