Paediatric airway management requires an approach that accounts for changing anatomy, developmental physiology, the nature of the planned operation, and the child’s individual risk profile. Compared with adults, infants and young children have a relatively large tongue and occiput, a more cephalad larynx, a narrower airway lumen, and less functional residual capacity relative to oxygen consumption. Consequently, obstruction or apnoea may lead to desaturation more quickly, and even brief airway manipulation can have clinically important consequences. These features make both the choice of airway device and the quality of insertion important components of perioperative safety [1,6,12]. A cuffed endotracheal tube provides a direct tracheal airway and can facilitate controlled ventilation, limit gross contamination of the lower airway, and improve the reliability of ventilation when airway pressures are high. Modern paediatric cuffed tubes, including Microcuff designs, aim to improve the seal while limiting excessive cuff pressure. Their safe use nevertheless depends on correct tube size, appropriate depth, cuff-pressure management, and careful assessment after positioning. Laryngoscopy and tracheal passage may provoke coughing, airway reflexes, transient haemodynamic responses, mucosal trauma, or post-extubation symptoms. Tube selection therefore involves balancing the benefits of a tracheal airway against the potential effects of airway instrumentation [2,5,11,17,18]. Supraglottic airway devices provide an alternative for selected procedures by creating a seal around the laryngeal inlet without routine passage of a tube through the vocal cords. They can reduce the need for laryngoscopy and may be associated with less coughing or other airway stimulation during emergence. Their suitability is influenced by device design, seal pressure, patient positioning, aspiration risk, ventilation requirements, and operator familiarity. A supraglottic airway should not be viewed as interchangeable with a tracheal tube in every case: it may be inappropriate when aspiration risk is substantial, airway access will be limited, high ventilation pressures are anticipated, or the procedure requires a particularly secure tracheal airway [3,8,9,16]. The term “laryngeal mask airway” covers devices with different cuff geometries, drainage channels, ventilation-tube configurations, and intended uses. Findings from one model cannot automatically be generalized to another. The Blockbuster LMA is a specific supraglottic device, and its performance should be assessed in the clinical context in which it is used. Similarly, results for cuffed endotracheal tubes depend on tube design and the protocol used to select size and manage cuff pressure. Device-specific comparative evidence is therefore useful to clinicians making practical decisions in paediatric operating theatres [14,15]. Previous comparative studies and systematic reviews have generally suggested that supraglottic airway devices can reduce some airway-related adverse events in selected paediatric patients, although the magnitude and consistency of benefit vary across studies and outcomes [7,8]. A large prospective cohort study also demonstrated that perioperative respiratory risk is multifactorial and is affected by patient, anaesthetic, and procedural characteristics, rather than by airway device alone [12]. Differences in age, recent respiratory infection, airway reactivity, surgical site, anaesthetic technique, and the experience of the person inserting the device can all affect the observed event rate. These factors should be considered when interpreting small single-centre trials. Against this background, the present study compared Microcuff ETT and Blockbuster LMA use in children undergoing selected elective operations. The principal focus was perioperative respiratory complications, with insertion time, first-attempt success, and haemodynamic observations as additional outcomes. The purpose was not to establish one device as universally superior, but to assess the relative performance of the two devices within the study population and protocol described in the dissertation. Airway management is a central component of paediatric anaesthesia. Children have age-dependent airway anatomy and limited respiratory reserve; airway instrumentation can precipitate coughing, desaturation, laryngospasm, bronchospasm, or upper-airway obstruction. Risk is influenced not only by the device but also by age, respiratory history, surgical procedure, anaesthetic depth, and the experience of the anaesthesia team.[1,2] Tracheal intubation provides a secured tracheal airway and facilitates controlled ventilation, but laryngoscopy and passage of a tube through the vocal cords may provoke airway stimulation and postoperative symptoms. Modern cuffed paediatric tubes, including Microcuff designs, use a thin polyurethane cuff and depth markings intended to provide a seal while limiting excessive cuff pressure and the need for tube exchange.[3–6] Laryngeal mask airways (LMAs) sit above the glottis and generally require less direct airway instrumentation. In appropriately selected patients undergoing elective procedures, supraglottic airway devices can be associated with reduced coughing or other airway-related events compared with tracheal intubation; however, they do not provide the same degree of airway protection as a tracheal tube in every clinical situation. Device choice must therefore balance respiratory morbidity against aspiration risk, airway pressures, surgical access, and procedure-specific needs.[4,7–10] Evidence comparing supraglottic devices and ETTs in children includes randomized studies and systematic reviews, but findings vary by device generation, patient population, and outcome definitions.[7–12] Evidence specifically comparing the Blockbuster LMA with a Microcuff ETT in young children is limited. This study compared perioperative respiratory complications, insertion time, number of attempts, and haemodynamic parameters in children undergoing elective surgery at a tertiary-care centre.

Study design and setting This prospective randomized comparative study was conducted in the Department of Anaesthesiology, SMS Medical College and attached hospitals, at J.K. Lon Hospital, Jaipur, Rajasthan. The dissertation reports the study period as 6 October 2023 to 16 January 2024 and Clinical Trials Registry–India registration number CTRI/2023/10/058407. Institutional research review/ethics permission and written informed consent from parents or guardians were obtained, as stated in the dissertation. Participants and allocation Eighty children scheduled for elective surgery under general anaesthesia were enrolled and allocated equally: Group A received a Microcuff ETT (n=40), and Group B received a Blockbuster LMA (n=40). The stated inclusion criteria were ASA physical status I–II, age 1–5 years, elective inguinal or urological surgery, and willingness to participate. Exclusion criteria included acute respiratory infection, anticipated difficult airway, and emergency surgery. Allocation was performed using opaque sealed envelopes. Anaesthetic technique and outcome definitions The dissertation describes routine non-invasive monitoring, baseline recording of heart rate, systolic and diastolic blood pressure, and oxygen saturation, preoxygenation, induction, device insertion according to allocation, confirmation of ventilation by chest movement and capnography, and recording of insertion time and number of attempts. Anaesthesia was maintained with oxygen/nitrous oxide, sevoflurane, and atracurium; reversal and awake removal were performed according to the study protocol. Major respiratory events were defined as laryngospasm and bronchospasm. Minor events included desaturation (SpO₂ <95%), severe coughing lasting more than 10 seconds, airway obstruction associated with snoring or increased respiratory effort, and postoperative stridor. Haemodynamic variables were recorded at specified intraoperative time points. Statistical analysis For continuous variables, the dissertation reports means and standard deviations and describes between-group comparisons using independent-samples t-tests. For categorical variables, counts and percentages are reported, with between-group comparisons performed using categorical tests as described in the source paper. Because respiratory events were uncommon, individual event counts and absolute percentages are presented alongside the reported p values to make the scale of the observations transparent. The small number of events means that non-significant results should not be interpreted as proof of equivalence or as evidence that the devices have identical safety profiles. The available manuscript source did not provide a complete statistical output, confidence intervals, a prespecified sample-size calculation, or the numerical values for all haemodynamic time points. These have not been reconstructed or imputed. The p values shown in the results are transcribed from the dissertation and should be checked against the original dataset before submission. Where a confidence interval or effect estimate would improve interpretation, it should be calculated from the verified patient-level data rather than inferred from rounded summary values. The paper reports continuous variables as mean±standard deviation and categorical variables as number (percentage). Independent-samples t-tests were used for between-group comparisons of continuous haemodynamic variables, and chi-square tests with continuity correction for categorical variables; p≤0.05 was considered statistically significant. This manuscript reproduces the reported summary results. Raw participant-level data were not supplied for independent reanalysis.

Eighty children were included, with 40 participants in each group. The paper reports broadly comparable baseline demographic and operative characteristics, although some values require author verification before submission. Characteristic Microcuff ETT (n=40) Blockbuster LMA (n=40) Reported p value Age, years (mean±SD) 2.47±1.074 1.97±1.209 0.096 Weight, kg (mean±SD) 9.64±1.336 8.97±1.290 0.054 Male participants 90% 100% 0.137 Duration of surgery, min (mean) 60.87 51.29 0.15 Insertion time, seconds (mean±SD) 12.80±0.882 12.29±1.006 0.01813 Successful placement on first attempt 37/40 (92.5%) 39/40 (97.5%) 0.608 Table 1. Baseline characteristics and insertion outcomes as reported in the dissertation. SD, standard deviation. The weight eligibility criterion in the methods (10–30 kg) conflicts with the reported group mean weights and must be checked against the original master chart. Perioperative respiratory complications Outcome Microcuff ETT (n=40) Blockbuster LMA (n=40) Reported p value Laryngospasm 0 (0%) 0 (0%) Not applicable / not reported Bronchospasm 1 (2.5%) 0 (0%) 0.3143 Desaturation 1 (2.5%) 0 (0%) 0.3143 Severe coughing 3 (7.5%) 1 (2.5%) 0.3049 Airway obstruction 2 (5.0%) 0 (0%) 0.5121 Postoperative stridor 1 (2.5%) 0 (0%) 0.3143 Table 2. Respiratory events by airway device. Percentages are calculated using 40 patients per group. Events may not be mutually exclusive; therefore, counts should not be summed to estimate the number of patients with at least one event. No laryngospasm was recorded in either group. Each reported respiratory event was numerically more frequent in the Microcuff ETT group, but the paper reports no statistically significant between-group difference for these individual outcomes. Haemodynamic outcomes The source dissertation describes heart rate, systolic blood pressure, diastolic blood pressure, and peripheral oxygen saturation as comparable between the two groups at the recorded time points. However, the extract available for manuscript preparation did not contain the complete timepoint-specific means, standard deviations, or p values. For that reason, the manuscript reports the qualitative conclusion of the dissertation rather than constructing a numerical table that cannot be independently checked. The final submission should include the full values from the master chart if these measurements are intended to remain secondary outcomes. The dissertation states that heart rate, systolic blood pressure, diastolic blood pressure, and SpO₂ were comparable between groups at recorded time points, without statistically significant between-group differences. Exact time-point means, standard deviations, and p values are not reproduced here because a complete numerical series could not be confirmed from the extracted summary; these should be transcribed from the original results tables/master chart before journal submission.

The central observation in this study was that the Blockbuster LMA had a slightly shorter reported mean insertion time than the Microcuff ETT. The difference between the reported means was approximately half a second. Although the dissertation reports statistical significance for this comparison, the absolute difference is modest, and its clinical importance should be interpreted in context. In a stable elective case, a small difference in insertion time may have limited effect on the overall anaesthetic course; in a child with limited oxygen reserve, however, a consistently efficient first-pass technique can be valuable. Time alone should not determine device choice, and it must be interpreted together with placement success, ventilation quality, airway security, and adverse events. First-attempt placement was high in both groups: 92.5% with Microcuff ETT and 97.5% with Blockbuster LMA. The numerical difference favoured the LMA, but the study did not demonstrate a statistically significant difference according to the reported analysis. These results suggest that both devices were generally placeable in the hands of the clinicians participating in this study. They do not establish that the LMA is easier to use in every setting, because first-attempt success can be affected by operator experience, airway anatomy, device sizing, anaesthetic depth, and how an attempt is defined. Future reports should specify the number of operators, their experience with each device, and the criteria used to count an insertion attempt. Respiratory complications were uncommon in the study population. No laryngospasm was recorded in either group. Bronchospasm, desaturation, airway obstruction, and postoperative stridor were each reported only in the ETT group, while severe coughing occurred in both groups but was more frequent after ETT use. These observations are directionally consistent with the hypopaper that avoiding passage of a device through the glottis may reduce airway stimulation in selected children. However, the event counts are small: one additional event changes the estimated percentage by 2.5 points in a group of 40. Consequently, the pattern should be treated as descriptive and hypopaper-generating rather than definitive evidence of a reduction in respiratory complications. The interpretation of low event rates requires particular caution. A non-significant p value does not demonstrate that there is no difference between devices, and a numerical difference does not by itself demonstrate that one device is safer. With only 40 participants per group, the study is unlikely to estimate uncommon events precisely. Reporting absolute risks and confidence intervals would help readers understand the range of effects compatible with the data. The primary outcome should also be clearly defined as either the occurrence of at least one event per participant or the number of event episodes. If one child experienced more than one event, event counts cannot be treated as independent observations; the manuscript should therefore preserve the source paper’s caveat that different events may overlap. The present findings are broadly compatible with published work comparing supraglottic devices with tracheal intubation in children. Drake-Brockman and colleagues reported that airway-device choice can influence perioperative respiratory adverse events in paediatric anaesthesia [7]. Yu and Beirne’s systematic review also found a lower risk of selected airway complications with laryngeal mask airways compared with endotracheal intubation in the surgical populations included in their review [8]. These sources support the biological plausibility of the observed direction of effect, but they should not be interpreted as proving that every supraglottic device has the same performance profile. The present study evaluates a specific LMA model and a specific cuffed ETT in a limited clinical setting. The broader paediatric airway literature emphasizes that patient characteristics and perioperative context influence respiratory outcomes. The prospective cohort work by von Ungern-Sternberg and colleagues identified multiple risk factors for respiratory complications, reinforcing the importance of considering recent upper respiratory infection, personal or family history of atopy, airway reactivity, and other patient-level features when selecting an airway plan [12]. The current study excluded children with acute respiratory infection and anticipated difficult airway, which makes the findings most applicable to relatively selected elective patients. They should not be extrapolated directly to emergency cases, children with significant respiratory disease, procedures with substantial aspiration risk, or operations requiring high airway pressures. The Microcuff ETT remains an important option in paediatric anaesthesia. A tracheal tube may be preferred when reliable controlled ventilation is needed, when surgical positioning or access makes a supraglottic device less appropriate, or when aspiration risk and procedural requirements favour a tracheal airway. Evidence supporting cuffed paediatric tubes has emphasized the importance of suitable tube design, appropriate sizing, and controlled cuff pressure [11,17,18]. The goal is not to replace endotracheal intubation indiscriminately, but to match the device to the patient and procedure. Conversely, an LMA may be a reasonable option for selected short elective operations when the expected ventilation conditions and aspiration risk are acceptable and the anaesthesia team is prepared to manage device displacement or inadequate seal. The haemodynamic findings in the dissertation were described as comparable between groups. This is plausible because both devices were used under general anaesthesia with standard monitoring, but the available summary does not provide sufficient numerical detail to quantify the size or timing of any differences. Laryngoscopy and tracheal instrumentation can produce transient sympathetic responses, whereas supraglottic placement generally avoids direct laryngoscopy; nevertheless, the observed haemodynamic response depends on anaesthetic depth, drug choice, timing of measurement, and baseline physiology. Without the complete data, the study should not claim a haemodynamic advantage for either device. Several methodological issues should be addressed before publication. The dissertation describes random allocation using opaque sealed envelopes, but the manuscript should clarify who generated the sequence, who prepared and numbered the envelopes, whether they were sequentially opened, and whether envelopes were tamper-evident. Blinding the clinician inserting the device is not feasible, but outcome assessment and data analysis may be performed by personnel unaware of group allocation where practical. The study should also identify the prespecified primary outcome and explain how the sample size was determined. These details improve transparency and allow readers to assess the risk of selection and measurement bias. An important internal consistency issue requires resolution: the eligibility criteria are described as a body-weight range of 10–30 kg, whereas the reported group mean weights are 9.64 kg and 8.97 kg. Both means fall below the stated lower limit. This may reflect a transcription error in the eligibility criterion, a data-entry issue, or an error in the reported summary statistics. It cannot be reconciled from the available extract and must be checked against the original protocol, screening log, and master chart. The manuscript should not be submitted until the correct criterion and group values have been confirmed. The reference list also needs a final bibliographic audit. Each citation should be checked against PubMed, the publisher record, or Crossref for exact author order, article title, year, volume, issue, pages or article number, and DOI. In particular, incomplete references retained from the initial draft should not remain in a submitted manuscript. The authors should confirm whether each source supports the statement attached to it and ensure that citation numbering follows the target journal’s requirements. The current references are intended as a working Vancouver-style list, not as a substitute for final source verification. Other limitations include the single-centre design, small sample, selected elective population, limited number of respiratory events, and absence of complete numerical haemodynamic results in the available manuscript extract. The source material does not provide enough information to independently verify all statistical assumptions, the prespecified outcome hierarchy, or confidence intervals. The short recruitment period may also limit the number of operators and clinical scenarios represented. The study did not assess longer-term outcomes such as persistent sore throat, swallowing discomfort, or delayed respiratory symptoms, and no cost-effectiveness analysis was available. These issues limit the strength and generalizability of the conclusions. Despite these limitations, the study provides a useful local comparison of two commonly considered airway strategies in a defined paediatric elective-surgery population. It documents high first-attempt success with both devices and a numerical pattern of fewer recorded respiratory events in the LMA group. A larger multicentre trial with a prespecified composite respiratory outcome, standardized event definitions, adequate sample-size calculation, operator stratification, and confidence intervals would be better positioned to determine whether these differences are clinically meaningful. Future work should also report device-specific sizing, cuff-pressure management, ventilation parameters, airway seal quality, and recovery outcomes to support reproducibility. In this prospective randomized comparison of 80 children undergoing elective surgery, the Blockbuster LMA was associated with a modestly shorter mean insertion time than Microcuff ETT (12.29 versus 12.80 seconds; reported p=0.01813). First-attempt placement was frequent with both devices and did not differ significantly. Respiratory events were uncommon and numerically less frequent in the LMA group, but the study was too small to establish reliable differences in uncommon events such as bronchospasm or stridor. The direction of the respiratory findings is consistent with the broader literature suggesting that supraglottic airway devices may reduce airway stimulation in appropriately selected paediatric patients. Drake-Brockman and colleagues reported fewer perioperative respiratory adverse events with an LMA than with an ETT in infants undergoing minor elective procedures.[7] Systematic review evidence has also found differences in some airway complications between LMAs and tracheal tubes, although outcomes vary across device types and clinical settings.[8,9] These studies provide context, but their results should not be assumed to apply identically to a Blockbuster LMA or to every paediatric operation. The faster insertion time observed with LMA is clinically plausible because placement avoids laryngoscopy and passage through the vocal cords. Similar practical advantages of supraglottic airway devices have been described in paediatric anaesthesia literature.[4,10,11] Nevertheless, a difference of approximately half a second in this study should be interpreted cautiously: the clinical importance of the time difference is uncertain, and insertion time can be influenced by operator familiarity, device sizing, and how timing is defined. Coughing was the most frequently reported event, occurring in 7.5% of the ETT group and 2.5% of the LMA group. Airway obstruction was reported in 5% of ETT recipients and none of the LMA recipients. These differences were not statistically significant. With only 40 participants per arm and very few events, estimates are imprecise; absence of statistical significance does not establish equivalence. A larger, adequately powered study with prespecified composite respiratory outcomes would be required to determine whether the observed numerical differences represent a reproducible clinical benefit. Haemodynamic variables were reported as comparable. This broadly agrees with the concept that both techniques can be used successfully under general anaesthesia, although tracheal intubation can produce a greater transient sympathetic response in some contexts. Prior comparative studies have reported variable haemodynamic effects depending on patient age, anaesthetic depth, and the device used.[10–12] The Microcuff ETT remains important when a tracheal airway, reliable controlled ventilation, or enhanced airway security is needed. Its cuff design is intended to provide an effective seal while limiting excessive pressure when correctly sized and managed.[3,5,6] An LMA may be appropriate for selected elective procedures in patients with low aspiration risk and acceptable airway pressure requirements, but it should not be treated as interchangeable with a tracheal tube in all circumstances. The choice should be guided by individual patient risk, procedure, positioning, anticipated ventilation pressures, and clinician expertise. Several limitations affect interpretation. First, the sample was small and the number of respiratory events low. Second, allocation concealment by sealed envelopes is described, but details such as envelope preparation and sequential numbering are not fully available in the extracted text. Third, the study was conducted at a single centre and included a selected elective-surgery population, limiting generalizability. Fourth, the paper itself notes that preoperative and intraoperative risk factors were not thoroughly evaluated. Fifth, the stated weight eligibility range conflicts with the reported mean weights, and the results should be verified against source data. Finally, the available summary does not provide full numerical haemodynamic data or a clearly reported primary composite endpoint. These issues should be resolved before submission. Overall, the findings support the feasibility of both devices in the selected population and suggest quicker insertion with the Blockbuster LMA. They do not prove that LMA significantly reduces perioperative respiratory complications, and they do not justify replacing ETT when tracheal intubation is clinically indicated.

Clinical implications For selected children undergoing elective procedures, the Blockbuster LMA was associated with a modestly shorter insertion time and numerically fewer recorded respiratory events than Microcuff ETT in this 80-patient study. The low number of events and unresolved data consistency issue mean that the findings should be interpreted cautiously. Device selection should remain individualized according to aspiration risk, anticipated ventilation requirements, surgical position, airway anatomy, and the experience of the anaesthesia team. Among 80 selected paediatric patients undergoing elective surgery, Blockbuster LMA insertion was faster than Microcuff ETT insertion according to the reported analysis. Respiratory events were numerically fewer in the LMA group, while individual between-group differences were not statistically significant. Haemodynamic parameters were reported as comparable. Larger, adequately powered multicentre studies using clearly defined composite respiratory outcomes and verified source data are needed.

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