Can Nasopharyngeal Suction Under Anesthesia Reduce the Incidence of Respiratory Adverse Events After Supraglottic Airway Removal in Children? A Randomized Controlled Trial.

This study aimed to determine whether nasopharyngeal suction reduces the incidence of perioperative respiratory adverse events (PRAE) after supraglottic airway (SGA) removal in children. Four hundred children (ages 1-6 years) undergoing general anesthesia using SGA, were randomized into two groups: combined nasopharyngeal and oral suction (Group N), and oral suction alone (Group O). Suction was performed under anesthesia prior to SGA removal. Patients were observed for coughing, breath-holding, airway obstruction, laryngospasm, bronchospasm, and desaturation--the incidence of any one or more of which was considered positive for PRAE. Subgroup analysis of patients with active or recent upper respiratory tract infection (URTI) was decided a priori. The incidence of PRAE was 21.8%, with no significant difference between Group N (21.2%) and Group O (22.3%). In children with active or recent URTI, the incidence of PRAE was significantly lower in group N (21.7%) compared with group O (44.7%); relative risk 0.486 (95% CI, 0.258 to 0.917), P = .019; number needed to treat = 4.4. In the general pediatric population, nasopharyngeal suctioning did not reduce the incidence of PRAE. However, in children with URTI, PRAE incidence was significantly lower in those who underwent nasopharyngeal suctioning prior to SGA removal.