Abstract
ObjectivesConflicting results have been reported for the i-gel and the laryngeal mask airway proseal (LMA-P) during general anesthesia. The objective of the current investigation was to compare the efficacy and safety of the i-gel vs. the LMA-P during general anesthesia.MethodsTwo authors performed searches of MEDLINE, EMBASE, CENTRAL, and Google Scholar to identify randomized clinical trials that compared the LMA-P with the i-gel during general anesthesia. A meta -analysis was performed using both random and fixed-effect models. Publication bias was evaluated using Begg's funnel plot and Egger's linear regression test.ResultsTwelve randomized clinical trials met the eligibility criteria. There were no significant differences in insertion success rate at the first attempt (risk ratio [RR] 1.01, 95% confidence interval [CI] 0.97, 1.06), ease of insertion (RR 1.14, 95% CI 0.93, 1.39), oropharyngeal leak pressure (OLP) (MD -1.98, 95% CI -5.41, 1.45), quality of fiberoptic view (RR 1.00, 95% CI 0.91, 1.10) and success rate of gastric tube insertion (RR 1.07, 95% CI 0.98, 1.18) between the i-gel and the LMA-P, respectively. The i-gel had a shorter insertion time than the LMA-P (MD -3.99, 95% CI -7.13, -0.84) and a lower incidence of blood staining on the device (RR 0.26, 95% CI 0.14, 0.49), sore throat (RR 0.28, 95% CI 0.15, 0.50) and dysphagia (RR 0.27, 95% CI 0.10, 0.74).ConclusionsBoth devices were comparable in ease of insertion to insert and both had sufficient OLP to provide a reliable airway. Only a few minor complications were reported. The i-gel was found to have fewer complications (blood staining, sore throat, dysphagia) than the LMA-P and offers certain advantages over the LMA-P in adults under general anesthesia.
Highlights
Supraglottic airway devices (SGAs) have been shown to be suitable for use in routine anesthesia and emergency airway procedures [1]
Two authors performed searches of MEDLINE, EMBASE, CENTRAL, and Google Scholar to identify randomized clinical trials that compared the laryngeal mask airway proseal (LMA-P) with the i-gel during general anesthesia
There were no significant differences in insertion success rate at the first attempt, ease of insertion (RR 1.14, 95% CI 0.93, 1.39), oropharyngeal leak pressure (OLP) (MD -1.98, 95% CI -5.41, 1.45), quality of fiberoptic view (RR 1.00, 95% CI 0.91, 1.10) and success rate of gastric tube insertion (RR 1.07, 95% CI 0.98, 1.18) between the i-gel and the LMA-P, respectively
Summary
Supraglottic airway devices (SGAs) have been shown to be suitable for use in routine anesthesia and emergency airway procedures [1]. The i-gel is a single use SGA composed of a soft, gel-like, non-inflatable cuff made from a thermoplastic elastomer. It has a widened, flattened stem with a rigid bite block that acts as a buccal stabilizer to reduce axial rotation and mal-positioning, and a port for gastric tube insertion. The posterior inflatable cuff and the increased bulk of the LMA-P substantially increase the pharyngeal seal [5]. Because of the larger bulk of the LMA-P tip and the absence of a back-plate on the device, poor insertion technique results in posterior folding over of the device. There are 3 insertion techniques for the LMA-P (standard, introducer, and bougie-guided) [6,7]
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