Comparison of Size 2 LMA-ProSeal™ and LMA-Supreme™ in Spontaneously Breathing Children: a Randomised Clinical Trial

We conducted both conventional pairwise and Bayesian network meta-analyses to compare the clinical properties of supraglottic airway devices in children. We searched six databases for randomised clinical trials. Our primary end-points were oropharyngeal leak pressure, risk of insertion failure at first attempt, and blood staining risk. The risk of device failure, defined as the abandonment of the supraglottic airway device and replacement with a tracheal tube or another device, was also analysed. Sixty-five randomised clinical trials with 5823 participants were identified, involving 16 types of supraglottic airway device. Network meta-analysis showed that the i-gel™, Cobra perilaryngeal airway™ and Proseal laryngeal mask airway (LMA -Proseal) showed statistically significant differences in oropharyngeal leak pressure compared with the LMA -Classic, with mean differences (95% credible interval, CrI) of 3.6 (1.9-5.8), 4.6 (1.7-7.6) and 3.4 (2.0-4.8) cmH O, respectively. The i-gel was the only device that significantly reduced the risk of blood staining of the device compared with the LMA-Classic, with an odds ratio (95%CrI) of 0.46 (0.22-0.90). The risk (95%CI) of device failure with the LMA-Classic, LMA -Unique and LMA-Proseal was 0.36% (0.14-0.92%), 0.49% (0.13-1.8%) and 0.50% (0.23-1.1%), respectively, whereas the risk (95%CI) of the i-gel and PRO-Breathe was higher, at 3.4% (2.5-4.7%) and 6.0% (2.8-12.5%), respectively. The risk, expressed as odds ratio (95%CrI), of insertion failure at first attempt, was higher in patients weighing < 10 kg at 5.1 (1.6-20.1). We conclude that the LMA-Proseal may be the best supraglottic airway device for children as it has a high oropharyngeal leak pressure and a low risk of insertion. Although the i-gel has a high oropharyngeal leak pressure and low risk of blood staining of the device, the risk of device failure should be evaluated before its routine use can be recommended.

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“…The full texts of 118 articles were examined in detail. We included 65 articles in this network meta‐analysis (Fig. ).…”

Section: Resultsmentioning

confidence: 99%

A network meta‐analysis of the clinical properties of various types of supraglottic airway device in children

et al. 2017

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“…[ 13 ] Arslan et al . [ 14 ] found OPL 26.4 ± 5.5 cm H 2 O for PLMA size 2 in spontaneously breathing patient. Lardner et al .…”

Section: Discussionmentioning

confidence: 99%

Comparison of ProSeal laryngeal mask airway size 2 and 2½ in anesthetized and paralyzed pediatric patients with same weight group: A prospective randomized clinical study

Mahajan

Taxak

2014

Anesth Essays Res

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Context:ProSeal laryngeal mask airway (PLMA) efficacy in pediatric anesthesia.Aims:The aim of this study was to compare PLMA size 2 and 2½ in anesthetized paralyzed pediatric patients weighing 20–30 kg undergoing elective surgery.Settings and Design:A prospective randomized study was conducted in a tertiary care teaching hospital.Materials and Methods:A total of 60 American Society of Anesthesiologists I pediatric patients of either sex having body weight between 20 and 30 kg undergoing elective surgeries were randomly allocated to PLMA of either size 2 or 2½. Standardized anesthetic technique with propofol, sevoflurane, vecuronium bromide, nitrous oxide was used in all patients. Parameters such as number of attempts, time to achieve an effective airway, hemodynamic parameters, drain tube test, oropharyngeal leak pressure (OPL), gastric tube placement, and postoperative adverse events were noted. Statistical analysis by Kolmogorov-Smirnov analysis, Mann-Whitney U-test, Student's t-test, Wilk's lambda test and power analysis was done.Results:There were no significant differences in demographic variables, ease of insertion and ventilation, number of insertion attempts, hemodynamics, and postoperative complications. OPLs were slightly higher in PLMA size 2½ (27.38 ± 6.36 vs. 22.62 ± 2.85 cm H2O, respectively; P = 0.001) than size 2.Conclusions:Both PLMA size 2 and 2½ provided adequate seal pressures that would allow positive pressure ventilation in healthy children. Thus PLMA of either size 2 or 2½ can be used as a reliable airway device in children weighing 20-30 kg.

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“…Zehra Ipek Arslam et al 38 compared size 2 LMAProseal with size 2 LMA-Supreme in spontaneously breathing children undergoing lower abdominal elective surgeries lasting less than 1 hour. There were no differences in the demographic variable, ease of gastric tube placement, ease of insertion and ventilation, no.…”

Section: Review Of Literaturementioning

confidence: 99%

Comparison of supraglottic airway devices I-Gel and LMA-Supreme in adults

Kumar¹,

Raj²

2020

IJCA

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Whenever the conventional laryngoscopy fails, insertion of supraglottic airway device may be indicated. The I-Gel and LMASupreme are both novel supraglottic airway devices which are disposable, cheap and aids the passage of gastric tube which helps in gastric drainage. Both the devices can be used as an adjunct to endotracheal intubation in patient with difficult airway. This prospective randomized, single blind study was designed to compare the supraglottic airway devices I-Gel and LMASupreme in patients undergoing general anaesthesia for elective surgeries. After obtaining the institutional ethical committee approval, 60 adult patients of ASA I and II physical status of either sex undergoing elective surgical procedures under general anaesthesia were randomly allocated into 2 groups. Group A I-Gel group (n=30) and Group B LMA-Supreme (n=30). The study showed no significant difference between the two groups based on demographic variables. The mean insertion time for LMA-Supreme is significantly lower than I-Gel (P<0.05). The airway leak pressure was comparable between the two devices. The first attempt success rate and the ease of insertion was significantly better in LMA-Supreme than I-Gel (P<0.05). There was no significant variation in the hemodynamic response in both the groups. Post-operative sore throat was noted in LMA-Supreme and blood staining was noted in I-Gel group. When compared with I-Gel LMA-Supreme has a higher first attempt success rate and also a lower insertion time.

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Comparison of Size 2 LMA-ProSeal™ and LMA-Supreme™ in Spontaneously Breathing Children: a Randomised Clinical Trial

Cited by 4 publications

References 17 publications

A network meta‐analysis of the clinical properties of various types of supraglottic airway device in children

A network meta‐analysis of the clinical properties of various types of supraglottic airway device in children

Comparison of ProSeal laryngeal mask airway size 2 and 2½ in anesthetized and paralyzed pediatric patients with same weight group: A prospective randomized clinical study

Comparison of supraglottic airway devices I-Gel and LMA-Supreme in adults

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