Comparison of the Incidence of Laryngospasm after LMA Removal between Children Undergoing LMA Insertion with Simple Lubricant versus Lidocaine Gel
Abstract
Background: Pediatric patients are particularly vulnerable to airway stimulation, increasing the risk of perioperative respiratory adverse events such as laryngospasm and cough during emergence. Although the laryngeal mask airway (LMA) is less invasive than endotracheal intubation, it may still provoke airway irritation. This randomized clinical trial compared lidocaine gel with simple lubricant applied to the LMA surface in reducing airway-related complications in children.
Methods: Sixty children undergoing elective surgery at Mofid Children’s Hospital, Tehran, were randomly assigned to two groups (n=30 each). In the intervention group, lidocaine gel was used as the LMA lubricant; in the control group, a simple lubricant was applied. Demographic variables, underlying disease, laryngospasm, recovery-room cough, and cough 12 hours postoperatively were recorded and analyzed.
Results: Demographic characteristics did not differ significantly between groups (P>0.05). Laryngospasm and recovery-room cough occurred in none of the patients in the lidocaine group and in one patient (3.33%) in the control group, without statistical significance (P>0.05). No patient in either group experienced a cough
12 hours after surgery.
Conclusion: This study suggests that lidocaine gel, when used as an LMA lubricant in pediatric patients, may offer a potential advantage in attenuating airway-related complications during LMA removal, compared to simple lubricants. Considering its favorable safety profile and the observed trend towards improved airway stability, lidocaine gel warrants consideration as a beneficial adjunct for optimizing airway management in this population.
[2] Francois A, Rosenbaum M, Adams W, Schantz O, Stankiewicz J. The use of a supraglottic airway vs tracheal tube for endoscopic nasal sinus surgery. Trends Anaesth Crit Care. 2020; 33:17-22.
[3] Kriege M, Noppens RR. What should we expect in anaesthesia, critical care and pre-hospital care from extra glottic airways? Proven clinical performance for a variety of indications and patients. Trends Anaesth Crit Care. 2019; 25:32-5.
[4] van Esch BF, Stegeman I, Smit AL. Comparison of laryngeal mask airway vs tracheal intubation: a systematic review on airway complications. J Clin Anesth. 2017; 36:142-50.
[5] Nevešćanin A, Vickov J, Elezović Baloević S, Pogorelić Z. Laryngeal mask airway versus tracheal intubation for laparoscopic hernia repair in children: analysis of respiratory complications. J Laparoendosc Adv Surg Tech A. 2020; 30(1):76-80.
[6] Seyed Siamdoust S, Rokhtabnak F, Djalali Motlagh S, Rahimzadeh P, Hassani V, Farnaghizad M. Comparison of the success rate of intubation between the LMA Fastrach and AirQ-ILA methods in patients undergoing elective surgery during general anaesthesia. Anesth Pain Med. 2018; 8(4):e63424.
[7] Langeron O, Semjen F, Bourgain JL, Marsac A, Cros AM. Comparison of the intubating laryngeal mask airway with the fiberoptic intubation in anticipated difficult airway management. Anesthesiology. 2001; 94(6):968-72.
[8] Gong Y, Xu X, Wang J, Che L, Wang W, Yi J. Laryngeal mask airway reduces incidence of post-operative sore throat after thyroid surgery compared with endotracheal tube: a single-blinded randomized controlled trial. BMC Anesthesiol. 2020; 20(1):16.
[9] Kang SH, Park M. Comparison of early postoperative recovery between laryngeal mask airway and endotracheal tube in laparoscopic cholecystectomy: a randomized trial. Medicine (Baltimore). 2019; 98(25):e16022.
[10] Walker RW. The laryngeal mask airway in the difficult paediatric airway: an assessment of positioning and use in fibreoptic intubation. Paediatr Anaesth. 2000; 10(1):53-8.
[11] Li L, Zhang Z, Yao Z, Wang H, Wang H, An H, et al. The impact of laryngeal mask versus other airways on perioperative respiratory adverse events in children: a systematic review and meta-analysis of randomized controlled trials. Int J Surg. 2019; 64:40-8.
[12] de Carvalho ALR, Vital RB, de Lira CCS, Magro IB, Sato PTS, Lima LHN, et al. Laryngeal mask airway versus other airway devices for anesthesia in children with an upper respiratory tract infection: a systematic review and meta-analysis of respiratory complications. Anesth Analg. 2019; 128(2):e37.
[13] Monem A, Khan FA. Laryngeal mask airway insertion anaesthesia and insertion techniques. J Pak Med Assoc. 2007; 57(12):607-11.
[14] Mansfield MD, Miller CD. The laryngeal mask airway and resuscitation. Anaesthesia. 1993; 48(7):637-8.
[15] Huang RC, Hung NK, Lu CH, Wu ZF. Removal of laryngeal mask airway in adults under target-controlled, propofol-fentanyl infusion anesthesia: awake or deep anesthesia? Medicine (Baltimore). 2016; 95(17):e3441.
[16] Koo CH, Lee SY, Chung SH, Ryu JH. Deep vs. awake extubation and LMA removal in terms of airway complications in pediatric patients undergoing anesthesia: a systemic review and meta-analysis. J Clin Med. 2018; 7(10):353.
[17] Ramgolam A, Hall GL, Zhang G, Hegarty M, von Ungern-Sternberg BS. Deep or awake removal of laryngeal mask airway in children at risk of respiratory adverse events undergoing tonsillectomy-a randomised controlled trial. Br J Anaesth. 2018; 120(3):571-80.
[18] von Ungern-Sternberg BS, Davies K, Hegarty M, Erb TO, Habre W. The effect of deep vs. awake extubation on respiratory complications in high-risk children undergoing adenotonsillectomy: a randomised controlled trial. Eur J Anaesthesiol. 2013; 30(9):529-36.
[19] Brain AI. Modification of laryngeal mask insertion technique in children. Anesth Analg. 1995; 81(1):212.
[20] Hung KC. The effect of intravenous lidocaine on laryngeal mask airway insertion conditions. Eur J Anaesthesiol. 2010; 27(3):308.
[21] Mihara T, Uchimoto K, Morita S, Goto T. The efficacy of lidocaine to prevent laryngospasm in children: a systematic review and meta-analysis. Anaesthesia. 2014; 69(12):1388-96.
[22] Schebesta K, Güloglu E, Chiari A, Mayer N, Kimberger O. Topical lidocaine reduces the risk of perioperative airway complications in children with upper respiratory tract infections. Can J Anaesth. 2010; 57(8):745-50.
[23] Gharaei B, Jafari A, Poor Zamany M, Kamranmanesh M, Aghamohammadi H, Roodneshin F, et al. Topical versus intravenous lidocaine in children with upper respiratory infection undergoing anesthesia: a randomized, double blind, clinical trial. Anesth Pain Med. 2015; 5(4):e23501.
[24] Edwards ND. Lignocaine gel and the laryngeal mask airway. Anaesthesia. 1995; 50(8):746-7.
[25] Damshenas MH, Kalani N, Rastgarian A. Comparison of two methods of using lubricant gel and lidocaine 2% gel when placing the laryngeal mask airway on the symptoms of hemodynamics and anesthesia reactions in patients undergoing cataract surgery: a randomized double-blind clinical trial study. Koomesh. 2021; 23(2):e153259.
[26] Sun R, Bao X, Gao X, Li T, Wang Q, Li Y. The impact of topical lidocaine and timing of LMA removal on the incidence of airway events during the recovery period in children: a randomized controlled trial. BMC Anesthesiol. 2021; 21(1):10.
[27] Rahmanian M, Kalani N, Razavizadegan SA, Jafari SM, Sahraei R. Comparison of the use of two methods of lidocaine and lubricant gel on reactions coming out of anesthesia with two methods of using laryngeal mask and endotracheal tube in patients undergoing cataract surgery: a randomized double-blind clinical trial study. J Emerg Health Care. 2022; 11(4):1-10.
| Files | ||
| Issue | Article in Press |
|
| Section | Research Article(s) | |
| Keywords | ||
| Laryngeal mask airway Lidocaine Laryngospasm Pediatrics Airway management | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |


