The Use of Laryngeal Mask Airway Versus Endotracheal Intubation in Pediatric Laparoscopic Inguinal Hernia Repair: A Randomized Controlled Trial.

Creator(s)

Emily Weisberg, Children's Mercy Kansas CityFollow
Benjamin J. Pieters, Children's Mercy HospitalFollow
Meredith S. Elman, Children's Mercy Kansas City
Cory Nonnemacher, Children's Mercy Kansas CityFollow
Janelle R. Noel-Macdonnell PhD, Children's Mercy HospitalFollow
Tolulope A. Oyetunji MD MPH, Children's Mercy Kansas CityFollow

Document Type

Article

Publication Date

8-2025

Identifier

DOI: 10.1016/j.jpedsurg.2025.162367

Abstract

BACKGROUND: A laryngeal mask airway (LMA) is routinely used for many types of pediatric surgical procedures and as a rescue airway device. Laparoscopic procedures in pediatric surgery are common and are becoming increasingly widespread. In laparoscopic surgery, the traditional airway approach is the use of endotracheal intubation, while the use of LMA in laparoscopic surgery is not well studied.

AIMS: To evaluate the effectiveness of general anesthesia with LMA versus traditional endotracheal tube (ETT) for pediatric patients aged 12 months to 8 years old undergoing laparoscopic inguinal hernia repair.

METHODS: In a single institution prospective randomized trial, pediatric patients undergoing laparoscopic inguinal hernia repair were recruited from April 2023 to May 2024. Patients were randomized to general anesthesia with either an LMA or ETT. The primary endpoint was oxygen saturation in percent saturation (SpO₂) measured at three standardized timepoints. Secondary endpoints were end tidal carbon dioxide (EtCO₂) levels and peak airway pressure (PAP) measurements at the same three standardized timepoints as well as the occurrence of any episodes of laryngospasm or desaturation documented in each group.

RESULTS: Fifty patients underwent laparoscopic inguinal hernia surgery with general anesthesia, twenty-five patients with LMA and twenty-five with ETT. There was no clinically significant difference in oxygenation between study groups. Additionally, there was no statistically significant difference between study arms in EtCO₂ levels. Patients with ETT had higher peak airway pressures compared to patients with LMA at all three time points. There was one incident of desaturation in each study arm and no episodes of laryngospasm.

CONCLUSIONS: The use of LMA in short laparoscopic surgery is a safe and effective alternative to ETT in appropriate pediatric patients.

LEVEL OF EVIDENCE: 1b.

CLINICAL TRIAL REGISTRATION: This study is registered with ClinicalTrials.gov NCT06023394.

CLINICAL IMPLICATIONS: The use of LMA in pediatric surgery is common. There is limited data and no studies from the United States assessing the efficacy of LMA in pediatric laparoscopic surgery and this study aims to add prospective data.

Journal Title

Journal of pediatric surgery

Volume

60

Issue

8

First Page

162367

Last Page

162367

MeSH Keywords

Humans; Laryngeal Masks; Hernia, Inguinal; Laparoscopy; Intubation, Intratracheal; Male; Child; Female; Child, Preschool; Infant; Herniorrhaphy; Prospective Studies; Anesthesia, General

PubMed ID

40381798

Keywords

Hernia; Inguinal; Laparoscopic surgery; Laparoscopy; Laryngeal masks

Recommended Citation

Weisberg EL, Pieters BJ, Elman MS, Nonnemacher CJ, Noel-MacDonnell J, Oyetunji TA. The Use of Laryngeal Mask Airway Versus Endotracheal Intubation in Pediatric Laparoscopic Inguinal Hernia Repair: A Randomized Controlled Trial. J Pediatr Surg. 2025;60(8):162367. doi:10.1016/j.jpedsurg.2025.162367