SummaryThe Airtraq laryngoscope is a single-use laryngoscope designed to facilitate tracheal intubation in patients with either normal or difficult airways. The aim of this systematic review and meta-analysis was to compare the Airtraq with the conventional Macintosh laryngoscope. Data were retrieved from Medline, Embase, the Cochrane register of controlled trials, and by a manual search of bibliographies. Twelve randomised controlled trials (published between 2006 and 2011) including 1061 patients met the inclusion criteria. The Airtraq reduced intubation time significantly (mean difference )15 s; 95% CI )25 to )4 s, p < 0.00001) used by both experienced anaesthetists and novices, and it increased the first attempt success rate only in novices (relative risk 1.25; 95% CI 1.05-1.49, p = 0.07). The incidence of oesophageal intubation (relative risk 0.12; 95% CI 0.03-0.48, p < 0.05) was significantly reduced by the Airtraq. We conclude that the Airtraq laryngoscope facilitates a more rapid and accurate intubation, especially when used by novices. The Airtraq laryngoscope (Prodol Ltd, Vizcaya, Spain) is a single-use optical laryngoscope designed to facilitate tracheal intubation in patients with either normal or difficult airways [1,2]. It has a light source and a guiding channel in which to place the tracheal tube and also a heating system to prevent misting of the viewfinder. Owing to the special design of the optical components and the curvature of the rigid blade, the Airtraq allows viewing the glottic without alignment of the oral-pharyngeal-tracheal axes.Several randomised controlled trials have compared the Airtraq with the Macintosh laryngoscope, but the results were conflicting. To provide greater clarity about outcomes, we carried out a systematic review and meta-analysis. We pooled the results of the intubation time, the first attempt success rate, the incidence of complications and the incidence of oesophageal intubation. A subgroup analysis was carried out to investigate heterogeneity, and a sensitivity analysis was conducted to evaluate the degree of certainty of the result. MethodsTwo reviewers (Y.L and H.J) independently carried out a comprehensive search (last update 31 March 2011) of Medline (Pubmed), Embase and the Cochrane register of controlled trials, searching for randomised controlled trials that compared the Airtraq with the Macintosh laryngoscope. The search strategy consisted of a combination of free text words: 'Airtraq' and 'Macintosh'. There were no restrictions concerning the language of the article or publication type.We included all randomised controlled trials comparing the Airtraq with the Macintosh laryngoscope. We excluded manikin studies, case reports, reviews and crossover or non-randomised controlled trials, identified as such after reading the title and abstract.

Study Type – Therapy (meta‐analysis)
Level of Evidence 1a OBJECTIVE To review the evidence for the use of α‐blockers after extracorporeal shock wave lithotripsy (ESWL) in enhancing the effectiveness of renal and ureteric stone clearance. METHODS We searched MEDLINE, Embase and the Cochrane Library up to January 2009. All randomized controlled trials in which α‐blockers were evaluated after ESWL were eligible for the analysis. Outcome measures assessed were clearance rate (primary) and expulsion time (secondary). Two authors independently assessed study quality and extracted data. All data were analysed using RevMan 5. RESULTS Of the 29 identified papers, seven trials with a total of 484 patients met the predefined criteria. These studies evaluated the effectiveness of the α‐blocker tamsulosin, and studied clearance rate as the primary outcome. There was large heterogeneity between trials, but their methodological quality was adequate. The pooled absolute risk difference of clearance rate was 16% (95% confidence interval 5–27%) in favour of the tamsulosin group, i.e. an average of six patients have to be treated with tamsulosin after ESWL to achieve clearance in one. Subgroup analysis for the six studies that used a dose of 0.4 mg tamsulosin showed a pooled risk difference of 19 (10–29)%. The expulsion time was analysed in three studies and the pooled mean difference was 8  (−3–20) days in favour of the tamsulosin group. Pain and analgesic usage was reported to be lower with tamsulosin. Adverse effects of tamsulosin, mainly dizziness, were reported in eight patients (3%). CONCLUSIONS Treatment with tamsulosin after ESWL appears to be effective in assisting stone clearance in patients with renal and ureteric calculi. To make a definite clinical recommendation to use tamsulosin after ESWL for renal and ureteric calculi, a high quality confirmatory trial is warranted.

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