This randomized controlled trial evaluated whether performing nasopharyngeal suction under anesthesia before removal of a supraglottic airway (SGA) reduces the incidence of perioperative respiratory adverse events (PRAE) in young children. The authors randomized 400 pediatric patients to compare combined nasopharyngeal plus oral suction with oral suction alone, with suctioning performed under anesthesia prior to SGA removal.
Four hundred children aged 1 to 6 years undergoing general anesthesia with an SGA were enrolled and randomized into two groups. Allocation produced Group N (combined nasopharyngeal and oral suction) and Group O (oral suction alone). A subgroup analysis of children with active or recent upper respiratory tract infection (URTI) was prespecified.
Suctioning in both groups was performed while the child remained under anesthesia and immediately before removal of the SGA. Group N received combined nasopharyngeal and oral suction; Group O received oral suction only. The source provides these procedural designations but does not report additional procedural parameters (for example, suction device specifications, suction pressure, duration, or anesthesia depth) in the abstract.
The primary clinical outcome was the occurrence of any perioperative respiratory adverse event (PRAE) following SGA removal. PRAE was defined as the presence of one or more of the following: coughing, breath-holding, airway obstruction, laryngospasm, bronchospasm, or desaturation. Incidence of any single or combined event met the endpoint definition for a positive PRAE outcome. The URTI subgroup (children with active or recent upper respiratory tract infection) was analyzed a priori to determine whether infection status modified the effect of nasopharyngeal suction.
Across the full study cohort the overall incidence of PRAE was 21.8%. There was no statistically significant difference in the primary outcome between treatment arms: Group N had a PRAE incidence of 21.2% and Group O 22.3%. The abstract reports these group incidences and concludes that, in the general pediatric population studied, nasopharyngeal suctioning prior to SGA removal did not reduce the incidence of PRAE.
In the prespecified subgroup of children with active or recent upper respiratory tract infection, the study found a significant reduction in PRAE incidence with nasopharyngeal suction. Reported results were 21.7% PRAE in Group N versus 44.7% in Group O. The reported relative risk was 0.486 with a 95% confidence interval of 0.258 to 0.917, P = .019. The authors calculated a number needed to treat (NNT) of 4.4 for this subgroup. These figures indicate a clinically and statistically significant difference in this predefined URTI subgroup in favor of nasopharyngeal suction prior to SGA removal.
The randomized trial was registered in the Clinical Trial Registry of India (registration number CTRI/2022/09/045150; date provided in the record). The abstract cites a data accessibility statement with a DOI linking to a data repository. The authors list conflict of interest statements indicating no disclosures. Full author affiliations are provided in the record.
The trial’s principal finding is twofold. First, when considering the entire cohort of children aged 1–6 years who underwent general anesthesia with an SGA, adding nasopharyngeal suction to oral suction did not reduce the overall incidence of PRAE compared with oral suction alone. Second, in the prespecified subgroup of children with active or recent URTI, nasopharyngeal suction performed under anesthesia before SGA removal was associated with a lower incidence of PRAE (21.7% vs 44.7%), a relative risk reduction reported as 0.486 (95% CI, 0.258–0.917), P = .019, and an NNT of 4.4.
These results suggest that routine nasopharyngeal suction before SGA removal may not be necessary for all children but could be beneficial in children with recent or active upper respiratory tract infection. The abstract does not provide granular procedural parameters or detailed safety data beyond the reported PRAE outcomes; such details, along with full methodology and any additional subgroup or secondary analyses, would be available in the full text and associated data repository. Trial registration and the authors’ disclosure statements are reported in the source.
Keywords: pediatric airway, perioperative respiratory adverse events, suctioning, supraglottic device.