Laryngeal mask airway reduces perioperative respiratory adverse events by 35.0 percentage points in childrenLaryngeal mask reduces breathing issues for children during tonsillectomy

BMJ (Clinical research ed.) Published November 6, 2026 Study authors: Han Yuan, Yi Xiuwen, Xia Junming, Zhang Wei, Zhao Zengxiao, Zhu Nana, Liu Ningning, Chen Xuejie, Wan… PubMed ↗ DOI ↗ Editorial oversight: Dr. Sofia Müller, MD · Lifespan & Whole-Person Care

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Key Takeaway

Note that LMA ventilation significantly reduces perioperative respiratory adverse events in children during adenotonsillectomy.

This multicentre, randomized, parallel group trial enrolled 400 children aged 2 to 7 years scheduled for adenotonsillectomy under general anaesthesia at four tertiary hospitals in China. The study compared ventilation using a laryngeal mask airway (LMA) against ventilation with an endotracheal tube (ETT) to evaluate the incidence of perioperative respiratory adverse events (PRAEs), including laryngospasm, bronchospasm, desaturation, airway obstruction, severe cough, or stridor.

In the primary outcome, the LMA group experienced a 22.5% rate of PRAEs (45/200) compared to 57.5% (115/200) in the ETT group (95% CI -43.5 to -25.7; P<0.001). This represents a reduction of 35.0 percentage points. Secondary outcomes also favored LMA: intraoperative PRAEs were 9.0% (18/200) versus 17.5% (35/200) (P=0.01), and postoperative PRAEs were 16.5% (33/200) versus 49.5% (99/200) (P<0.001). Specific complications were also lower in the LMA group, including laryngospasm (0.0% vs 3.0%, P=0.03), desaturation (15.0% vs 28.0%, P=0.002), airway obstruction (3.5% vs 12.5%, P<0.001), and severe cough (10.5% vs 42.0%, P<0.001).

No serious adverse events were reported in either group. While LMA was converted to ETT in three participants, the overall results suggest that LMA ventilation by experienced anaesthesiologists may reduce respiratory complications in this pediatric population. Clinical application should consider the expertise of the anaesthesiology team.

When a child undergoes surgery to remove their tonsils and adenoids, keeping their airway clear and stable is a top priority for the medical team. This procedure, known as an adenotonsillectomy, requires general anesthesia, which can sometimes lead to breathing complications during or after the operation.

A study of 400 children aged between 2 and 7 years compared two ways of managing their breathing. One group used a standard endotracheal tube, while the other used a laryngeal mask. The results showed that children using the laryngeal mask had much lower rates of respiratory issues. Specifically, only 22.5% of children with the mask experienced problems compared to 57.5% of those with the tube.

These issues included things like severe coughing, airway blockages, and oxygen drops. Notably, the risk of severe coughing was much lower in the mask group. While the study showed that the laryngeal mask was safer for breathing, it is important to note that the mask was switched to a tube in three cases. Talk to your doctor to see if this approach is right for your child.

What this means for you:

Laryngeal masks significantly reduced breathing complications for children during tonsillectomy surgery.

Common questions

Is it safe for children to use a laryngeal mask during surgery?

Yes, the study of 400 children found that neither group experienced serious adverse events. However, while the laryngeal mask was associated with fewer respiratory issues than a tube, the mask was converted to a tube in three participants during the study.

What kind of breathing problems were reduced by using a mask?

The laryngeal mask led to fewer cases of severe coughing, airway obstruction, and desaturation (a drop in oxygen levels). Specifically, only 10.5% of children with a mask had a severe cough compared to 42.0% of those with a tube.

How does the laryngeal mask compare to a standard tube?

The laryngeal mask was linked to significantly fewer overall respiratory events. Only 22.5% of children using the mask experienced issues, while 57.5% of children using the standard endotracheal tube experienced them. These results were seen both during and after the surgery.

Study Details

Study typeRct

Sample sizen = 200

EvidenceLevel 2

Follow-up24.0 mo

PublishedNov 2026

PMID42982504

View Original Abstract ↓

OBJECTIVE: To assess the effect of ventilation with a laryngeal mask airway (LMA) compared with endotracheal tube (ETT) on perioperative respiratory adverse events (PRAEs) in children undergoing adenotonsillectomy. DESIGN: Multicentre, randomised, parallel group trial. SETTING: Four tertiary hospitals in China, 2023-24. PARTICIPANTS: 400 children aged ≥2 years and <7 years who were scheduled for adenotonsillectomy under general anaesthesia. INTERVENTIONS: Participants were randomised 1:1 to receive ventilation with a laryngeal mask airway (n=200) or an endotracheal tube (n=200) during adenotonsillectomy. MAIN OUTCOME MEASURE: The primary outcome was the proportion of participants who developed any perioperative respiratory adverse event (PRAE): laryngospasm, bronchospasm, desaturation, airway obstruction, severe cough, or stridor in the intention-to-treat population. RESULTS: 400 children (mean age 4.7 (standard deviation 1.0) years; 155 (38.7%) girls) were enrolled between 24 May 2023 and 4 April 2024, with last follow-up on 4 May 2024. LMA was converted to ETT in three participants. Overall, 22.5% (45/200) participants in the LMA group experienced PRAEs versus 57.5% (115/200) in the ETT group (absolute risk difference -35.0 percentage points, 95% confidence interval -43.5 to -25.7; P<0.001). The LMA group had fewer PRAEs in both the intraoperative (9.0% (18/200) 17.5% (35/200); -8.5, -15.2 to -1.8; P=0.01) and the postoperative period (16.5% (33/200) 49.5% (99/200); -33.0, -41.2 to -24.0; P<0.001). The LMA group also had a lower proportion of participants with laryngospasm (0.0% 3.0%; P=0.03), desaturation (15.0% 28.0%; P=0.002), airway obstruction (3.5% 12.5%; P<0.001), and severe cough (10.5% 42.0%; P<0.001). Neither group experienced serious adverse events. CONCLUSION: Ventilation with an LMA by experienced anaesthesiologists resulted in fewer perioperative respiratory adverse events than ventilation with an ETT in children undergoing adenotonsillectomy. TRIAL REGISTRATION: Chictr.org.cn ChiCTR2300071399.

Laryngeal mask airway reduces perioperative respiratory adverse events by 35.0 percentage points in childrenLaryngeal mask reduces breathing issues for children during tonsillectomy

Common questions

Study Details

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Laryngeal mask airway reduces perioperative respiratory adverse events by 35.0 percentage points in childrenLaryngeal mask reduces breathing issues for children during tonsillectomy

Common questions

Study Details

Evaluating Text Message Video Interventions for Improving Infant Sleep Safety Practices

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Clinical research that matters. Delivered to your inbox.

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