Comparison of emergence agitation between tracheal tube and laryngeal mask airway in pediatric ophthalmic surgery: a propensity-score matching analysis

Background Although emergence agitation (EA) is common and can threaten patient safety in children undergoing ophthalmic surgery, large-scale studies examining the effects of airway management techniques on its development remain limited. This study aimed to compare the development of EA between tracheal tube and laryngeal mask airway (LMA) in pediatric ophthalmic surgery. Methods We retrospectively analyzed the medical records of 1029 children aged 3–7 years who underwent strabismus or epiblepharon surgery between January 2014 and December 2022 in Daegu Catholic University Medical Center, Daegu, Republic of Korea. Patients were assigned to either the tracheal tube or LMA groups and matched in a 1:1 ratio using propensity scores. Multivariable logistic regression analysis was performed to further assess the effects of airway management techniques on EA in the unmatched cohort. Results EA occurred in 543 patients (52.8%). The EA incidence in the propensity score-matched cohort was significantly higher in the tracheal tube group than in the LMA group [74% (123/166) versus 16% (26/166); relative risk: 4.73, 95% CI: 3.31–6.88, P < 0.001]. In the unmatched cohort, only when ketamine was used alone for anesthesia induction, the use of a tracheal tube was significantly associated with EA, compared with LMA use (odds ratio: 7.94, 95% CI: 3.38–18.63, P < 0.001). Conclusion LMA use is associated with a lower incidence of EA than tracheal tube use in pediatric ophthalmic surgery, particularly when anesthesia is induced with ketamine.