Comparison of Emergence Quality Between Awake Extubation of the Endotracheal Tube and Laryngeal Mask Airway in Pediatric Patients: A Retrospective Study

Abstract Background: Emergence agitation is common in children after ophthalmic surgery and may complicate early recovery. Although laryngeal mask airways (LMAs) are associated with fewer respiratory adverse events than endotracheal tubes (ETTs), their influence on behavioral emergence remains unclear, particularly during the immediate post-extubation phase. Materials and Methods: This retrospective cohort study included children aged 3–9 years undergoing ophthalmic surgery between August 2023 and January 2024. Patients were managed with either an ETT or an LMA, according to the clinician’s preference. Behavior during emergence was assessed using the Extubation Quality Scale (EQS) and Riker Sedation-Agitation Scale (SAS) at extubation and the Pediatric Anesthesia Emergence Delirium (PAED) scale during post-anesthesia care unit (PACU) recovery. Group comparisons and Spearman analyses were performed. Results: Forty-four patients were assessed (ETT n = 23, LMA n = 21). The LMA group showed significantly better extubation quality and lower agitation at extubation, with lower EQS and SAS scores (both P < 0.001). Moderate positive correlations were observed between EQS and SAS ( ρ = 0.592) and between SAS and PAED at PACU admission ( ρ =0.572). These associations were not sustained at later PACU time points. PAED scores showed no significant between-group differences during PACU recovery. Conclusion: In pediatric ophthalmic surgery, LMA use was associated with smoother immediate emergence but not with reduced emergence delirium during PACU recovery. These findings suggest that airway device selection may influence very early emergence behavior, whereas later delirium appears multifactorial. Prospective studies are warranted to clarify phase-specific effects.