The impact of topical lidocaine and timing of LMA removal on the incidence of airway events during the recovery period in children: a randomized controlled trial

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Abstract

Background

The timing of laryngeal mask airway (LMA) removal remains undefined. This study aimed to assess the optimal timing for LMA removal and whether topical anesthesia with lidocaine could reduce airway adverse events.

Methods

This randomized controlled trial assessed one-to-six-year-old children with ASA I-II scheduled for squint correction surgery under general anesthesia. The children were randomized into the LA (lidocaine cream smeared to the cuff of the LMA before insertion, with mask removal in the awake state), LD (lidocaine application and LMA removal under deep anesthesia), NLA (hydrosoluble lubricant application and LMA removal in the awake state) and NLD (hydrosoluble lubricant application and LMA removal in deep anesthesia) groups. The primary endpoint was a composite of irritating cough, laryngeal spasm, SpO ₂ < 96%, and glossocoma in the recovery period in the PACU. The secondary endpoints included the incidence of pharyngalgia and hoarseness within 24 h after the operation, duration of PACU stay, and incidence of agitation in the recovery period. The assessor was unblinded.

Results

Each group included 98 children. The overall incidence of adverse airway events was significantly lower in the LA group (9.4%) compared with the LD (23.7%), NLA (32.6%), and NLD (28.7%) groups ( P=0.001). Cough and laryngeal spasm rates were significantly higher in the NLA group (20.0 and 9.5%, respectively) than the LA (5.2 and 0%, respectively), LD (4.1 and 1.0%, respectively), and NLD (9.6 and 2.1%, respectively) groups ( P=0.001). Glossocoma incidence was significantly lower in the LA and NLA groups (0%) than in the LD (19.6%) and NLD (20.2%) groups ( P< 0.001). At 24 h post-operation, pharyngalgia incidence was significantly higher in the NLA group (15.8%) than the LA (3.1%), LD (1.0%), and NLD (3.2%) groups ( P< 0.001).

Conclusions

LMA removal in the awake state after topical lidocaine anesthesia reduces the incidence of postoperative airway events.

Trial registration

ChiCTR, ChiCTR-IPR-17012347. Registered August 12, 2017.

Related collections

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Author and article information

Contributors

Ruiqiang Sun:

ORCID: http://orcid.org/0000-0001-9468-2548

38940444@qq.com

Xiaoyun Bao: Bxy1019@163.com

Xuesong Gao: 282571721@qq.com

Tong Li: Cat19900402@126.com

Quan Wang: 402465896@qq.com

Yueping Li: leeyueping@aliyun.com

Journal

Journal ID (nlm-ta): BMC Anesthesiol

Journal ID (iso-abbrev): BMC Anesthesiol

Title: BMC Anesthesiology

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2253

Publication date (Electronic): 8 January 2021

Publication date PMC-release: 8 January 2021

Publication date Collection: 2021

Volume: 21

Electronic Location Identifier: 10

Affiliations

[1 ]GRID grid.412729.b, ISNI 0000 0004 1798 646X, Department of Anesthesiology, , Tianjin Eye Hospital, ; No. 4 Gansu Road, Heping District, Tianjin, 300022 China

[2 ]Tianjin Huaming Community Healthcare Service Center, Tianjin, China

Author information

Ruiqiang Sun http://orcid.org/0000-0001-9468-2548

Article

Publisher ID: 1235

DOI: 10.1186/s12871-021-01235-7

PMC ID: 7791716

PubMed ID: 33419400

SO-VID: 5118ceb1-1371-4166-bcfe-584f2d00746b

License:

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