Comparison of the clinical performance of i-gel and Ambu laryngeal masks in anaesthetised paediatric patients: A meta-analysis

Abstract

BACKGROUND Paediatric supraglottic airway devices (SGAs) are widely used in routine anaesthesia and serve as primary or back-up devices for difficult airway management. The inflatable Ambu laryngeal masks and non-inflatable i-gel are two improvements of SGAs based on classic laryngeal masks. The clinical performance and safety of these two devices in paediatric patients are still unclear and warrant further investigation. AIM To perform a systematic review and meta-analysis on the clinical performance and safety of Ambu laryngeal masks and i-gel in anaesthetised paediatric patients. METHODS MEDLINE, Embase, Web of Science and Cochrane Central Register of Controlled Trials were searched from inception dates to April 2020. We identified published randomised controlled trials (RCTs) in which the intervention involved the use of Ambu laryngeal masks and i-gel in anaesthetised paediatric patients (age < 18 years). We assessed the oropharyngeal leak pressure (OLP) as the primary outcome. The secondary outcomes were insertion time, success rate of insertion on the first attempt, and incidence of adverse events. RESULTS After searching for all relevant trials published up to April 2020, data from seven RCTs with a total of 667 paediatric patients (323 and 344 participants in the i-gel and Ambu groups, respectively) were evaluated. The mean OLP in anaesthetised paediatric patients was lower in the Ambu group [21.82 cmH 2 O for Ambu vs 23.98 cmH 2 O for i-gel, P = 0.003, 95% confidence interval (CI): -3.58 to -0.75, I 2 = 68%, Mantel-Haenszel random model]. We did not find any clear evidence of differences between the devices in terms of insertion time, success rate of insertion, and incidence of adverse events except for blood staining (risk ratio 5.86, 95%CI: 1.76 to 19.46, P = 0.004, I 2 = 0, fixed-effect model). CONCLUSION The i-gel airway may provide a better seal and is therefore probably more suitable than the Ambu laryngeal mask airway in anaesthetised paediatric patients. However, the evidence is insufficient to allow making firm conclusions or to guide clinical practice, owing to the small number of relevant published studies.

Anesthesia management for a child with the Koolen-de Vries syndrome: a case report

“…Because of the less stimulation of the laryngeal mask which allowed reduction of anesthetics and free of muscle relaxant, and advantages for difficult airway management compared to endotracheal tube, we took it as the first choice for airway management. Previous studies had shown that inflatable and non-inflatable laryngeal masks could provide equal ventilation quality, and the i-gel presented a better sealing effect [4,5]. Meanwhile, the gellaryngeal mask is the most commonly used LMA in our center which usually provides very high seal pressure as good as inflatable LMAs.…”

Comparison of two different flexible laryngeal airway masks in pediatric ophthalmic surgeries: A retrospective study

“…The OLP is an important index for evaluating the effectiveness and safety of laryngeal mask ventilation and is of great significance in maintaining airway tightness, ensuring ventilation, and reducing the entry of oropharyngeal and gastric contents into the respiratory tract. [10][11][12][13] OLP results from a tight surface-to-surface fit between the laryngeal mask and soft tissue surrounding the glottis. The study of Ambu AuraFlex laryngeal mask by Liu et al [2] showed that when the intracapsular pressure reached 30 cm H 2 O, the OLP could reach 19 to 20 cm H 2 O, which could meet the ventilation needs of pediatric ophthalmic surgery anesthesia.…”