The Use of Laryngeal Mask Airway Versus Endotracheal Intubation in Pediatric Laparoscopic Inguinal Hernia Repair: A Randomized Controlled Trial.

BACKGROUND

A laryngeal mask airway (LMA) is routinely used for many types of pediatric surgical procedures and as a rescue airway device. Laparoscopic procedures in pediatric surgery are common and are becoming increasingly widespread. In laparoscopic surgery, the traditional airway approach is the use of endotracheal intubation, while the use of LMA in laparoscopic surgery is not well studied.

AIMS: To evaluate the effectiveness of general anesthesia with LMA versus traditional endotracheal tube (ETT) for pediatric patients aged 12 months to 8 years old undergoing laparoscopic inguinal hernia repair.

METHODS

In a single institution prospective randomized trial, pediatric patients undergoing laparoscopic inguinal hernia repair were recruited from April 2023 to May 2024. Patients were randomized to general anesthesia with either an LMA or ETT. The primary endpoint was oxygen saturation in percent saturation (SpO2) measured at three standardized timepoints. Secondary endpoints were end tidal carbon dioxide (EtCO2) levels and peak airway pressure (PAP) measurements at the same three standardized timepoints as well as the occurrence of any episodes of laryngospasm or desaturation documented in each group.

RESULTS

Fifty patients underwent laparoscopic inguinal hernia surgery with general anesthesia, twenty-five patients with LMA and twenty-five with ETT. There was no clinically significant difference in oxygenation between study groups. Additionally, there was no statistically significant difference between study arms in EtCO2 levels. Patients with ETT had higher peak airway pressures compared to patients with LMA at all three time points. There was one incident of desaturation in each study arm and no episodes of laryngospasm.

CONCLUSIONS

The use of LMA in short laparoscopic surgery is a safe and effective alternative to ETT in appropriate pediatric patients.

LEVEL OF EVIDENCE: 1b.

CLINICAL TRIAL REGISTRATION: This study is registered with ClinicalTrials.gov NCT06023394.

CLINICAL IMPLICATIONS: The use of LMA in pediatric surgery is common. There is limited data and no studies from the United States assessing the efficacy of LMA in pediatric laparoscopic surgery and this study aims to add prospective data.