Supraglottic airways linked to fewer respiratory events in children with reactive airways

Design

Multicentre retrospective registry cohort with propensity weighting

Population

4878 anaesthetics in children with airway hyperresponsiveness, 12 Japanese centres

Primary outcome

Respiratory adverse events during induction

Effect

Adjusted RR 0.41 (95% CI 0.19 to 0.62), supraglottic airway vs intubation

This retrospective registry study from 12 Japanese tertiary centres examined 4878 anaesthetics in children with an active or recent (within 14 days) upper respiratory infection, an asthma exacerbation or household smoke exposure, between 2022 and 2025. Propensity weighting adjusted for differences between children given a supraglottic airway and those intubated.

Supraglottic airway use was associated with fewer respiratory adverse events during induction (adjusted RR 0.41, 95% CI 0.19 to 0.62), fewer airway management-related events (0.32, 0.19 to 0.45) and less severe desaturation (0.47, 0.19 to 0.75).

This fits the existing view that avoiding tracheal instrumentation reduces airway reactivity in these children. Choice of device was not randomised, and children judged to need intubation may have been sicker or having different surgery, which the weighting cannot fully address. Where surgery and aspiration risk allow, a supraglottic airway is a reasonable first choice.

• Ask about respiratory infection in the past two weeks, recent asthma flares and smoke exposure at every paediatric preoperative visit.
• Consider a supraglottic airway rather than intubation for these children when the procedure and aspiration risk allow.
• Have an experienced anaesthetist manage the airway in children with recent respiratory infection.
• Prepare for laryngospasm and bronchospasm with drugs and equipment ready at induction.

Why it matters

Respiratory adverse events are the commonest serious complication of paediatric anaesthesia, and airway choice is one of the few levers available.

Don't overread it

This registry analysis shows an association; it does not prove that supraglottic airways cause fewer events.

The statistics, in plain English

An adjusted RR of 0.41 means about 60% lower risk of a respiratory event with a supraglottic airway. Propensity weighting balances the measured differences between groups but not unmeasured ones, so part of the gap may reflect which children were chosen for each device.

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