Adenotonsillectomy is the treatment of choice for pediatric obstructive sleep apnea. Although tracheal intubation remains the standard method of airway management, the laryngeal mask (LM) has been proposed as an effective alternative for reducing operative time, despite longstanding controversy. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy and safety of LM use compared to tracheal intubation in adenotonsillectomies.

The search was performed in PubMed, Embase, and Cochrane up until January 14, 2025, for RCTs comparing LM with tracheal tube (TT) in patients undergoing adenotonsillectomies. Adverse events (bronchospasm, laryngospasm, desaturation, and coughing), conversion, blood aspiration and surgical time were the researched outcomes. The analysis included risk of bias assessment, publication bias, and Harbord regression test.

Six studies totaling 765 participants undergoing adenotonsillectomies were included. The LM was associated with a longer surgical time (MD 3.35 minutes; P < 0.01), a smaller blood aspiration rate (LM 3.6% vs. TT 17.1%) and a conversion from LM to intubation of 4.7%. There was no difference between the two ventilation types regarding total adverse events (RR 0.98; P = 0.96). Results of the individual outcomes, related to adverse events for the use of the LM, were bronchospasm (RR 0.89; P = 0.80), laryngospasm (RR 0.68; P = 0.40), desaturation (RR 1.40; P = 0.35), and coughing (RR 1.08; P = 0.92).

For adenotonsillectomies, the LM is an alternative to the TT, without differences concerning adverse events associated to both methods, although it is associated with a prolonged operation time.