Supraglottic airway devices versus endotracheal intubation for laparoscopic surgeries: An updated systematic review and meta-analysis of randomised controlled trials

Abstract

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, P < 0.00001 [0.30, 0.65], i 2 = 72% and RR 0.38, P < 0.001 [0.21, 0.69], i 2 = 72%, respectively. However, incidence of nausea, vomiting and stridor was not significant with RR 0.83, P = 0.26 [0.60, 1.15], i 2 = 52% for nausea and RR 0.55, P = 0.03 [ 0.33, 0.93], i 2 = 14% for vomiting. Incidence of cough was more in ETT group with RR 0.11, P < 0.00001 [ 0.06, 0.20], i 2 = 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.