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

Design

Multicentre retrospective registry cohort with propensity weighting

Population

4,878 anaesthetics in children with airway hyperresponsiveness, Japan

Primary outcome

Respiratory adverse events at induction

Effect

aRR 0.41 (0.19–0.62); severe desaturation aRR 0.47 (0.19–0.75)

This multicentre Japanese registry study examined 4,878 general anaesthetics at 12 tertiary hospitals between 2022 and 2025 in children with an active or recent (within 14 days) upper respiratory infection, an asthma exacerbation, or household smoke exposure. Investigators compared supraglottic airway placement with tracheal intubation, using inverse probability weighting.

Supraglottic airways were associated with fewer respiratory adverse events (aRR 0.41, 95% CI 0.19–0.62), fewer airway-management events (aRR 0.32) and less severe desaturation (aRR 0.47).

This matches the direction of earlier trials in children with recent colds. Where the procedure allows, a supraglottic airway is a reasonable first choice in a child with reactive airways. Selection bias is likely — anaesthetists choose intubation for harder cases — so the effect size is probably overstated.

• Ask about recent colds, asthma control and smoke exposure at every paediatric pre-assessment
• Consider a supraglottic airway instead of intubation in children with reactive airways when the procedure allows
• Have bronchodilator and deep-anaesthesia plans ready for induction and emergence
• Use an experienced anaesthetist for airway management in these children

Why it matters

Supports a simple airway choice that may reduce laryngospasm and desaturation in a high-risk group.

Don't overread it

Observational registry data; residual confounding by procedure and illness severity is likely.

The statistics, in plain English

An adjusted risk ratio of 0.41 suggests less than half the respiratory events, but this is registry data; children who were intubated may have been sicker or having more complex surgery in ways the weighting did not capture.

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