Complications Associated with Removal of the Laryngeal Mask Airway: Deep Anesthesia Versus Waking State

Park, Jin Woo; Im, Dae Guen; Jung, Soon Ho; Choe, Young Kyun; Kim, Young Jae; Shin, Chee Mahn; Park, Ju Yuel

Abstract

BACKGROUND: The optimal time to remove the laryngeal mask airway (LMA) at the end of surgery is still a matter of controversy. The purpose of this study was to compare the incidence of complications associated with the removal of the LMA from the deeply anesthetized and from the awake patient.
METHODS
The LMA was used in 120 adults undergoing general elective lower abdominal or extremity surgery. The patients were randomly assigned to two groups. In 60 patients the LMA was removed by the anesthetist with the patient deeply anesthetized in the operating room. In the other 60 patients it was removed by the anesthetist when the patient responded to verbal commands in the operating room. Any airway complications occurring within 15 minutes of LMA removal were recorded. These complications included coughing, biting, retching, vomiting, excessive salivation, airway obstruction and laryngospasm.
RESULTS
Groups were similar in age, weight, and duration of surgery. Airway complications associated with LMA removal were noted in fourteen patients. Airway complications occurred in six patients who had their LMA removed during deep anesthesia, and in eight patients who under went removal of their LMA on awakening. In the anesthetized group, there were four kinds of airway complications in six patients (retching, excessive salivation, airway obstruction and laryngospasm). In the awake group, eight patients experienced six kinds of airway complications (coughing, biting, vomiting, excessive salivation, airway obstruction and laryngospasm). There was no significant difference between the two groups in the incidence of complications after removal of the LMA.
CONCLUSIONS
Removal of the LMA under deep anesthesia had no advantage compared to removal from awakening patients in terms of complications in adult.