Abstrait

Survey of the Use of Laryngeal Mask Airway vs Endotracheal Tube for Pediatric Tonsillectomy in Essex Hospitals.

Manuela Cresswell, Harriet Walker, Laura Harding

Introduction: Tonsillectomy is one of the most frequently performed surgical procedures in children. Endotracheal tube and laryngeal mask are widely used as airway adjuncts for children undergoing tonsillectomy, the choice of which varies according to anesthetist’s and surgeon’s preferences. Studies demonstrate no significant difference in laryngospasm rates, although post-operative stridor is less frequent after laryngeal mask use. The aim of this survey was to establish current practice in hospitals in Essex.

Materials and methods: An anonymous online questionnaire containing 5 questions was created using www.surveymonkey.com. Dissemination to regional middle grade ENT surgeons and ENT consultants was done via e-mail.

Results: The response rate was 56.3% (18 of 32). 87.8% of respondents reported using mostly endotracheal tube and 22.2% laryngeal mask. 66.7% of them preferred endotracheal intubation, while 11.1% preferred laryngeal mask and 22.2% had no preference. When respondents asked about reasons for airway selection could mark more than one answer: 64.3% selected ‘better surgical access’, 57.1% ‘it is a secure airway’, 21.4% ‘patients experience less gagging and coughing postoperatively’ and 14.2% 'others'. 61.1% of respondents reported an anesthetic preference for endotracheal tube. Only 16.67% of respondents reported a change in practice during their career.

Discussion: In our hospital network there is no consensus in use of endotracheal tube versus laryngeal mask for pediatric tonsillectomy. Endotracheal intubation is the most frequently used and preferred ventilation method by both ENT surgeons and anesthetists, but may be associated with longer extubation period and increased incidence of post-operative stridor.