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

作者：Mihara T; Asakura A; Owada G; Yokoi A; Ka K; Goto T

来源：Anaesthesia, 2017, 72(10): 1251-1264.

DOI：10.1111/anae.13970

<jats:title>Summary</jats:title><jats:p>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 (<jats:styled-content style="fixed-case">LMA</jats:styled-content><jats:sup>®</jats:sup>‐Proseal) showed statistically significant differences in oropharyngeal leak pressure compared with the <jats:styled-content style="fixed-case">LMA</jats:styled-content><jats:sup>®</jats:sup>‐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<jats:sub>2</jats:sub>O, respectively. The i‐gel was the only device that significantly reduced the risk of blood staining of the device compared with the <jats:styled-content style="fixed-case">LMA</jats:styled-content>‐Classic, with an odds ratio (95%CrI) of 0.46 (0.22–0.90). The risk (95%<jats:styled-content style="fixed-case">CI</jats:styled-content>) of device failure with the <jats:styled-content style="fixed-case">LMA</jats:styled-content>‐Classic, <jats:styled-content style="fixed-case">LMA</jats:styled-content><jats:sup>®</jats:sup>‐Unique and <jats:styled-content style="fixed-case">LMA</jats:styled-content>‐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%<jats:styled-content style="fixed-case">CI</jats:styled-content>) of the i‐gel and <jats:styled-content style="fixed-case">PRO</jats:styled-content>‐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 &lt; 10 kg at 5.1 (1.6–20.1). We conclude that the <jats:styled-content style="fixed-case">LMA</jats:styled-content>‐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.</jats:p>

• 出版日期2017-10