Introduction The impact of a low-dose propofol (0.5 mg/kg) prior to extubation on perioperative respiratory adverse events (PRAEs) in children is unclear. This is particularly so in children with upper respiratory tract infections (URTIs). This study aimed to determine the impact of this new approach on extubation-related adverse events in children with URTI.Methods In this randomized, double-blind prospective clinical trial (Pan African Clinical Trials Registry: PACTR 202412599188741), we recruited 144 children aged 1–6 years old with mild signs of URTI. These children were American Society of Anesthesiologists (ASA) II–III, undergoing abdominal surgeries with tracheal intubation using standardized anesthetic management. Patients were randomly divided into two groups: group P (propofol) received 0.5 mg propofol/kg before awake extubation and group C (control) received normal saline. Main outcomes were the incidence of PRAEs, emergence delirium, postoperative coughing and requirement for oxygen support. Statistical significance was set at p<0.05.Results Patient characteristics and intraoperative data were comparable between groups. Low-dose propofol reduced the risk of tachycardia (9.7% vs 44.4%; p=0.0001; relative risk (RR)=0.290 (0.146–0.577)), respiratory adverse events (6.9% vs 25%; p=0.003; RR=0.393 (0.178–0.867)) and emergence delirium (1.38% vs 30.5%; p=0.0001; RR=0.074 (0.011–0.507)) following tracheal extubation. Low-dose propofol also reduced the need for oxygen support in the postanesthesia care unit (2.7% vs 26.3%; p=0.0001; RR=0.074 (0.011–0.507)) and the incidence of prolonged coughing (1.38% vs 19.4%; p=0.0001; RR=0.121 (0.018–0.810)).Conclusion Use of a low dose of propofol before extubation appears to be safe and beneficial for children undergoing abdominal surgery with concurrent URTI.