Application of laryngeal mask airway and target-control infused propofol and remifentanil in interventional therapy of congenital heart disease in children

Objective To observe the feasibility and safety of propofol and remifentanil anesthesia under laryngeal mask airway(LMA) in interventional therapy of congenital heart disease in children.Methods Two hundred and thirty-six ASA Ⅰ or Ⅱ, 3-9 years old congenital heart disease children scheduled for interventional therapies were randomly allocated to two groups: laryngeal mask airway group (group LMA, n=120) and endotracheal tube group(group ET, n=116). All patients were induced with propofol TCI 4.0 μg/ml, remifentanil 4.0 ng/ml(effect-site concentration). Group ET also received vecuronium 0.15 mg/kg but not for group LMA. Anesthesia was maintained with propofol TCI 2.5-4.0 μg/ml, remifentanil 4.0 ng/ml (effect-site concentration).During surgery, the target propofol effect-site concentration was adjusted to maintain an auditory evoked potentials index (AAI) value between 25 and 30, while the target remifentanil effect-site concentration was maintain 4.0 ng/ml. HR,SBP, SpO2, PETCO2 and AAI were recorded. Intraoperative body movements, vasoactive drug usage, extubation time or the time to remove LMA, incidence of coughing and agitation during recovery period were also recorded. Results BP and HR in group ET after intubation and after extubation(laryngeal mask) were significantly higher than baseline and those of group LMA (P0.01). BP and HR decreased mildly but without significance when compared with baseline. The extubation time in group ET was longer than that of group LMA (P0.01). The incidence of emergence coughing and agitation was significantly lower in the group LMA than the group ET (P0.01). No body movement was found in either group. Conclusion TCI based propofol and remifentanil anesthesia under LMA in interventional therapy of congenital heart disease in children is a perfect and safe anesthesia method with stable hemodynamics, quick recovery, low incidence of emergence agitation.