Surgery · Pediatrics ·
Laryngeal Mask Airway Linked to Fewer Respiratory Events in Pediatric Adenotonsillectomy
In a multicentre randomized trial of 400 children undergoing adenotonsillectomy at four hospitals in China, laryngeal mask airway (LMA) ventilation was associated with fewer perioperative respiratory adverse events than endotracheal tube ventilation. Events occurred in 22.5% of the LMA group and 57.5% of the endotracheal tube group.
- Randomized trial included 400 children at four Chinese hospitals.
- Any respiratory adverse event: 22.5% with LMA versus 57.5% with ETT.
- LMA was converted to ETT in three participants.
- No serious adverse events occurred in either group.
This multicentre, parallel-group randomized trial enrolled 400 children aged 2 to under 7 years undergoing adenotonsillectomy under general anaesthesia at four tertiary hospitals in China during 2023-24. Participants were assigned 1:1 to ventilation with a laryngeal mask airway (LMA) or an endotracheal tube (ETT). The primary outcome was the proportion experiencing any perioperative respiratory adverse event, including laryngospasm, bronchospasm, desaturation, airway obstruction, severe cough or stridor.
In the intention-to-treat analysis, 45 of 200 children (22.5%) in the LMA group had an event, compared with 115 of 200 (57.5%) in the ETT group: an absolute risk difference of -35.0 percentage points (95% CI -43.5 to -25.7; P<0.001). Events were less frequent with LMA both intraoperatively (9.0% vs 17.5%) and postoperatively (16.5% vs 49.5%). LMA was converted to ETT in three children; neither group had serious adverse events.
The findings support considering LMA ventilation in this setting, but applicability may depend on clinician experience: the trial conclusion specifies experienced anaesthesiologists. The study was conducted in four hospitals in China, and the supplied report does not provide further detail on generalizability or individual event severity.
In practice
For children aged 2 to under 7 years undergoing adenotonsillectomy, this randomized trial found fewer perioperative respiratory adverse events with LMA than with ETT ventilation. The result may inform airway-device selection in this procedure, particularly when anaesthesiologists are experienced with LMA use. It does not establish applicability across all settings or levels of clinician experience: participants came from four tertiary hospitals in China, and three LMA assignments required conversion to ETT. Neither group had serious adverse events.
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The BMJ: Perioperative respiratory adverse events in children undergoing adenotonsillectomy with laryngeal mask airway versus endotracheal tube ventilation: multicentre, randomised controlled trial ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.