Effect of Laryngeal Mask Airway Insertion on Intraocular Pressure Response: Systematic Review and Meta-Analysis

Abstract

<jats:p><jats:italic>Background</jats:italic>. Use of laryngeal mask airway as an alternative to the endotracheal tube has attracted the attention of several workers with regard to intraocular pressure changes. However, the previous studies have reported different results while comparing intraocular pressure, following insertion of laryngeal mask airway or the endotracheal tube. Therefore, this systematic review and meta-analysis was aimed to generate the best possible evidence on the intraocular pressure response to endotracheal tube intubation and laryngeal mask airway insertion. <jats:italic>Methods</jats:italic>. Electronic databases like PubMed, CINAHL, EMBASE, Google Scholar, Cochrane library databases, and Mednar were used. All original peer-reviewed papers which reported the mean and standard deviation of IOP before and after airway instrumentation in both groups were included. Two reviewers independently extracted the data using a standardized data extraction format for eligibility and appraised their quality. Data were analyzed using the STATA version 14 software. The pooled standard mean difference was estimated with the random-effect model. Heterogeneity between studies was assessed by the <jats:italic>I</jats:italic><jats:sup>2</jats:sup> statistics test. A subgroup analysis was done to assess the source of variation between the studies. <jats:italic>Result</jats:italic>. A total of 47 research papers were reviewed, of which, six studies were finally included in this systematic review and meta-analysis. The overall pooled standard mean difference of intraocular pressure was 1.30 (95% CI, 0.70, 1.90), showing that LMA insertion is better than ETT intubation to maintain stable intraocular pressure. A random-effect model was employed to estimate the pooled standard mean differences due to severe heterogeneity (<jats:italic>I</jats:italic><jats:sup>2</jats:sup> 79.45, <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M1"><mml:mi>p</mml:mi></mml:math> ≤ 0.001). <jats:italic>Conclusion</jats:italic>. The available information suggests that the LMA provides lesser intraocular pressure response in comparison with the conventional tracheal tube.</jats:p>

Changes in intraocular pressures associated with inhalational and mixed anesthetic agents currently used in ophthalmic surgery

“…[ 10 11 23 24 25 26 ] Laryngeal airway mask induces lesser hemodynamic changes compared to endotracheal intubation. [ 27 ] Although our primary aim was not to compare variations in IOP between the two types of airway maintenance (endotracheal tube or laryngeal mask airway) used during GA, we had enough data to do so; this comparison is important for determining if IOPs recorded under GA with these two methods can be used interchangeably. In this study, although the mean reduction in IOP was slightly more for patients on whom laryngeal mask airways were used as compared to those on whom endotracheal intubation was used, the difference was not statistically significant, owing to small sample size.…”

Childhood glaucoma registry in Germany: initial database, clinical care and research (pilot study)

“…In order to reduce interference of depth of anesthesia with IOP values [24,25], IOP was always measured within the first minutes after initiation of anesthesia. Time point of IOP measurements, method of anesthesia, detailed description of anterior segment and gonioscopy findings, surgical status of the eye and signs of secondary glaucoma were thoroughly documented in the extended GAEF (see Additional file 3: Fig.…”

Effects of Supraglottic Airway Devices on Hemodynamic Response and Optic Nerve Sheath Diameter: Proseal LMA, LMA Supreme, and I-gel LMA

“…The literature on SADs is vast, and varying results have been reported on their insertion success rates and times. The main factors that could have affected these results in the methodologies of previous studies have been reported as the experience levels of practitioners and differences in the use of muscle relaxants [3][4][5][6][7]30,33,37,38]. Mukadder et al investigated the effects of the pLMA, sLMA, and I-gel on insertion time and success and found that the insertion time of the I-gel was shorter, whereas there was no significant difference among the devices in terms of insertion success.…”

“…Supraglottic airway devices (SADs) have recently become increasingly prevalent in the provision of safe and efficient airways in appropriate conditions. Many studies including adult and pediatric patients have revealed that in comparison to endotracheal intubation, SADs are more beneficial, as they do not require muscle relaxation, are easily applied without laryngoscopy, are less traumatic, and provide more stable hemodynamic and IOP values [3][4][5].…”

“…The I-gel (Intersurgical Ltd., Wokingham, UK) is a relatively new device that is made out of a soft, gel-like, and translucent thermoplastic elastomer designed to not apply pressure on the anatomical structures of the larynx and pharynx with a cuffless, single-use, and narrow-bore gastric drain tube [7]. Studies have reported similar placement times and placement success rates on the first try for all three SDAs [3][4][5][6][7].…”