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Is Laryngeal Mask a Good Alternative in Children Undergoing Laparoscopic Inguinal Hernia Repair with Percutaneous
Damla Uysal1, Sanem Çakar Turhan1, Ergun Ergün2
1Department of Anaesthesiology and Reanimation, Ankara University Faculty of Medicine, Ankara, Turkey.
Insights
Laryngeal mask airway (LMA) use in pediatric laparoscopic inguinal hernia repair provides comparable surgical conditions and satisfaction. This method also resulted in shorter anesthesia and recovery times compared to endotracheal tubes.
Area of Science:
- Pediatric Anesthesiology
- Minimally Invasive Surgery
- Respiratory Physiology
Background:
- Percutaneous internal ring suturing (PIRS) is a laparoscopic technique for pediatric inguinal hernia repair.
- Airway management is crucial during general anesthesia in pediatric surgery.
- Comparing airway devices like laryngeal mask airway (LMA) and endotracheal tube (ETT) is essential for optimizing patient outcomes.
Purpose of the Study:
- To evaluate and compare respiratory parameters during PIRS for inguinal hernia repair.
- To assess the efficacy of LMA versus ETT in pediatric patients undergoing laparoscopic inguinal hernia repair.
- To determine the impact of airway device choice on anesthesia duration, recovery time, and surgical satisfaction.
Main Methods:
- 180 pediatric patients (ASAI-II) were randomized into four groups based on age and airway device (LMA or ETT).
- Anesthesia was induced and maintained using standard protocols, with rocuronium added for ETT groups.
- Respiratory parameters (peak airway pressure, EtCO2, SpO2), hemodynamic data, and clinical outcomes were recorded.
Main Results:
- Surgical duration and satisfaction were similar across all groups.
- LMA groups demonstrated significantly shorter anesthesia and recovery times.
- Peak airway pressure and end-tidal carbon dioxide (EtCO2) levels were significantly lower in the LMA groups.
- Airway complications were rare and not statistically significant between groups.
Conclusions:
- Laryngeal mask airway (LMA) provides effective airway management for pediatric laparoscopic inguinal hernia repair using the PIRS technique.
- LMA is associated with improved anesthetic efficiency, indicated by shorter anesthesia and recovery times.
- LMA offers comparable surgical operating conditions and patient satisfaction to endotracheal tubes in this setting.
Objective:
This study aimed to evaluate respiratory parameters during percutaneous internal ring suturing (PIRS) for inguinal hernia repair in two different-aged pediatric patients in whom the airway is provided with a laryngeal mask or endotracheal tube for general anaesthesia.
Methods:
After local ethics committee and parental consent, 180 ASAI-II children were randomly allocated to 4 groups; according to their age (0-24 months / 25-144 months) and airway device laryngeal mask (LMA) / endotracheal tube (ETT) used for general anaesthesia (45 children each) for laparoscopic inguinal hernia repair. Standard anaesthesia induction was done with lidocaine, propofol, and fentanyl, and 0.6 mg kg-1 rocuronium was added to the ETT groups. Sevoflurane is used for maintenance. Hemodynamic parameters, peak airway pressure, end-tidal carbon dioxide (EtCO2), and peripheric oxygen saturation (SpO2) values were recorded after induction, before, and during pneumoperitoneum. The duration of anaesthesia, surgery, recovery time, and surgical satisfaction was recorded. Airway complications (cough, laryngospasm, bronchospasm, desaturation, and aspiration) were recorded.
Results:
Hundred and eighty patients (45 in each group) were analyzed. Duration of surgery and surgical satisfaction were similar in all groups. Duration of anaesthesia and recovery times were significantly shorter in the LMA groups. Peak airway pressure and EtCO2 levels were significantly lower in the LMA groups. Rare airway complications were observed without significance.
Conclusion:
In laparoscopic inguinal hernia repair with the PIRS technique, LMA offered comparable operating conditions and surgical satisfaction.
