Timing of laryngeal mask removal in children with a high risk for postoperative respiratory complications –awake or anesthetized?

None listed

Removal of the laryngeal mask airway can be performed while children are still deeply anesthetized or when they are awake (as defined by eye opening, grimacing, coughing, and purposeful movements). Each technique has its own advantages and disadvantages. In healthy children, it has been shown that there are no clinical differences between removal of the laryngeal mask airway in the awake state vs anesthetized state. In patients with a high risk of developing a postoperative respiratory problems (e.g. coughing) such as those with asthma, it may be preferable to remove the laryngeal mask airway while the patients are still anesthetized to avoid airway stimulation and consecutively bucking, coughing and bronchospasm. The results of a recent large prospective cohort study at our institution with over 9000 children allow to identify children with a high risk for developping postoperative respiratory complications. The aim of this present randomized controlled trial is to assess whether children at a high risk for respiratory problems benefit from anethetized removal of the laryngeal mask airway as compared to awake removal of the laryngeal mask airway following adenoidectomy. We hypothesize that children with a high risk for respiratory problems defined by the presence of either airway susceptibility, eczema or a positive family history who have their laryngeal mask airway removed deeply anaesthetised will demonstrate less respiratory problems compared with high risk children who have it removed awake.