【Background and Goal of study】Most current reports demonstrated no difference in the incidence of pediatric respiratory complications resulting from laryngeal mask airway (LMA) removal whether this was done under deep anesthesia or when the patient was awake. However, we were unable to find reports on the quality of sedation during transport to the recovery unit after LMA removal under deep anesthesia with sevoflurane. The goal of this study was to assess the safety of transport and sedative effects immediately after deep sevoflurane anesthesia. 【Material and Methods】We retrospectively reviewed all cases of elective ambulatory inguinal herniorrhaphy from 6 months to 15 years of age in a one-year period from July 2015. After anesthesia induction with sevoflurane, a LMA was inserted, and an ilioinguinal-iliohypogastric nerve block was performed. Anesthesia was maintained with 3% sevoflurane in oxygen and air until LMA removal. After LMA removal the patients were promptly fitted with an oxygen mask and transferred to the postsurgical unit. SpO2 was monitored until full recovery. The primary outcomes were the incidence of agitation and hypoxemia (defined as SpO2< 90%) during transport. The secondary outcome was the statistical analysis of risk factors predicting hypoxemia using logistic regression analysis. We compared incidence with age, preoperative snoring, upper airway symptoms, anesthesia duration, and end-tidal sevoflurane concentration at removal of LMA. 【Results and Discussion】The subjects were 323 children with an average age of 4 years and 4 months and an average transport time of 5 minutes 57 seconds. Adequate sedation was maintained in 95.7 % (309/323) of cases, and 2.5% (8/323) showed hypoxemia. Serious events due to agitation did not occur. Six patients required airway maneuvers and two needed mask ventilation. One patient was hospitalized for upper respiratory symptoms, fever, and dehydration. The remaining patients were discharged on the same day. Preoperative snoring was significantly associated with the incidence of hypoxemia by an odds ratio of 6.6 (p< 0.05). 【Conclusion】Preventing agitation during transport after anesthesia with sevoflurane in children is challenging. Residual sevoflurane provided adequate sedation but 2.5% of patients showed hypoxemia. Preoperative snoring was related to the incidence of hypoxemia. The presence of a doctor during transport is strongly advised.

Sedative effects and risk factors for desaturation during transport after general anesthesia with sevoflurane in pediatric ambulatory inguinal herniorrhaphy cases: an observational study