Transcutaneous ST6 Stimulation Versus Shoulder Tapping on Laryngeal Mask Airway Removal in Pediatric Patients: A Randomized Controlled Trial

Background Extubation timing is crucial in pediatric anesthesia recovery to avoid complications such as hypoxia and laryngospasm. Non-pharmacological techniques that stimulate arousal and respiration could aid in timely and safe removal of airway devices. This study evaluated whether applying pressure at the jaw angle (masseter region corresponding to the ST6 acupoint) would hasten emergence from anesthesia and improve the safety and efficiency of laryngeal mask airway (LMA) removal in children. Methods In this randomized controlled trial, 175 ASA I children (ages 1–12) undergoing elective laparoscopic hernia repair with a laryngeal mask airway (LMA) were allocated 1:1 to jaw-angle (ST6) stimulation or gentle shoulder tapping (control) during emergence. Anesthesia was standardized: induction with sufentanil 0.3 µg/kg, propofol 3 mg/kg, and cisatracurium 0.15 mg/kg; maintenance with propofol–remifentanil titrated to BIS 40–60. At surgery end, all anesthetics were stopped; after spontaneous breathing returned, the intervention group received repeated bilateral 5-second firm presses at the jaw angles (~ 1.5 kg force) and controls received shoulder taps of similar force. Extubation (LMA removal) occurred at eye opening or purposeful movement. The primary outcome was extubation time (T1–T0: first stimulation to LMA removal). Secondary outcomes were change in BIS from start of stimulation to extubation and the incidence of adverse events (coughing, agitation, hypoxemia, laryngospasm, aspiration). Results Baseline characteristics were similar between the ST6 stimulation group (n = 86) and control group (n = 89). Extubation was significantly faster with ST6 stimulation, with a median time of 7.2 minutes (IQR 5.7–9.3) versus 13.3 minutes (11.9–15.7) in controls ( P  < 0.001). The intervention group also had a greater increase in BIS during emergence (median ΔBIS + 9.0 vs + 4.0, P  < 0.001), indicating higher arousal at extubation. Kaplan–Meier analysis confirmed a shorter time to extubation with intervention (log-rank P  < 0.001). In a multivariate Weibull regression adjusting for age, BMI, and anesthesia duration, ST6 stimulation reduced extubation time by approximately 37% (time ratio 0.63, 95% CI 0.56–0.69, P  < 0.001) compared to control. Fewer participants in the ST6 stimulation group experienced coughing (10% vs 22%, P  = 0.033) or emergence agitation (8% vs 19%, P = 0.035). The incidence of hypoxemia was low and similar between groups (7% vs 6%, P  = 0.71). No laryngospasm or aspiration occurred in either group. Conclusions Targeted bilateral jaw angle pressure (ST6 acupoint stimulation) significantly shortened LMA removal time in children without increasing adverse events. This simple technique may serve as a useful non-pharmacological adjunct to enhance pediatric anesthesia recovery, potentially complementing conventional Enhanced Recovery After Surgery (ERAS) strategies. Trial registration: International Traditional Medicine Clinical Trial Registry, http://itmctr.ccebtcm.org.cn,ITMCTR2024000464 (registered on 13 September 2024).