Abstract: Objective To investigate the effects of applying lidocaine cream on the surface of laryngeal mask for pharyngeal surface anesthesia on children with a high risk of perioperative respiratory adverse events (PRAEs). Methods A total of 156 children who were scheduled for surgery with a high risk of PRAEs were recruited. According to the random number table, they were divided into two groups (n=78): a lidocaine group and a lubricate group. After anesthesia induction, the lidocaine group was intubated with laryngeal mask coated with lidocaine cream on the surface, while the lubricate group used lubricate oil in the replacement of lidocaine cream. Both groups were compared for the incidence of PRAEs and lidocaine-related complications. Results The lidocaine group presented a lower incidence of PRAEs than the lubricate group (P<0.05). For different PRAEs, there was statistical difference only in postoperative severe cough between the two groups (P<0.05). For children at different ages, statistical difference was found as to PRAEs in children aged 6 months to 3 years between the two groups (P<0.05). No lidocaine-related complications were observed in the lidocaine group. Conclusions Application of lidocaine cream on the surface of laryngeal mask for pharyngeal surface anesthesia can reduce the incidence of PRAEs in children with a high risk of PRAEs without increasing the incidence of lidocaine-related complications.