Comparison of respiratory events following proseal laryngeal mask airway removal in children undergoing total intravenous anesthesia with propofol and sevoflurane anesthesia: A randomized parallel group trial

Objectives: This study aims to compare the incidence of respiratory adverse events following removal of ProSeal laryngeal mask airway (PLMA) after total intravenous anesthesia (TIVA) with propofol and inhalational anesthesia with sevoflurane in healthy children undergoing lower limb, lower abdominal, or genitourinary surgery under general anesthesia with caudal analgesia. Patients and methods: This randomized, parallel-group, double-blind trial was conducted with children with American Society of Anesthesiologists physical status Class I or II between August 01, 2023, and September 30, 2024. Children were randomly allocated to the TP group (TIVA with propofol) to receive induction and maintenance with total intravenous anesthesia with propofol or the IS group (inhalation with sevoflurane) to receive induction and maintenance of anesthesia with sevoflurane. The primary outcome was the incidence of any respiratory event (coughing, biting of device/teeth clenching, oxygen desaturation, breath holding, laryngospasm, bronchospasm, or upper airway obstruction) during emergence from anesthesia and PLMA removal. Secondary outcomes were prevalence of individual respiratory events, airway hyperreactivity scores, emergence times, incidence of emergence agitation, duration of postanesthesia care unit stay, postoperative nausea and vomiting, hemodynamic parameters, and peripheral oxygen saturation during emergence. Results: A total of 86 children (70 males, 16 females; mean age: 4.265±2.23 years; range, 6 months to 7 years) were enrolled in the study, with 43 in both groups. A respiratory event occurred in 15 patients in the IS group (34.8%) and four patients in the TP group (9.30%; p=0.004). There was no difference in the occurrence of individual events. Airway hyperreactivity scores were higher in the IS group (p=0.032). Emergence time was quicker and emergence agitation and excessive salivation were more common in the IS group. Time to postanesthesia care unit discharge, postoperative nausea and vomiting and, hemodynamic parameters before and after PLMA removal were comparable. Conclusion: The incidence and severity of adverse respiratory events during emergence from anesthesia was more frequent in the sevoflurane group.