Comparison of oropharyngeal leak pressure and clinical performance of LMA ProSeal™ and i-gel® in adults: Meta-analysis and systematic review

Journal of International Medical Research, May 2016

Background A meta-analysis and systematic review of randomized controlled trials to compare the oropharyngeal leak pressure (OLP) and clinical performance of LMA ProSeal™ (Teleflex® Inc., Wayne, PA, USA) and i-gel® (Intersurgical Ltd, Wokingham, UK) in adults undergoing general anesthesia.

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Comparison of oropharyngeal leak pressure and clinical performance of LMA ProSeal™ and i-gel® in adults: Meta-analysis and systematic review

Downloaded from imr.sagepub.com by guest on December 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 . - 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)


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Hye Won Shin, Hae Na Yoo, Go Eun Bae, Jun Chul Chang, Min Kyung Park, Hae Seun You, Hyun Jung Kim, Hyung Sik Ahn. Comparison of oropharyngeal leak pressure and clinical performance of LMA ProSeal™ and i-gel® in adults: Meta-analysis and systematic review, Journal of International Medical Research, 2016, pp. 405-418, 44/3, DOI: 10.1177/0300060515607386