The purpose of this study is to compare the incidence of undesirable respiratory events when the laryngeal mask airway is either removed from patients who are fully awake or from patients who are deeply anaesthetized. Three-hundred patients aged 1.5–81 years were randomly assigned to have their laryngeal mask airway removed either when deeply anaesthetized or after airway reflexes had returned. The occurrence of adverse respiratory events (coughing, oxygen desaturation and airway obstruction) was recorded. Airway obstruction after laryngeal mask airway removal was evident in 20% of patients in the deep anaesthesia group and in 8% of patients in the awake group (P=0.007). In spite of this finding, oxygen desaturation in children of less than 6 years of age (SaO2 < 96%) occurred most frequently after awake removal (31.3%) compared with deep anaesthesia removal (4.5%) (P=0.023).