Association between supraglottic airway device use and respiratory adverse events during airway management in children with airway hyperresponsiveness: a report from the Japan Paediatric Difficult Airway in Anaesthesia (J-PEDIA) registry.

Abstract

Background: Children with airway hyperresponsiveness face higher risks of perioperative respiratory adverse events. Although the use of supraglottic airway devices (SADs) is associated with fewer perioperative respiratory adverse events than tracheal intubation in selected paediatric populations, evidence remains limited regarding induction-phase airway management in children with airway hyperresponsiveness. We aimed to investigate the association between SAD placement (vs tracheal intubation) and respiratory adverse events during induction-phase airway management in children with airway hyperresponsiveness using propensity score-based inverse probability of treatment weighting.

Methods: This multicentre retrospective cohort study was conducted at 12 tertiary-care institutions (six paediatric and six mixed adult-paediatric university hospitals) in the Japan Paediatric Difficult Airway in Anaesthesia registry between July 2022 and February 2025. We included children aged <18 yr undergoing general anaesthesia who had an active upper respiratory tract infection, an upper respiratory tract infection within the preceding 14 days, asthma exacerbation, or household smoking exposure. The primary outcome was the occurrence of respiratory adverse events.

Results: Of the 27 844 encounters, 4878 were analysed (tracheal intubation 3005 of 4878 [61.6%]; SAD 1873 of 4878 [38.4%]). After adjustment, SAD placement was associated with a lower risk of respiratory adverse events (adjusted risk ratio [aRR] 0.41; 95% confidence interval [CI] 0.19-0.62; P<0.001), airway management-related adverse events (aRR 0.32; 95% CI 0.19-0.45; P<0.001), and severe oxygen desaturation (aRR 0.47; 95% CI 0.19-0.75; P<0.001).

Conclusions: Overall, SAD use during induction of anaesthesia was associated with a lower risk of adverse respiratory events in children with airway hyperresponsiveness. These findings support consideration of SADs when clinically appropriate while acknowledging potential residual confounding.