ABSTRACT
Airway management during pedodontic operations were evaluated by using three different methods in fifty four patients ASA class I and rate 1 according to Frankl Behavioral Rating Scale with multiple decayed teeth. These patients were divided into three equal groups. In the first group; airway maintained by using nasal mask over a nasopharyngeal airway. In the second group airway maintained by using nasotracheal tube, and the third group arranged to maintain their airway by using flexible laryngeal mask. Anesthesia was induced with intravenous propofol. The mean induction time was significantly longer for nasotracheal group 8.692+/-0.221 minutes and laryngeal mask group 6.885+/-0.221 minutes compared to nasal mask over a nasopharyngeal airway group 3.615+/-0.221 minutes. The mean oxygen saturation levels during the different stages of anesthesia revealed no significant differences between groups regarding the pre-induction base-line levels. Nasotracheal group reported the lowest oxygen saturation levels during insertion. Also flexible laryngeal mask group revealed significant decrease in oxygen saturation levels during the insertion. There were significant decrease in mean oxygen saturation levels in these two groups compared to nasal mask group. During surgical procedures, the nasotracheal group reported the highest oxygen saturation level; followed by the nasal mask group. Flexible laryngeal mask group reported the lowest oxygen saturation level. Surgical access was better in both nasotracheal group and nasal mask group, but there was more interruption of surgery in laryngeal mask group. There was incidence of epistaxis in the nasotracheal group [30.76%] and nasal mask group [17.34%] compared to flexible laryngeal mask group. Sore throat was reported in both flexible laryngeal mask group [61.54%] and nasotracheal group [46.15%]. There was a significantly greater incidence of jaw pain after operation in laryngeal mask group [76.92%] compared to nasotracheal group [23.08%] and nasal mask group [15.38%]. In conclusion, nasal mask over a nasopharyngeal airway was effective as laryngeal mask in maintaining the airway. Both can be inserted without use of muscle relaxants. The time for induction of anesthesia was shorter in the nasal mask over a nasopharyngeal airway. Both flexible laryngeal mask and endotracheal intubation required deep level of anesthesia and longer lime of induction. Endo- tracheal intubation performed through the nose was the safest anesthetic technique. It provided an excellent airway and good surgical access. Better arterial oxygen saturation, and airway maintenance were found in this group. Surgical access was better in both nasotracheal group and nasal mask group, but more interruption for surgery was found in laryngeal mask group