Effect of Airway Devices on Emergence Delirium in Pediatric Strabismus Surgery

Area of Science:

• Anesthesiology
• Pediatric Surgery
• Critical Care Medicine

Background:

• Pediatric anesthesia emergence delirium (PAED) is a common complication following general anesthesia in children.
• Symptoms of PAED include agitation, hyperactivity, and confusion, impacting patient recovery.
• Strabismus surgery is a frequent procedure in pediatric populations requiring general anesthesia.

Purpose of the Study:

• To compare the incidence and severity of emergence delirium (ED) between laryngeal mask airway (LMA) and endotracheal tube (ETT) use in children undergoing strabismus surgery.
• To evaluate secondary outcomes including pain scores, intubation/extubation times, and post-anesthesia care unit (PACU) stay.

Main Methods:

• A randomized controlled trial involving 73 children aged 3-9 years undergoing strabismus surgery.
• Patients were allocated to either the LMA group (n=36) or the ETT group (n=37).
• Emergence delirium was assessed using the PAED scale (score >10) and FLACC scale, with measurements taken at regular intervals post-surgery.

Main Results:

• The LMA group experienced significantly shorter intubation and PACU stay durations compared to the ETT group (P=0.02).
• Higher PAED scale scores were observed in the ETT group at multiple time points post-surgery (P<0.05).
• The incidence of ED was significantly lower in the LMA group at 5, 10, and 15 minutes post-surgery (P<0.05).

Conclusions:

• Laryngeal mask airway (LMA) use is associated with a reduced incidence and severity of emergence delirium in pediatric strabismus surgery.
• LMA facilitates faster recovery, evidenced by shorter PACU stay and reduced postoperative pain compared to ETT.
• LMA represents a potentially superior airway management strategy for pediatric strabismus procedures.