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Ahn E, Choi G, Kang H, Baek C, Jung Y, Woo Y, Bang S. Supraglottic airway devices as a strategy for unassisted tracheal intubation: A network meta-analysis. PLoS One 2018; 13:e0206804. [PMID: 30395614 PMCID: PMC6218066 DOI: 10.1371/journal.pone.0206804] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 10/19/2018] [Indexed: 12/03/2022] Open
Abstract
We aimed to compare the effectiveness of supraglottic airway devices as a strategy for unassisted tracheal intubation. Accordingly, we searched the OVID-MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, KoreaMed, and Google Scholar databases to identify all relevant randomized controlled trials (RCTs) on supraglottic airway devices as a strategy for tracheal intubation published until May 2017. The primary outcome was the overall success rate of intubation by the intention to treat (ITT) strategy. The secondary outcomes of the study were the overall success rate of tracheal intubation by the per protocol (PP) strategy and the success rate of tracheal intubation at first attempt by ITT and PP. We conducted a network meta-analysis with a mixed-treatment comparison method to combine direct and indirect comparisons among supraglottic airway devices. Of 1396 identified references, 16 RCTs (2014 patients) evaluated unassisted intubation with supraglottic airway devices. Patients were grouped according to the type of device used: LMA-CTrach, LMA-Fastrach, Air-Q, i-gel, CobraPLA, Ambu-Aura, or single-use LMA devices. Based on the surface under the cumulative ranking curve, the three best supraglottic airway devices for use as a strategy for unassisted tracheal intubation were LMA-CTrach (which included video-assisted tracheal tube guidance), single-use LMA-Fastrach, and LMA-Fastrach. LMA-Fastrach showed a higher success rate of intubation than did i-gel, CobraPLA, Air-Q, and Ambu-Aura. However, this study was limited by the small number of eligible RCTs. Therefore, well-designed RCTs performed on large patient populations are required to increase the confidence of the results.
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Affiliation(s)
- EunJin Ahn
- Department of Anaesthesiology and Pain Medicine, InJe University Seoul Paik Hospital, Seoul, Korea
| | - GeunJoo Choi
- Department of Anaesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyun Kang
- Department of Anaesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Korea
- * E-mail:
| | - ChongWha Baek
- Department of Anaesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - YongHun Jung
- Department of Anaesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - YoungCheol Woo
- Department of Anaesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - SiRa Bang
- Department of Anaesthesiology and Pain Medicine, InJe University Seoul Paik Hospital, Seoul, Korea
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Xu R, Zhu Y, Fan Q, Shen X, Li WX. Comparison Between the Cobra Perilaryngeal Airway and Laryngeal Mask Airways Under General Anesthesia: A Systematic Review and Meta-analysis. Anesth Analg 2017; 125:958-966. [PMID: 28753166 DOI: 10.1213/ane.0000000000002316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The complication rate and efficacy of the Cobra Perilaryngeal Airway (CobraPLA) and laryngeal mask airways (LMAs®) have been evaluated in the published literature, but the conclusions have been inconsistent. The aim of this systematic review and meta-analysis was thus to assess the performance of the CobraPLA and LMAs under general anesthesia. We searched PubMed, Embase, and the Cochrane Library for randomized controlled trials comparing the CobraPLA with LMAs under general anesthesia. The LMAs used for comparison were the classic LMA (CLMA) and the unique LMA (ULMA). The random effect model was used if heterogeneity was observed, otherwise the fixed effect model was used. Seventeen randomized controlled trials were included; number of studies analyzed for each result are different and were up to 10. The current result suggests that no significant difference between the devices in the insertion success rate at the first attempt. The success rate of first insertion of the CobraPLA was not different from the rates for the CLMA and the ULMA (relative risk: 0.95, 95% confidence interval [CI], 0.91-1.00). CobraPLA insertion was not different from CLMA and ULMA insertion. The CobraPLA provided an oropharyngeal leak pressure higher than that provided by the CLMA (weight mean difference: 3.90, 95% CI, [1.59-6.21] cmH2O) and ULMA (weight mean difference: 6.57, 95% CI, [4.30-8.84] cmH2O). We also found a higher likelihood of blood staining in the airway with the CobraPLA than with the CLMA. In our research, the principal finding of our meta-analysis is that the success rate of first insertion of the CobraPLA was not different from the rate for each of the CLMA and the ULMA, which featured a short learning curve implying its ease of insertion. There was also no significant difference in the incidence of the best view (with a score of 4) obtained with the CobraPLA compared with the other 2 devices. The CobraPLA does seem to be superior to the CLMA and ULMA in providing a higher oropharyngeal leak pressure. The data were insufficient to establish differences in airway adverse events between the groups except for blood staining in the devices, although mucosal trauma occurred more frequently with the Cobra PLA device than with the CLMA and the ULMA.
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Affiliation(s)
- Rui Xu
- From the *Department of Anesthesiology, the Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai Medical College of Fudan University, Shanghai, China; and †Department of Oro-maxillofacial Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China
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Chalam KS, Gupta J. Comparison of intubating laryngeal mask airway and fiberoptic bronchoscopy for endotracheal intubation in patients undergoing cervical discectomy. J Anaesthesiol Clin Pharmacol 2016; 32:515-518. [PMID: 28096586 PMCID: PMC5187620 DOI: 10.4103/0970-9185.194765] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background and Aims: Direct laryngoscopy is hazardous in patients with cervical posterior intervertebral disc prolapse (PIVD) as it may worsen the existing cord compression. To achieve smooth intubation, many adjuncts such as fiberoptic bronchoscope (FOB), video laryngoscopes, lighted stylets, and intubating laryngeal mask airways (ILMAs) are available. However, there is a paucity of literature comparing ILMA with fiberoptic intubation in patients with PIVD. Hence, this study was designed to compare the effectiveness of ILMA technique with FOB to accomplish endotracheal intubation in patients undergoing cervical discectomy. Material and Methods: Sixty patients of age group 20–60 years, of American Society of Anesthesiologists status I or II, were enrolled in this prospective and randomized study. They were allocated to one of the two groups, ILMA group and FOB group. The patients were intubated orally using either equipment, after dexmedetomidine premedication and induction of general anesthesia. Chi-square and Fisher exact tests were used to find the significance of study parameters on a categorical scale. Paired samples t-test and Student's t-test were used to find the significance of study parameters on a continuous scale. Significance was assessed at 5% level of significance. Results: Bronchoscopy was a faster method of securing airway as compared with ILMA (38.13 ± 11.52 vs. 29.83 ± 13.75 s). Tracheal intubation was successful in all 60 patients (100%), belonging to both groups. Conclusion: ILMA and FOB were comparable with regards to ease of intubation in terms of time, the number of attempts and hemodynamic stability.
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Affiliation(s)
- Kolli S Chalam
- Department of Anaesthesiology, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bengaluru, Karnataka, India
| | - Jyothi Gupta
- Department of Anaesthesiology, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bengaluru, Karnataka, India
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Szarpak Ł, Kurowski A, Truszewski Z, Robak O, Frass M. Comparison of 4 supraglotttic devices used by paramedics during simulated CPR : a randomized controlled crossover trial. Am J Emerg Med 2015; 33:1084-8. [PMID: 25963675 DOI: 10.1016/j.ajem.2015.04.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 04/23/2015] [Accepted: 04/24/2015] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Ensuring an open airway during cardiopulmonary resuscitation is fundamental. The aim of this study was to determine the success rate of blind intubation during simulated cardiopulmonary resuscitation by untrained personnel. METHODS Four devices were compared in a simulated resuscitation scenario: ILMA (Intavent Direct Ltd, Buckinghamshire, United Kingdom), Cobra PLA (Engineered Medical Systems Inc, Indianapolis, IN), Supraglottic Airway Laryngopharyngeal Tube (SALT) (ECOLAB, St. Paul, MN), and Air-Q (Mercury Medical, Clearwater, FL). A group of 210 paramedics intubated a manikin with continuous chest compressions. RESULTS The mean times to intubation were 40.46 ± 4.64, 33.96 ± 6.23, 17.2 ± 4.63, and 49.23 ± 13.19 seconds (SALT vs ILMA, Cobra PLA, and Air-Q; P < .05). The success ratios of blind intubation for the devices were 86.7%, 85.7%, 100%, and 71.4% (SALT vs ILMA, Cobra PLA, and Air-Q; P < .05). CONCLUSION The study showed that the most efficient device with the shortest blind intubation time was the SALT device.
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Affiliation(s)
- Łukasz Szarpak
- Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland.
| | - Andrzej Kurowski
- Department of Anesthesiology, Institute of Cardiology, Warsaw, Poland
| | - Zenon Truszewski
- Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Oliver Robak
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Michael Frass
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
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Girgis KK, Youssef MMI, ElZayyat NS. Comparison of the air-Q intubating laryngeal airway and the cobra perilaryngeal airway as conduits for fiber optic-guided intubation in pediatric patients. Saudi J Anaesth 2014; 8:470-6. [PMID: 25422603 PMCID: PMC4236932 DOI: 10.4103/1658-354x.140841] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND One of the methods proposed in cases of difficult airway management in children is using a supraglottic airway device as a conduit for tracheal intubation. The aim of this study was to compare the efficacy of the Air-Q Intubating Laryngeal Airway (Air-Q) and the Cobra Perilaryngeal Airway (CobraPLA) to function as a conduit for fiber optic-guided tracheal intubation in pediatric patients. MATERIALS AND METHODS A total of 60 children with ages ranging from 1 to 6 years, undergoing elective surgery, were randomized to have their airway managed with either an Air-Q or CobraPLA. Outcomes recorded were the success rate, time and number of attempts required for fiber optic-guided intubation and the time required for device removal after intubation. We also recorded airway leak pressure (ALP), fiber optic grade of glottic view and occurrence of complications. RESULTS Both devices were successfully inserted in all patients. The intubation success rate was comparable with the Air-Q and the CobraPLA (96.7% vs. 90%), as was the first attempt success rate (90% vs. 80%). The intubation time was significantly longer with the CobraPLA (29.5 ± 10.9 s vs. 23.2 ± 9.8 s; P < 0.05), but the device removal time was comparable in the two groups. The CobraPLA showed a significantly higher ALP (20.8 ± 5.2 cmH2O vs. 16.3 ± 4.5 cmH2O; P < 0.001), but the fiber optic grade of glottic view was comparable with the two devices. The CobraPLA was associated with a significantly higher incidence of blood staining of the device on removal and post-operative sore throat. CONCLUSION Both the Air-Q and CobraPLA can be used effectively as a conduit for fiber optic-guided tracheal intubation in children. However, the Air-Q proved to be superior due to a shorter intubation time and less airway morbidity compared with the CobraPLA.
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Affiliation(s)
- Karim K Girgis
- Department of Anesthesia, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Maha M I Youssef
- Department of Anesthesia, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Nashwa S ElZayyat
- Department of Anesthesia, Faculty of Medicine, Cairo University, Giza, Egypt
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Mathew DG, Ramachandran R, Rewari V, Trikha A, Chandralekha. Endotracheal intubation with intubating laryngeal mask airway (ILMA), C-Trach, and Cobra PLA in simulated cervical spine injury patients: a comparative study. J Anesth 2014; 28:655-61. [PMID: 24554246 DOI: 10.1007/s00540-014-1794-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 01/17/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of our study was to evaluate the success rate of fiberoptic-guided endotracheal intubation through an Intubating Laryngeal Mask Airway (ILMA), a Cobra Perilaryngeal Airway (Cobra PLA), and a C-Trach Laryngeal Mask Airway (C-Trach) in patients whose necks are stabilized in a hard cervical collar. METHODS One hundred and eighty ASA I-II patients were randomized to undergo endotracheal intubation after general anesthesia via an ILMA (group ILMA), a C-Trach (group C-Trach) or a Cobra PLA (group CPLA) with the application of an appropriately-sized hard cervical collar. A fiberoptic bronchoscope was used for intubation via the ILMA and Cobra PLA. Rate of successful insertion of an endotracheal tube through the three devices was the primary aim. Other parameters compared were time taken for device insertion, endotracheal intubation, hemodynamic changes, incidence of hypoxia, and mucosal injury during the procedure. The incidence of postoperative sore throat was also compared between the three groups. RESULTS The success rates of intubation in the ILMA, C-Trach, and CPLA groups were 100, 100, and 98% respectively. The first-attempt success rate was significantly better with the C-Trach compared to Cobra PLA (100 vs. 85%, p < 0.05). The time taken for device insertion was significantly more with the Cobra PLA as compared to that taken with an ILMA or a C-Trach (35.7 vs. 30.3 and 27.5 s, respectively). Intubation through a C-Trach took the least amount of time (84.4 s) as compared to an ILMA (117.9 s) or a Cobra PLA (139.2 s). The incidence of hypoxia and airway morbidity was similar between the groups. CONCLUSION The success rates of fiberoptic-guided endotracheal intubation through an ILMA and a Cobra PLA are similar to the success rate of intubation using a C-Trach in patients whose cervical spines are immobilized with a hard cervical collar.
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Affiliation(s)
- Deepak G Mathew
- Department of Anesthesiology, All India Institute of Medical Sciences, Delhi, India
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Timmermann A. Supraglottic airways in difficult airway management: successes, failures, use and misuse. Anaesthesia 2011; 66 Suppl 2:45-56. [DOI: 10.1111/j.1365-2044.2011.06934.x] [Citation(s) in RCA: 132] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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