Comparison of oropharyngeal leak pressure and clinical performance of LMA ProSeal™ and i-gel® in adults: Meta-analysis and systematic review
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Comparison of oropharyngeal leak pressure and clinical performance of TM LMA ProSeal and i-gel in adults: Meta-analysis and systematic review
Meta-Analysis
Hye Won Shin 1
Hae Na Yoo 1
Go Eun Bae 1
Jun Chul Chang 1
Min Kyung Park 1
Hae Seun You 1
Hyun Jung Kim 0
Hyung Sik Ahn 0
0 Institute for Evidence-based Medicine, Department of Preventive Medicine, College of Medicine, Korea University , Seoul , Republic of Korea
1 Department of Anesthesiology and Pain Medicine, College of Medicine, Korea University Anam Hospital , Seoul , Republic of Korea
Background: A meta-analysis and systematic review of randomized controlled trials to compare the oropharyngeal leak pressure (OLP) and clinical performance of LMA ProSealTM (Teleflex Inc., Wayne, PA, USA) and i-gel (Intersurgical Ltd, Wokingham, UK) in adults undergoing general anesthesia. Methods: Searches of MEDLINE , EMBASE , CENTRAL, KoreaMed and Google Scholar were performed. The primary objective was to compare OLP; secondary objectives included comparison of clinical performance and complications. Results: Fourteen RCTs were included. OLP was significantly higher with LMA ProSealTM than with i-gel (mean difference [MD] 2.95 cmH2O; 95% confidence interval [CI] 4.30, 1.60). The i-gel had shorter device insertion time (MD 3.01 s; 95% CI 5.80, 0.21), and lower incidences of blood on device after removal (risk ratio [RR] 0.32; 95% CI 0.18, 0.56) and sore throat (RR 0.56; 95% CI 0.35, 0.89) than LMA ProSealTM. Conclusion: LMA ProSealTM provides superior airway sealing compared to i-gel .
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Introduction
Use of supraglottic airway (SGA) devices is
increasingly common in clinical anesthesia.1
Second-generation SGAs including
LMA ProSealTM (Teleflex Inc., Wayne,
PA, USA) and i-gel (Intersurgical Ltd,
Wokingham, UK) were introduced in 2000
and 2007, respectively. These devices
provide better airway sealing characteristics
than classic LMATM, have an additional
drainage tube for stomach decompression to
reduce the risk of pulmonary aspiration, and
are designed for use with spontaneous or
positive pressure ventilation (PPV).2
Oropharyngeal leak pressure (OLP),
measured by closing the expiratory valve of
the anesthetic circle system at a fixed
gas flow rate and noting the equilibrium
airway pressure, is used to quantify the
efficacy of airway sealing in SGA devices.3
Importantly, OLP indicates airway
protection, successful SGA placement, and PPV.3,4
Several methods are used to quantify OLP,
including audible noise detection, oral
capnography, stethoscopic noise and
manometric stability.3,4
The clinical performance and safety of
both LMA ProSealTM and i-gel have been
studied extensively,5–19 but reports vary as
to which device offers superior OLP. Studies
have shown LMA ProSealTM to have
comparable OLP to i-gel ,5,9,11,12,14 or
significantly higher7,8,10,13,15,17 or lower19 OLP
than i-gel .
The present meta-analysis of published
randomized controlled trials (RCTs) was
performed to compare the clinical
performance and airway-sealing characteristics,
including OLP, of LMA ProSealTM and
i-gel in adult patients undergoing general
anesthesia.
Materials and methods
This meta-analysis was performed based
upon the Preferred Reporting Items for
Systematic Reviews and Meta-Analyses
(PRISMA) statements.20
Literature search
The electronic databases MEDLINE ,
EMBASE , CENTRAL (Cochrane
Central Register of Controlled Trials) and
KoreaMed, as well as the web search engine
Google Scholar , were searched for eligible
studies. All searches were conducted in April
2014 and updated in December 2014. The
Medical Subject Heading search terms and
text words included ‘LMA ProSeal’,
‘ProSeal LMA’, ‘PLMA’, and ‘i-gel’. The
search was performed across all languages.
The title and abstract of each paper were
screened by two reviewers (H.W.S. and
H.J.K.) and potentially relevant references
retrieved.
Study selection
Prospective RCTs that compared LMA
ProSealTM and i-gel for general anesthesia
in patients aged >18 years were included in
the analysis. Studies were selected according
to predetermined inclusion criteria by two
independent reviewers (H.N.Y. and G.E.B.).
Any discrepancies were resolved through
discussion or consultation with a third
independent investigator (H.S.A).
Data extraction
Data were extracted independently and
in duplicate by two reviewers (G.E.B.
and H.S.Y.) and were recorded using a
predefined form that included: name of the
first author; year of publication; total number
of patients studied; OLP; time required for
device insertion; rate of insertion on the first
attempt without assistance; fiber-optic view
of the glottis (glottis visualization); ease of
gastric tube insertion; incidence of blood on
the device after removal; and incidence of
patient sore throat. The primary objective
was to compare OLP between the two
devices; secondary objectives were to
compare their clinical performance and rate of
complications. At (...truncated)