Optimal timing for removing a laryngeal mask airway in patients with special needs

Abstract

ObjectiveWhether a laryngeal mask airway (LMA) should be removed under deep anesthesia or after awakening from general anesthesia remains controversial. Among patients with special needs, removing an LMA after awakening might be difficult because they may be unable to follow instructions during LMA removal. Thus, requirements of patients with special needs must be taken into consideration while deciding on LMA removal. This study aimed to determine optimal timing of LMA removal after dental treatment under general anesthesia in disabled patients by comparing adverse event occurrence rates. MethodsBetween February and December 2018, we randomly categorized 80 disabled patients administered general anesthesia into two groups, namely, the Deep group (40 patients, LMA removed under deep anesthesia) or the Preawake group (40 patients, LMA removed in the Preawake state). Anesthesia in both groups comprised propofol (PROP) and remifentanil (RMFT), and flexible LMAs were used. Dental anesthesiologists assessed the frequency of adverse events, both during and immediately after LMA removal. ResultsClenching, gross body movement, and difficult ventilation were more frequently seen in the Preawake group than in the Deep group (P < 0.05; χ2 test). The rate of coughing, although higher in the Preawake group, was not significantly different between the groups. Laryngospasm occurred in one case in the Preawake group, but the event was insignificant and was responsive to 40 mg PROP administration. ConclusionsAmong disabled patients requiring general anesthesia with PROP and RMFT for dental treatment, LMA should be removed under deep anesthesia to minimize adverse events.