Comparing Deep Sedation to LMA for Pediatric Sedation Cases

Introduction: Our sedation team consisting of a Pediatric Anesthesiologist and a Pediatric Intensivist provides sedation for pediatric dental procedures in a dental office setting. This is usually provided using deep propofol sedation with a shared non-instrumented airway. This complex sedation requires careful monitoring and may need airway assistance. Using a Laryngeal mask airway (LMA) may reduce these airway risks. The aim of this study was to compare airway and sedation outcomes between these two groups.


Methods: After IRB approval we performed a retrospective review of sedation cases from 2024, target is 300 cases between the ages of 5 and 8 years. The DEEP cases received Midazolam, Fentanyl and Propofol infusion using our weight/kinetic based dosing algorithm. The LMA cases had a sevoflurane induction, IV and then LMA placed, maintenance with Sevoflurane and morphine administered. A custom 3D printed resin prop is used to secure the LMA. The LMA cases are all provided by the anesthesiologist and the DEEP mostly by the intensivist. Patient demographics, Airway interventions (Airway Score), sedation dosing, sedation quality (Behavior Score) and procedure timing were recorded.


Results: We have reviewed 31 charts so far, 17 LMA and 14 DEEP. The average Age, weight and BMI for DEEP/LMA were 6.9 years/6.6 years, 28.4kg/25.6 kg, 16.9/16.7 respectively. For the 9 components to the airway intervention score for DEEP and LMA cases there were 1.4 and 2.4 interventions per patient respectively. The average overall airway scores were similar, DEEP: 5.6, LMA: 5.2. Airway interventions beyond our QA guidelines were 3x more likely in the DEEP group, although none were considered major interventions. Average Behavior scores were 9.3 for DEEP and 10.0 for LMA. Average procedure duration and recovery times for DEEP/LMA were 17.1/24.2 mins and 37.7/26.5 min respectively. The average propofol infusion duration was 21 mins, total dose of 4.9 mg/kg. Average Sevoflurane duration was 26.3 mins. The median number dental procedures were; DEEP 7.5, LMA: 8.


Conclusions: In this early evaluation additional airway interventions are more common in the DEEP group with more delayed recovery but sedation quality appears equal. It is too early to determine which technique is better.