None listed
Conditions
Brief summary
Emergence delirium is a very common occurrence, typically presenting in young children, after waking up from anaesthesia. Emergence delirium poses risks for the child as they are likely to harm themselves by removing intravenous drips, catheters etc It also poses significant stress on the nurses and can cause dissatisfaction among the parents in regards to the care their child is receiving. Tonsillectomies are common surgical procedures performed on children so trying to minimize emergence delirium will be beneficial for all involved. Previous studies and research have shown the benefits of a laryngeal mask airway over an endotracheal tube but research is limited in terms of when the laryngeal mask airway should be removed. We hypothesize that the removal of the laryngeal mask airway whilst anaesthetized (deep) at the end of surgery for tonsillectomy in children aged 2-7 years results in a lower incidence of emergence delirium in the post-anaesthesia care unit compared to awake removal of the laryngeal mask airway. Patients will be recruited after consent is gained by the student or the student's supervisor from the child's parents. The student will then observe the child before the surgery and then for 5 minutes and 20 minutes after the child awakens from surgery. If the child or parents feel uncomfortable with their child's participation during the study then they are able to sign a withdrawal form (attached to the consent form) at any time stating a reason for withdrawal.
Interventions
The intervention will be when to remove the child's LMA after the surgeon has performed the tonsillectomy. Upon consent from the parents for their child to participate in the study, the anaesthetist in charge will be notified by the student when to remove the LMA. This is a randomized procedure with two options: Deep (removing the LMA whilst the child is anaesthetised) or awake (removing the LMA in the PACU upon awakening). Deep removal of the LMA will occur within 2 minutes of completion of ton
The intervention will be when to remove the child's LMA after the surgeon has performed the tonsillectomy. Upon consent from the parents for their child to participate in the study, the anaesthetist in charge will be notified by the student when to remove the LMA. This is a randomized procedure with two options: Deep (removing the LMA whilst the child is anaesthetised) or awake (removing the LMA in the PACU upon awakening). Deep removal of the LMA will occur within 2 minutes of completion of tonsillectomy in the operating theatre. The child will be placed in the left lateral position and LMA removed by the attending anaesthetist. In the awake group, the LMA will be removed by the nurse upon the child opening their eyes. Approximately within 20 minutes post tonsillectomy. The student will take no part in the surgery or induction and maintenance of anaesthesia. Fidelity to the intervention will be monitored by the student who is observing and recording the study.
Sponsors
Dr Luke Baitch
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Prevention
Masking
Blinded (masking used) (Subject)
Eligibility
Sex/Gender
All
Age
2 Years to 7 Years
Healthy volunteers
No
Inclusion criteria
Children aged 2-7 years undergoing elective tonsillectomy Successful placement of LMA after induction of anaesthesia
Exclusion criteria
Known or suspected difficult airway Endotracheal intubation for tonsillectomy for any medical or anaesthetic indication Anaesthetist concern regarding deep airway removal for any medical or anaesthetic reason Parents unable to speak English
Outcome results
None listed