Spatial relationship of i-gel® and Ambu® AuraOnceTM on pediatric airway: a randomized comparison based on three dimensional magnetic resonance imaging

Aqil, Mansoor; Delvi, Bilal; Abujamea, Abdullah; Alzahrani, Tariq; Alzahem, Abdullah; Mansoor, Saara; Al‐Jazaeri, Ayman

doi:10.23736/s0375-9393.16.11135-6

Cited by 5 publications

(14 citation statements)

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“…On the basis of the titles, abstracts, and full texts, 18 records were removed, of which 5 were found to be comments, overview, manikin studies, and conference summary, and 1 article compared two devices in the setting of difficult intubation. Finally, seven eligible trials involving 667 paediatric patients in total (323 patients in the Ambu group and 344 patients in the i-gel group) were included in this meta-analysis[ 9 , 13 - 18 ]. A flowchart for identification is shown in Figure 1 .…”

Section: Resultsmentioning

confidence: 99%

“…None of the studies administered neuromuscular blocking agents before laryngeal mask insertion, except for one trial[ 14 ]. Among the seven included RCTs, two studies did not report any funding sources[ 9 , 22 ]; one was not funded[ 13 ]; and the other four were sponsored by King Saud University[ 17 , 18 ], Asan Medical Center[ 15 ], or Seoul National University Hospital[ 14 ]. Further descriptions of the included trials are presented in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

“…One study did not set blinding[ 15 ]. One study did not evaluate blinding[ 18 ]. The other two studies did not mention the specific method of blinding[ 14 , 22 ].…”

Section: Resultsmentioning

confidence: 99%

“…However, it was obviously not possible in any study to blind the operator involved in airway management or the assessors of leak pressure. Funding sources were not stated in three studies[ 15 , 16 , 18 ], and it was not apparent whether any commercial sponsors were involved. The other studies had no obvious commercial involvements.…”

Section: Resultsmentioning

confidence: 99%

“…Several studies have compared the efficacy and safety of i-gel and Ambu laryngeal masks in paediatric patients[ 14 - 18 ]; however, the results have been inconsistent. To our knowledge, no previous systematic review has been sufficiently comprehensive to draw a clinically meaningful conclusion about the use of the two devices in paediatric patients[ 19 ].…”

Section: Introductionmentioning

confidence: 99%

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

Bao¹,

Yu²,

Wang³

et al. 2022

WJCC

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…One study did not set blinding[ 15 ]. One study did not evaluate blinding[ 18 ]. The other two studies did not mention the specific method of blinding[ 14 , 22 ].…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Bao¹,

Yu²,

Wang³

et al. 2022

WJCC

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Magnetic resonance imaging of the larynx in the pediatric population: A systematic review

Elders

Hermelijn

Tiddens

et al. 2019

Pediatric Pulmonology

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Background Magnetic Resonance Imaging (MRI) techniques to image the larynx have evolved rapidly into a promising and safe imaging modality, without need for sedation or ionizing radiation. MRI is therefore of great interest to image pediatric laryngeal diseases. Our aim was to review MRI developments relevant for the pediatric larynx and to discuss future imaging options. Methods A systematic search was conducted to identify all morphological and diagnostic studies in which MRI was used to image the pediatric larynx, laryngeal disease, or vocal cords. Results Fourteen articles were included: three studies on anatomical imaging of the larynx, two studies on Diffusion Weighted Imaging, four studies on vocal cord imaging and five studies on the effect of anaesthesiology on the pediatric larynx. MRI has been used for pediatric laryngeal imaging since 1991. MRI provides excellent soft tissue contrast and good visualization of vascular diseases such as haemangiomas. However, visualization of cartilaginous structures, with varying ossification during childhood, and tissue differentiation remain challenging. The latter has been partly overcome with diffusion weighted imaging (DWI), differentiating between benign and malignant masses with excellent sensitivity (94‐94.4%) and specificity (91.2‐100%). Vocal cord imaging evolved from static images focused on vocal tract growth to dynamic images able to detect abnormal vocal cord movement. Conclusion MRI is promising to evaluate the pediatric larynx, but studies using MRI as diagnostic imaging modality are scarce. New static and dynamic MR imaging techniques could be implemented in the pediatric population. Further research on imaging of pediatric laryngeal diseases should be conducted.

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

et al. 2017

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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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Spatial relationship of i-gel® and Ambu® AuraOnceTM on pediatric airway: a randomized comparison based on three dimensional magnetic resonance imaging

Cited by 5 publications

References 0 publications

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

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

Magnetic resonance imaging of the larynx in the pediatric population: A systematic review

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

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