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Indian Journal of Anaesthesia May 2023Laparoscopic surgeries are among the most frequent procedures done worldwide. There is a gradual shift in the method of airway securement from endotracheal intubation to...
BACKGROUND AND AIMS
Laparoscopic surgeries are among the most frequent procedures done worldwide. There is a gradual shift in the method of airway securement from endotracheal intubation to supraglottic airway devices (SAD). The objective of the current work was to perform a systematic review and meta-analysis of published RCTs on airway complications in laparoscopic surgery performed with a SAD or endotracheal intubation (ETT).
METHODS
The research was registered in PROSPERO, and a literature search was conducted in Google Scholar and PubMed until August 2022. Out of 78 studies, 31 studies were screened and 21 were included for analysis. RevMan 5.4 was used to analyse data on sore throat, hoarseness, nausea, vomiting, stridor and cough.
RESULTS
Twenty-one randomised controlled trials, enrolling a total of 2213 adult patients, were included in the quantitative analysis. A significant incidence of sore throat and hoarseness was seen at post-operative period in ETT group with risk ratio (RR) 0.44, < 0.00001 [0.30, 0.65], = 72% and RR 0.38, < 0.001 [0.21, 0.69], = 72%, respectively. However, incidence of nausea, vomiting and stridor was not significant with RR 0.83, = 0.26 [0.60, 1.15], = 52% for nausea and RR 0.55, = 0.03 [ 0.33, 0.93], = 14% for vomiting. Incidence of cough was more in ETT group with RR 0.11, < 0.00001 [ 0.06, 0.20], = 42%, as compared to SAD group.
CONCLUSION
There was a substantial variation between SADs and ETTs with respect to the incidence of hoarseness, sore throat, nausea and cough. The existing literature is reinforced by the evidence uncovered in this updated systematic review.
PubMed: 37333696
DOI: 10.4103/ija.ija_398_22 -
Medicine Oct 2022Non-inflatable cuff laryngeal masks are generally composed of thermoplastic material. The thermoplastic nature of the non-inflatable cuff will become soft and match the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Non-inflatable cuff laryngeal masks are generally composed of thermoplastic material. The thermoplastic nature of the non-inflatable cuff will become soft and match the laryngeal anatomy better as it reaches body temperature after intubation. This meta-analysis aims to evaluate the clinical validity of prewarming non-inflatable cuff laryngeal mask before insertion.
METHODS
We searched PubMed, Cochrane Library, Embase, Web of Science, Ovid Medline, CNKI, Wan Fang Database and VIP Database to find randomized controlled trials (RCTs) researching the clinical validity of prewarming non-inflatable cuff laryngeal mask. The retrieval time is up to June 2022. Articles published in the English and Chinese languages were considered. Quality assessment was conducted with the Cochrane Collaboration's tool and GRADE (Grading of Recommendations Assessment, Development and Evaluation) method. Subgroup analyses and trial sequential analysis (TSA) were performed to control the risk of random errors. Publication bias was assessed by funnel plots and Egger's regression test. The outcomes included sealing pressure immediately after successful ventilation, the first-attempt intubation success rate and the incidence of postoperative pharyngeal pain.
RESULTS
Eight RCTs evaluating 683 patients were identified. Pooled results showed that compared to the control group, prewarming non-inflatable cuff laryngeal mask provided a higher sealing pressure immediately after successful ventilation (mean difference: 1.73 cm H2O; 95% confidence interval [CI]: 0.95-2.52; P < .0001; I2 = 16; high quality), higher first-attempt intubation success rate (risk ratio [RR]: 1.05; 95% CI: 1.01-1.09; P = .01; I2 = 26%; high quality, number needed to treat [NNT] = 22 [95% CI 12.5-100]) and lower incidence of postoperative pharyngeal pain (RR: 0.59, 95% CI: 0.46-0.75; P < .0001; I2 = 0; high quality, NNT = 6 [95% CI 4.17-9.09]). The results were confirmed by TSA.
CONCLUSION
Prewarming non-inflatable cuff laryngeal mask could provide better mechanical ventilation efficiency with higher sealing pressure, a higher first-attempt intubation success rate and a lower incidence of postoperative pharyngeal pain.
TRIAL REGISTRATION NUMBER
PROSPERO CRD42021245350.
Topics: Humans; Laryngeal Masks; Pain; Respiration, Artificial
PubMed: 36316864
DOI: 10.1097/MD.0000000000031032 -
Scientific Reports Oct 2022This meta-analysis aimed at investigating the effectiveness of laryngeal mask airway (LMA) against postoperative pharyngolaryngeal complications after thyroidectomy.... (Meta-Analysis)
Meta-Analysis
Efficacy of laryngeal mask airway against postoperative pharyngolaryngeal complications following thyroid surgery: a systematic review and meta-analysis of randomized controlled studies.
This meta-analysis aimed at investigating the effectiveness of laryngeal mask airway (LMA) against postoperative pharyngolaryngeal complications after thyroidectomy. MEDLINE, Cochrane Library, google scholar, and EMBASE databases were searched from inception through February, 2021, for randomized controlled trials (RCTs) comparing the incidence of pharyngolaryngeal complications following the use of LMA or endotracheal tube (ETT). Pooled results from seven RCTs involving 600 patients showed an association of LMA with a reduced risk of postoperative sore throat (POST) at 24 h [risk ratio (RR) 0.75, p = 0.006, four trials], but not at 1 h and 48 h after thyroidectomy. POST severity and hoarseness risk were lower in the LMA group than the ETT group at 1 h, 24 h, and 48 h (all p < 0.05). Nevertheless, hoarseness severity was lower in the LMA group only at postsurgical 48 h [standardized mean difference = - 0.35, p = 0.008, three trials]. Moreover, the risk of emergence cough was lower in patients using LMA than those receiving ETT (RR = 0.14, p = 0.002, two trials). The two groups did not differ in the severity of dysphagia at postoperative 1 h, 24 h, and 48 h. This meta-analysis showed that LMA may be associated with fewer pharyngolaryngeal complications compared to ETT without airway impacts. The limited number of included studies warrants further research to support our findings.
Topics: Humans; Laryngeal Masks; Hoarseness; Thyroid Gland; Intubation, Intratracheal; Pharyngitis; Postoperative Complications
PubMed: 36307459
DOI: 10.1038/s41598-022-21989-5 -
Annals of Palliative Medicine Dec 2021During laryngeal mask airway (LMA) insertion, patients need to enter a sufficient depth of sedation to prevent limb movement, coughing, laryngospasm, and other adverse... (Meta-Analysis)
Meta-Analysis
BACKGROUND
During laryngeal mask airway (LMA) insertion, patients need to enter a sufficient depth of sedation to prevent limb movement, coughing, laryngospasm, and other adverse reactions. This study conducted a meta-analysis to investigate the effect of dexmedetomidine on anesthesia induction in patients undergoing laryngeal mask intubation (LMI).
METHODS
The Embase, PubMed, Cochrane, and Web of Science databases were searched using the keywords [Dexmedetomidine] AND [Laryngeal mask/Laryngeal mask intubation/LMI] OR [Anesthesia induction] to retrieve articles on randomized controlled trials (RCTs) in which dexmedetomidine sedation had been used in the LMI surgery. After screening the articles, the Jadad scale was used to assess the bias of the studies, and Stata16.0 software was used for the analysis to determine the anesthetic-induction effects of dexmedetomidine, fentanyl, morphine, and midazolam as sedatives.
RESULTS
In total, 352 articles were initially retrieved, and 7 articles with a total of 410 patients were ultimately included in the meta-analysis. The effective rate of LMI induced by dexmedetomidine-assisted sedation was better than that of the control group [odds ratio (OR) =1.10, 95% confidence interval (CI): 0.78, 1.53], but the difference between the 2 groups was not significant (Z=0.533, P=0.594). The respiratory rate of the dexmedetomidine group at 5 minutes after dexmedetomidine catheterization was higher than that of the control group [standardized mean difference (SMD) =3.17, 95% CI: 1.38, 4.96; Z=3.476, P=0.001]. The heart rate of the dexmedetomidine group at 1 minute after dexmedetomidine catheterization was significantly lower than that of the control group (SMD =-1.31, 95% CI: -1.91, -0.71; Z=-4.255, P=0.000). The mean arterial pressure (MAP) of the dexmedetomidine group at 1 minute after dexmedetomidine catheterization was lower than that of the control group (SMD =-0.24, 95% CI: -0.94, 0.45), but the difference was not statistically significant (Z=-0.684, P=0.494). The coughing count rate of the dexmedetomidine group was lower than that of the control group (OR =0.36, 95% CI: 0.15, 0.86; Z=-2.286, P=0.022).
DISCUSSION
The application of dexmedetomidine in the anesthesia induction with LMI has a good sedative effect, improves the success rate of LMI, reduces adverse reactions.
Topics: Anesthesia; Dexmedetomidine; Humans; Hypnotics and Sedatives; Laryngeal Masks; Midazolam
PubMed: 35016404
DOI: 10.21037/apm-21-2971 -
BMJ Open Aug 2021To systematically evaluate the efficiency of prewarming i-gel laryngeal mask for mechanical ventilation by meta-analysis and trial sequential analysis. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To systematically evaluate the efficiency of prewarming i-gel laryngeal mask for mechanical ventilation by meta-analysis and trial sequential analysis.
DESIGN
Systematic review and meta-analysis.
DATA SOURCES
Cochrane library, Web of Science, Ovid Medline and PubMed were searched from their inception to 31 August 2020. Only articles published in English language were considered.
METHODS
Randomised controlled trials (RCTs) comparing the efficiency of prewarming i-gel laryngeal mask versus keeping it at room temperature for mechanical ventilation were included. Primary outcome was sealing pressure immediately after successful ventilation. Secondary outcomes were the first-attempt insertion success rate and the incidence of postoperative pharyngeal pain. Two authors independently selected studies. Quality analysis was performed using the modified Jadad Scale. Trial sequential analysis (TSA) was used to control risk of random errors. Sensitivity analysis was done to assess the effect of a single study on the pooled estimates. Publication bias was assessed by funnel plots and Egger's regression test.
RESULTS
Four RCTs comprising 374 patients were included. The results of meta-analysis showed that compared with the control group, prewarming i-gel laryngeal mask provides a higher sealing pressure immediately after successful ventilation (mean difference 2.19 cm HO; 95% CI (1.17 to 3.21); p<0.0001; high quality), with firm evidence from TSA and lower publication bias (p=0.7372). No significant difference was observed in the first-attempt insertion success rate (relative ratio (RR) 1.06; 95% CI (1.00 to 1.12); p=0.07; high quality) with lower publication bias (p=0.1378). The TSA indicating further trials are required. No significant difference was assessed in the incidence of postoperative pharyngeal pain (RR 1.0; 95% CI (0.14 to 6.90); p=1.0; high quality).
CONCLUSION
Prewarming i-gel laryngeal mask provides higher sealing pressure compared with keeping it at room temperature. But prewarming i-gel laryngeal mask did not increase the first-attempt insertion success rate, nor did it decrease the incidence of postoperative pharyngeal pain.
Topics: Humans; Laryngeal Masks; Respiration, Artificial
PubMed: 34376440
DOI: 10.1136/bmjopen-2020-045461 -
Scientific Reports Jul 2021Numerous supraglottic airway device (SADs) have been designed for adults; however, their relative efficacy, indicated by parameters such as adequacy of sealing, ease of... (Meta-Analysis)
Meta-Analysis
Numerous supraglottic airway device (SADs) have been designed for adults; however, their relative efficacy, indicated by parameters such as adequacy of sealing, ease of application, and postinsertion complications, remains unclear. We conducted a systematic review and network meta-analysis to evaluate the efficacy of various SADs. We searched electronic databases for randomized controlled trials comparing at least two types of SADs published before December 2019. The primary outcomes were oropharyngeal leak pressure (OLP), risk of first-attempt insertion failure, and postoperative sore throat rate (POST). We included 108 studies (n = 10,645) comparing 17 types of SAD. The Proseal laryngeal mask airway (LMA), the I-gel supraglottic airway, the Supreme LMA, the Streamlined Liner of the Pharynx Airway, the SoftSeal, the Cobra Perilaryngeal Airway, the Air-Q, the Laryngeal Tube, the Laryngeal Tube Suction II, the Laryngeal Tube Suction Disposable, AuraGain, and Protector had significantly higher OLP (mean difference ranging from 3.98 to 9.18 cmHO) compared with that of a classic LMA (C-LMA). The Protector exhibited the highest OLP and was ranked first. All SADs had a similar likelihood of first-attempt insertion failure and POST compared with the C-LMA. Our findings indicate that the Protector may be the best SAD because it has the highest OLP.Systematic review registration PROSPERO: CRD42017065273.
Topics: Anesthesia, General; Humans; Laryngeal Masks; Network Meta-Analysis; Oropharynx; Pharyngitis; Pressure; Randomized Controlled Trials as Topic
PubMed: 34301986
DOI: 10.1038/s41598-021-94114-7 -
Revista Latino-americana de Enfermagem 2020to compare the mean development time of the techniques of direct laryngoscopy and insertion of supraglottic devices; and to evaluate the success rate in the first... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
to compare the mean development time of the techniques of direct laryngoscopy and insertion of supraglottic devices; and to evaluate the success rate in the first attempt of these techniques, considering health professionals wearing specific personal protective equipment (waterproof overalls; gloves; boots; eye protection; mask).
METHOD
meta-analysis with studies from LILACS, MEDLINE, CINAHL, Cochrane, Scopus and Web of Science. The keywords were the following: personal protective equipment; airway management; intubation; laryngeal masks.
RESULTS
in the "reduction of the time of the procedures" outcome, the general analysis of the supraglottic devices in comparison with the orotracheal tube initially presented high heterogeneity of the data (I2= 97%). Subgroup analysis had an impact on reducing heterogeneity among the data. The "laryngeal mask as a guide for orotracheal intubation" subgroup showed moderate heterogeneity (I2= 74%). The "2ndgeneration supraglottic devices" subgroup showed homogeneity (I2= 0%). All the meta-analyses favored supraglottic devices. In the "success in the first attempt" outcome, moderate homogeneity was found (I2= 52%), showing a higher proportion of correct answers for supraglottic devices.
CONCLUSION
in the context of chemical, biological or radiological disaster, the insertion of the supraglottic device proved to be faster and more likely to be successful by health professionals. PROSPERO record (CRD42019136139).
Topics: Emergencies; Humans; Intubation, Intratracheal; Laryngeal Masks; Laryngoscopy; Personal Protective Equipment
PubMed: 32876287
DOI: 10.1590/1518-8345.4024.3347 -
British Journal of Anaesthesia Sep 2020
Topics: Airway Management; Equipment Design; Humans; Intubation, Intratracheal; Laryngeal Masks; Laryngoscopy; Manikins; Personal Protective Equipment; Video Recording
PubMed: 32624187
DOI: 10.1016/j.bja.2020.06.011 -
Emergencias : Revista de La Sociedad...Various supraglottic devices are currently available for airway management and are used widely in emergency situations because they are easy to position. We undertook a... (Comparative Study)
Comparative Study
Various supraglottic devices are currently available for airway management and are used widely in emergency situations because they are easy to position. We undertook a systematic review of the literature comparing laryngeal tubes and various laryngeal mask airway devices (LMAs) to determine which ones can be used most efficiently in emergencies. Nine databases were searched, as follows: Cochrane Library Plus, MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Dialnet, Global Health, Nursing & Allied Health Database, CUIDEN, the Web of Science, and ScienceDirect. We collected studies published between 2014 and 2019 in Spanish, English, French, and Portuguese that compared laryngeal tubes to LMAs of different types for supraglottic airway management. Eighteen studies were selected for analysis after critical reading. Significant differences were not seen between tubes and LMAs with respect to most variables, but in certain contexts the oropharyngeal seal and speed of insertion were superior with laryngeal tubes; however, when fiberoptic bronchoscopes were then inserted the view of the glottis was poor. The different contexts in which these devices are used and the scarcity of studies comparing laryngeal tubes to LMAs does not allow us to identify clear differences among them with respect to efficiency. However, tubes seem to offer poorer visibility of the glottis according to evaluation with fiberoptic scopes, a factor to bear in mind if tracheal intubation, which is considered the gold standard, might become necessary.
Topics: Airway Management; Emergency Medical Services; Fiber Optic Technology; Glottis; Humans; Intubation, Intratracheal; Laryngeal Masks
PubMed: 31777215
DOI: No ID Found -
PloS One 2019Changes in head and neck position may significantly affect the performance of supraglottic airway devices (SADs) by altering the pharyngeal structure. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Changes in head and neck position may significantly affect the performance of supraglottic airway devices (SADs) by altering the pharyngeal structure.
PURPOSE
This systematic review and meta-analysis aimed to elucidate the effect of changes in head and neck position on performance of SADs.
DATA SOURCE
Bibliographic databases, including PubMed, EMBASE, the Cochrane library, and the Web of Science.
STUDY ELIGIBILITY CRITERIA
Prospective studies investigating the effects of head and neck positions on the performance of SADs.
METHODS
A random effect model was applied in the all analyses. Subgroup analysis was performed according to the type of device and the age of patient. The oropharyngeal leak pressure was the primary outcome measure. Secondary outcome measures included peak inspiratory pressure, fibreoptic view, and ventilation score (PROSPERO, CRD42017076971).
RESULTS
Seventeen studies met the eligibility criteria. Overall, the oropharyngeal leak pressure significantly increased (mean difference 4.07 cmH2O; 95% confidence interval 3.30 to 4.84) during neck flexion with adverse effects on ventilation and fibreoptic view. Conversely, the oropharyngeal leak pressure decreased (mean difference -4.05; 95% confidence interval -4.90 to -3.20) during neck extension with no significant effect on ventilation or fibreoptic view. Rotation of the head and neck did not significantly affect SAD performance.
CONCLUSIONS
The reduced oropharyngeal leak pressure in the extended neck position was not associated with impaired ventilation except with the air-Q self-pressurizing airway. The flexed neck position significantly worsens ventilation and the alignment between the SAD and glottis despite improving the seal except with the air-Q self-pressurizing airway and LMA Proseal.
Topics: Airway Management; Head; Humans; Intubation, Intratracheal; Laryngeal Masks; Neck; Outcome Assessment, Health Care; Posture; Prospective Studies
PubMed: 31071171
DOI: 10.1371/journal.pone.0216673