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Purpose: To compare the safety and efficacy of the laryngeal mask airway (LMA) with the Guedel airway during the recovery period. Methods: In a prospective randomised trial in the Post Anesthesia Care Unit (PACU), 52 patients (ASA 1 and 2) were randomised to receive either a laryngeal mask airway (LMA: n = 26) or a Guedel airway (n = 26) during the recovery period after middle ear surgery. Ease of airway maintenance was graded and the presence of coughing was noted. Peripheral arterial oxygen saturation (SpO2) was measured continuously by pulse oximetry in the PACU. Readings were taken on arrival (time 0) and for five minutes afterwards. Results: There was no difference in sex, age, weight or incidence of smoking between the two groups. In the LMA group 25 patients required no airway manipulation and only one patient required repositioning of the LMA. In the Guedel group severe difficulty maintaining the airway was experienced in two patients, moderate difficulty in five patients and mild difficulty in 12 patients. Seven patients required no airway manipulation. The LMA group showed higher ease of airway maintenance scores, (P= < 0.0001) and less coughing (P= 0.0496). At time 0 and at one minute the LMA group had higher median SpO2(97% and 97%) than the Guedel group (95% and 96%), (P= 0.0002 and 0.0362). There was no further difference in SpO2. Conclusions: The LMA provides easier airway maintenance, less coughing and initially higher median SpO2when compared with the Guedel airway in the recovery period.