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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

de Carvalho, Ana Lygia R. MD, PhD*; Vital, Roberto B. MD, PhD*; de Lira, Carlos C. S. MD; Magro, Igor B. MD; Sato, Patrícia T. S. MD*; Lima, Laís H. N. MD, PhD*; Braz, Leandro G. MD, PhD*; Módolo, Norma S. P. MD, PhD*

doi: 10.1213/ANE.0000000000003674
Pediatric Anesthesiology

There is an association between upper respiratory tract infection (URTI) and an increased incidence of perioperative respiratory adverse events (PRAEs), which is a major risk for morbidity during pediatric anesthesia. The aim of the present study was to compare the risk of PRAEs among different airway devices during anesthesia in children with a URTI. A systematic review according to the Cochrane Handbook and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. Only randomized clinical trials evaluating anesthesia in children with a URTI and who were submitted to any of the airway devices were included. From 1030 studies identified, 5 randomized clinical trials were included in the final analysis. There were no statistical differences between laryngeal mask airway (LMA®) and endotracheal tube (ETT) regarding breath holding or apnea (risk ratio [RR], 0.82; 95% confidence interval [CI], 0.41–1.65), laryngospasm (RR, 0.74; 95% CI, 0.18–2.95), and arterial oxygen desaturation (RR, 0.44; 95% CI, 0.16–1.17). The quality of evidence was low for the first outcome and very low for the 2 other outcomes, respectively. The LMA use produced a significant reduction of cough (RR, 0.75; 95% CI, 0.58–0.96, low quality of evidence) compared with ETT. The ideal airway management in children with a URTI remains obscure given that there are few data of perioperative respiratory complications during anesthesia. This systematic review demonstrates that LMA use during anesthesia in children with URTI did not result in decrease of the most feared PRAEs. However, LMA was better than ETT in reducing cough. Further research is needed to define the risks more clearly because cough and laryngospasm have similar triggers, and both bronchospasm and laryngospasm trigger cough.

From the *Departamento de Anestesiologia

Departamento de Neurologia, Psicologia e Psiquiatria, Faculdade de Medicina de Botucatu, UNESP, Universidade Estadual Paulista “Júlio de Mesquita Filho,” Botucatu, Brazil.

Published ahead of print July 27, 2018.

Accepted for publication June 18, 2018.

Funding: This research was carried out without funding. A.L.R.C. was granted a scholarship from Coordination of Improvement for Higher Academic Staff (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior [CAPES]). P.T.S.S. received a scholarship from São Paulo Research Foundation (Fundação de Amparo à Pesquisa do Estado de São Paulo [FAPESP]; #2014/16734–6). CAPES and FAPESP are Brazilian governmental agencies dedicated to promoting scientific research.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website.

Preliminary data for this study were presented as European Society of Anaesthesiology (ESA) Best Abstract Prize Competition at the ESA Euroanaesthesia May 30, 2015 to June 2, 2015, Berlin, Germany.

LMA is a registered trademark of Teleflex Incorporated or its affiliates.

Reprints will not be available from the authors.

Address correspondence to Ana Lygia R. de Carvalho, MD, PhD, Departamento de Anestesiologia, Universidade Estadual Paulista, UNESP, Faculdade de Medicina de Botucatu, Av. Prof. Mário Rubens Guimarães Montenegro, s/n, Bairro: UNESP, Campus de Botucatu, Botucatu, SP, Brazil. Address e-mail to

Copyright © 2018 International Anesthesia Research Society
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