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  • Title: Safety of laryngeal mask airway and short-stay practice in office-based adenotonsillectomy.
    Author: Gravningsbråten R, Nicklasson B, Raeder J.
    Journal: Acta Anaesthesiol Scand; 2009 Feb; 53(2):218-22. PubMed ID: 19076111.
    Abstract:
    BACKGROUND: It is still disputed whether laryngeal mask airway (LMA) is safe and convenient for adenotonsillectomy, and whether these procedures can be safely undertaken in an office-based short-stay ambulatory setting. We report the result of this practice in 1126 consecutive children < 16 years of age. METHODS: The patients received general anaesthesia with propofol and remifentanil. For analgesic prophylaxis, they received paracetamol, fentanyl and local anaesthetic administration. NSAIDs were given to patients weighing above 15 kg. A surgical technique with elevation, scissors and electrocoagulation was used. Post-operatively, the tonsillectomies were observed in the unit for at least 1.5 h and the adenoidectomies for at least 15-20 min. RESULTS: Conversion from LMA to an endotracheal tube was carried out in six patients (0.5%), mostly due to airway leakage during ventilation. One patient had a pulmonary atelectasis and was re-intubated. No re-operation was needed in the clinic after surgery, and all patients, except for the one with atelectasis (0.1%), were discharged home as planned. In 122 patients answering a questionnaire, after discharge, two patients (1.6%) were admitted to hospital and re-operated due to bleeding; a further six patients (4.9%) were admitted for observation. In 25% of the patients, nausea and vomiting occurred after discharge, including 21% vomiting of swallowed blood during home travel. Only 5.6% reported significant post-discharge pain. CONCLUSION: With a well-trained team, adenotonsillectomy on children can be carried out safely in an office-based setting with LMA and a short post-operative stay.
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