Abstract
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 cmH2O) 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.
Highlights
Numerous supraglottic airway device (SADs) have been designed for adults; their relative efficacy, indicated by parameters such as adequacy of sealing, ease of application, and postinsertion complications, remains unclear
The high oropharyngeal leak pressure (OLP) of the Protector may be attributable to the fact that it is made of medical grade silicone
Other SADs attained better OLP than that of the C-laryngeal mask airway (LMA), and this finding is consistent with that of a recent network meta-analysis of SADs for pediatric patients, which indicated that the I-gel, Cobra and Proseal laryngeal mask airway (P-LMA) achieved 3.4 to 4.6 c mH2O higher OLP than that of the C-LMA11
Summary
Numerous supraglottic airway device (SADs) have been designed for adults; 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). Since the introduction of the classic laryngeal mask airway (C-LMA)[2], at least 10 types of SADs with novel materials and designs have been developed[3] These SADs may have better efficacy than the C-LMA if they have a higher oropharyngeal leak pressure (OLP) and a lower risk of first-attempt insertion failure or airway c omplications[2]. We conducted a systematic review and network meta-analysis to evaluate the efficacy of SADs in terms of OLP, the risk of first-attempt insertion failure, postoperative sore throat rate (POST) and other efficacy-associated. Outcomes, including overall insertion failure rate during induction, poor function after successful insertion, SAD failure during maintenance, hypoxia and aspiration
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