Comparison of Intubation-Related Complications Between Laryngeal Mask and Endotracheal Intubation with Bronchial Blocker for One-Lung Ventilation in Pediatric Patients

To compare the incidence of intubation-related adverse events between 2 airway management techniques for one-lung ventilation (OLV) in pediatric thoracoscopic surgery: laryngeal mask airway (LMA) with bronchial blocker (BB) versus endotracheal tube (ETT) with BB.

A retrospective cohort study SETTING: A single tertiary care academic hospital PARTICIPANTS: Forty-eight pediatric patients (age 3 months to 8 years) undergoing elective thoracoscopic mediastinal mass resection were included.

OLV was achieved using either an LMA with BB (n = 24) or an ETT with BB (n = 24).

The primary outcomes were postoperative intubation-related complications, including sore throat severity, secretion grade, and laryngospasm, assessed in the postanesthesia care unit. Secondary outcomes included hemodynamic responses during intubation and early postoperative pulmonary complications. The LM cohort demonstrated significantly lower secretion scores (median 1 [interquartile range (IQR), 0.25-1) vs 1 [IQR 1-2]; P = .013) and a lower sore throat scale (median 0 [IQR, 0-0] vs 1 [IQR, 0-2]; P = .000). No laryngospasm cases occurred in either group. Hemodynamic profiles during airway manipulation (percent change in systolic blood pressure, 0.80 [IQR, 0.02-0.19] vs 0.07 [IQR, 0.05-0.16]; P = .975) and chest radiograph scores (median, 0 [IQR, 0-1] vs 1 [IQR, 0-1.75]; P = .124) showed comparable trends between the 2 groups.

In pediatric patients requiring OLV, the LMA-BB technique may be associated with reduced early postoperative airway adverse effects compared to the ETT-BB approach. These findings suggest that LMA with BB could be a valuable alternative for selected thoracic procedures in children.