A randomized comparison between the i-gel™ and the air-Q™ supraglottic airways when used by anesthesiology trainees as conduits for tracheal intubation in children

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.

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“…The full texts of 118 articles were examined in detail. We included 65 articles in this network meta‐analysis (Fig. ).…”

Section: Resultsmentioning

confidence: 99%

“…The trials had a median (range [IQR]) sample size of 60 (27–240 [53–100]). Sevoflurane was administered for anaesthesia induction in 44 studies . There were eight crossover designed studies .…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2017

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“…Although the i‐gel has been used successfully as a conduit for fiberoptic intubation in children, it was not designed for this purpose. It has been found to provide better views compared to older devices; however, its long and narrow tube in the smaller sized i‐gels (1, 1.5) made SGA removal more problematic compared to the air‐Q …”

Section: Characteristics Of the Perfect Pediatric Sgamentioning

confidence: 99%

The design of the perfect pediatric supraglottic airway device

Huang

Sarver

Widing

et al. 2020

Pediatric Anesthesia

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The design evolution of the pediatric supraglottic airway device has experienced a long and productive journey. We have a wealth of clinical studies to support progress and advancements in pediatric clinical practice. While all of the supraglottic airway devices have been used successfully in millions of children, it is important to be aware of design advantages and disadvantages of the different models of supraglottic airway devices. Current pediatric supraglottic airway devices may be improved in design to be more ideal. Industry‐changing technological advancements are likely to occur in the near future, which may further improve clinical performance of these devices.

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“…17 The air-Q provides better fiberoptic views than other first-generation SGAs 16 ; and several studies have shown that it outperforms various SGAs when used as a conduit for fiberopticguided tracheal intubation in children. 16,18,19 The air-Q has been used successfully to provide adequate ventilation and as a conduit for tracheal intubation in children with anticipated and unanticipated difficult airways. 18,20 In children with difficult airways, the air-Q provided adequate ventilation and allowed passage of a cuffed endotracheal tube using fiberoptic guidance and optical stylets.…”

Section: Air-qmentioning

confidence: 99%