Summary
A multicentre randomised trial in China found fewer perioperative respiratory adverse events among children aged 2 to under 7 who received a laryngeal mask rather than an endotracheal tube during adenotonsillectomy. The findings apply to a selected group treated by experienced anaesthesiologists at high-volume hospitals.
A multicentre randomised trial in China found that children undergoing adenotonsillectomy had fewer perioperative respiratory adverse events when ventilated through a laryngeal mask airway (LMA) rather than an endotracheal tube (ETT). The study involved 400 children aged 2 to under 7 at four tertiary hospitals, where participating anaesthesiologists had substantial experience with both devices.
An LMA sits above the vocal cords to deliver ventilation; an ETT passes through the vocal cords into the trachea. The trial compared the devices during surgery to remove the tonsils, adenoids or both. Its primary outcome was whether a child experienced at least one of six events—from anaesthesia induction until discharge from the recovery unit: laryngospasm, bronchospasm, oxygen desaturation, airway obstruction, severe cough or stridor.
What the trial found
Children were randomly assigned in equal numbers to LMA or ETT ventilation. At least one event occurred in 45 of 200 children in the LMA group (22.5%), compared with 115 of 200 in the ETT group (57.5%). The absolute difference was 35 percentage points fewer in the LMA group, with a 95% confidence interval of 25.7 to 43.5 percentage points fewer. The primary analysis included all randomised children; three assigned to LMA were switched to an ETT because ventilation was inadequate after placement of the surgical mouth gag.
The difference was seen both during surgery and in the recovery unit. Events occurred during the intraoperative period in 9.0% of the LMA group and 17.5% of the ETT group; postoperative events occurred in 16.5% and 49.5%, respectively. Laryngospasm, desaturation, airway obstruction and severe cough were each less frequent with an LMA. Bronchospasm rates did not differ between groups, and neither group had cases of stridor. No serious adverse events were reported.
The study also recorded fewer rescue airway manoeuvres after device removal in the LMA group: 12.0%, compared with 37.0% in the ETT group. These results concern events during anaesthesia and recovery, rather than a demonstrated difference in longer-term outcomes; the trial reported no difference in hospital stay or complications after discharge from the recovery unit.
Who the results apply to
The trial supports the possibility that an LMA can reduce short-term respiratory complications during adenotonsillectomy in children similar to those enrolled. It was conducted from 2023 to 2024 in four high-volume Chinese centres, each performing more than 1,800 paediatric adenotonsillectomies annually. The anaesthesiologists had each managed at least 100 such procedures with both LMA and ETT ventilation.
The participants were relatively young children classified as ASA I or II; children with severe obstructive sleep apnoea and several other significant conditions were excluded. The outcome included clinical judgements, and the anaesthesiologists, surgeons and recovery-unit assessors knew which device had been used. The authors also note that results may differ in less experienced teams or where airway-device removal and anaesthesia practices vary. These factors matter when considering whether the findings apply beyond the selected patients and specialist settings studied.