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

Abstract

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.

The design of the perfect pediatric supraglottic airway device

“…The Laryngeal Mask Airway ProSeal has undergone numerous studies since its inception and shown to provide superior oropharyngeal leak pressures compared to other SGAs . The i‐gel may have a slight advantage in practicality since institutions may be less inclined to use reusable devices, such as the ProSeal.…”

Leading papers in pediatric anesthesia from the last year

“…Cook et al 8 , em editorial, apontaram as vantagens do uso de dispositivos supraglóticos de segunda geração em crianças, uma vez que estes dispositivos estão associados a menor incidência de aspirações e melhor ventilação pulmonar. O uso de dispositivos de segunda geração foi recomendado por Mihara et al 9 Os autores conduziram uma revisão sistemática e metanálise de 65 estudos, onde 16 dispositivos Principais artigos de anestesia pediátrica do último ano foram analisados. Concluíram que a LMA Proseal TM pode ser considerada o melhor dispositivo, por apresentar uma pressão de vazamento maior e menores taxas de falha.…”

“…Existem vários dispositivos supraglóticos no mercado e vários estudos avaliando seu uso e segurança. Os resultados desta metanálise de Mihara et al 9 devem ser a avaliados com cautela, uma vez que não existe o "melhor dispositivo" que consegue cobrir todos os tipos de pacientes pediátricos e faixas etárias. 10 O uso de tubos endotraqueais com cuff é considerado seguro, uma vez que os cuffs atuais são de alto volume e baixa pressão.…”

Pharmacological interventions for protecting renal function after cardiac surgery: a Bayesian network meta‐analysis of comparative effectiveness

“…Network meta‐analysis is a statistical technique that enables comparison of different interventions or drugs that have not been directly compared through adequately powered head‐to‐head RCTs . Even without previous evidence, a comparison between two drugs is possible through a third common comparator , with direct and indirect comparisons integrated to assess multiple interventions at the same time.…”