Comparison of streamlined liner of the pharynx airway (SLIPA ™) and laryngeal mask airway: a systematic review and meta-analysis

Comparison of the Laryngeal Mask Airway ProSeal and the Streamlined Liner of the Pharynx Airway During General Anesthesia: A Systematic Review and Meta-analysis

PURPOSE

The purpose of this article is to compare the safety of the laryngeal mask airway ProSeal (PLMA) and the streamlined liner of the pharynx airway (SLIPA) during general anesthesia.

DESIGN

This study is a systematic review and meta-analysis.

METHODS

Two authors performed searches of Embase, Web of Science, and PubMed to identify clinical trials that compared PLMA and SLIPA in patients receiving general anesthesia. Relative risk (RR) with corresponding 95% confidence intervals (CI) were used to pool the dichotomous data. The mean difference (MD) and the associated 95% CI were applied to pool continuous data. RevMan 5.0 software was used for data analysis.

FINDINGS

A total of 15 studies with 1263 patients were included. There was no significant difference between PLMA and SLIPA in the rate of insertion success on the first attempt (RR = 1.02, 95% CI [0.95, 1.09], P = .59), airway sealing pressure (MD = 0.75, 95% CI [-0.09, 1.58], P = .08) and the incidence of a sore throat (RR = 0.85, 95% CI [0.7, 1.04], P = .12). The insertion time of PLMA was shorter than SLIPA (MD = 5.24, 95% CI [0.51, 9.98], P = .03), and the incidence of bloodstaining on the device was lower (RR = 0.72, 95% CI [0.55, 0.94], P = .02).

CONCLUSIONS

Both devices have a high rate of insertion success on the first attempt and airway sealing pressure. But PLMA has a shorter insertion time and less incidence of blood staining, which is more advantageous than SLIPA.

Prewarming non-inflatable cuff laryngeal mask for mechanical ventilation: A systematic review and meta-analysis with trial sequential analysis

BACKGROUND

Non-inflatable cuff laryngeal masks are generally composed of thermoplastic material. The thermoplastic nature of the non-inflatable cuff will become soft and match the laryngeal anatomy better as it reaches body temperature after intubation. This meta-analysis aims to evaluate the clinical validity of prewarming non-inflatable cuff laryngeal mask before insertion.

METHODS

We searched PubMed, Cochrane Library, Embase, Web of Science, Ovid Medline, CNKI, Wan Fang Database and VIP Database to find randomized controlled trials (RCTs) researching the clinical validity of prewarming non-inflatable cuff laryngeal mask. The retrieval time is up to June 2022. Articles published in the English and Chinese languages were considered. Quality assessment was conducted with the Cochrane Collaboration's tool and GRADE (Grading of Recommendations Assessment, Development and Evaluation) method. Subgroup analyses and trial sequential analysis (TSA) were performed to control the risk of random errors. Publication bias was assessed by funnel plots and Egger's regression test. The outcomes included sealing pressure immediately after successful ventilation, the first-attempt intubation success rate and the incidence of postoperative pharyngeal pain.

RESULTS

Eight RCTs evaluating 683 patients were identified. Pooled results showed that compared to the control group, prewarming non-inflatable cuff laryngeal mask provided a higher sealing pressure immediately after successful ventilation (mean difference: 1.73 cm H2O; 95% confidence interval [CI]: 0.95-2.52; P < .0001; I2 = 16; high quality), higher first-attempt intubation success rate (risk ratio [RR]: 1.05; 95% CI: 1.01-1.09; P = .01; I2 = 26%; high quality, number needed to treat [NNT] = 22 [95% CI 12.5-100]) and lower incidence of postoperative pharyngeal pain (RR: 0.59, 95% CI: 0.46-0.75; P < .0001; I2 = 0; high quality, NNT = 6 [95% CI 4.17-9.09]). The results were confirmed by TSA.

CONCLUSION

Prewarming non-inflatable cuff laryngeal mask could provide better mechanical ventilation efficiency with higher sealing pressure, a higher first-attempt intubation success rate and a lower incidence of postoperative pharyngeal pain.

TRIAL REGISTRATION NUMBER

PROSPERO CRD42021245350.

Comparison of the third-generation streamlined liner of the pharynx airway (SLIPA-3G) with the laryngeal mask airway supreme for laparoscopic cholecystectomy: a randomized prospective study

Background

The third-generation streamlined liner of the pharynx airway (SLIPA-3G) is a new-generation supraglottic airway device (SAD) that is non-cuffed and disposable, with a sealing pressure that varies dynamically with the airway pressure. This study compared the SLIPA-3G with the laryngeal mask airway supreme (LMAS) in patients undergoing laparoscopic cholecystectomy.

Methods

Two hundred and twenty patients scheduled for laparoscopic cholecystectomy were randomly allocated to either the SLIPA-3G group or the LMAS group. Data were collected on the patients’ hemodynamic parameters at different time points, ease of insertion, fiberoptic view, oropharyngeal leak pressure (OLP) at different time points and SAD-related complications.

Results

The mean OLP immediately after device placement in the LMAS group was significantly higher than that of the SLIPA-3G group (31.34 ± 6.99 cmH₂O vs.28.94 ± 6.01 cmH₂O, P = 0.008, 95% CI 0.62–4.17). The OLPs of the two groups were not significantly different after the induction of a pneumoperitoneum until the end of surgery. The OLP increased gradually through the course of the operation in the SLIPA-3G group (P value = 0.035) but not in the LMAS group (P value = 0.945). There was no significant difference between the two groups in hemodynamic parameters, insertion time and success rate, fiberoptic view and complication rate.

Conclusions

The SLIPA-3G and LMAS were associated with comparable OLPs, hemodynamic parameters, ease of insertion, fiberoptic views and complication rates when used during laparoscopic cholecystectomy. The SLIPA-3G can be used as an effective alternative to the LMAS in patients undergoing laparoscopic surgeries.

Comparison of the efficacy of supraglottic airway devices in low-risk adult patients: a network meta-analysis and systematic review

Numerous supraglottic airway device (SADs) have been designed for adults; however, their relative efficacy, indicated by parameters such as adequacy of sealing, ease of application, and postinsertion complications, remains unclear. We conducted a systematic review and network meta-analysis to evaluate the efficacy of various SADs. We searched electronic databases for randomized controlled trials comparing at least two types of SADs published before December 2019. The primary outcomes were oropharyngeal leak pressure (OLP), risk of first-attempt insertion failure, and postoperative sore throat rate (POST). We included 108 studies (n = 10,645) comparing 17 types of SAD. The Proseal laryngeal mask airway (LMA), the I-gel supraglottic airway, the Supreme LMA, the Streamlined Liner of the Pharynx Airway, the SoftSeal, the Cobra Perilaryngeal Airway, the Air-Q, the Laryngeal Tube, the Laryngeal Tube Suction II, the Laryngeal Tube Suction Disposable, AuraGain, and Protector had significantly higher OLP (mean difference ranging from 3.98 to 9.18 cmH₂O) compared with that of a classic LMA (C-LMA). The Protector exhibited the highest OLP and was ranked first. All SADs had a similar likelihood of first-attempt insertion failure and POST compared with the C-LMA. Our findings indicate that the Protector may be the best SAD because it has the highest OLP.Systematic review registration PROSPERO: CRD42017065273.

Evaluation of performance of Streamlined Liner of the Pharynx Airway™, Laryngeal Mask Airway-ProSeal and endotracheal tube in prone position: A prospective, randomised study

Background and Aims:

Airway used in prone position should be efficacious and safe. The Streamlined Liner of the Pharynx Airway (SLIPA™) and Laryngeal Mask Airway-ProSeal (PLMA) provide better airway seal and protection against aspiration. We planned to evaluate the performance of SLIPA™, PLMA and endotracheal tube (ETT) in prone position.

Methods:

114 adult patients undergoing elective surgery in prone position under general anaesthesia were randomised into Group-T (ETT), Group-S (SLIPA™) and Group-P (PLMA). Airways were inserted in supine position and patients turned prone subsequently. Airway characteristics, ventilatory parameters and complications were noted. One-way analysis of variance, Mann–Whitney U-test and Chi-square or Fisher's exact test were used.

Results:

Tidal volumes, peak airway pressure and compliance were comparable at all times. Leak pressure was significantly higher (P < 0.001) in Group-T (mean leak pressure = 40 cmH₂O) when compared to Group-S and Group-P at all the times of recording, and there was no significant difference between Group-S and Group-P. The number of patients requiring airway/neck manipulation in prone position was significantly higher (P < 0.001) in Group-S (19 [55.9%]) when the three groups were compared (none in Group-T) and in comparison with Group-P (5 [14.7%], P < 0.001). On airway removal, the incidence of complications and airway reaction was significantly higher in Group-T. Group-S had a significantly higher incidence of dysphagia at 2 h postoperatively.

Conclusion:

ETT was most efficacious. SLIPA™ and PLMA were efficacious, safe and less stimulating to the airway during removal. More patients required SLIPA™ airway/neck manipulation.

Insertion methods comparison for The Streamlined Liner of the Pharynx Airway in children by novice

BACKGROUND

The Streamlined Liner of the Pharynx Airway (SLIPA™) is a popular supraglottic airway device used for pediatric anesthesia. However, based on the anatomical features of pediatric patients, novice residents are expected to have difficulties inserting the device. The objective of this work was to improve the SLIPA insertion by modifying the device.

METHODS

A total of 134 children were randomized into two groups. Anesthesia was standardized among all patients except for the way in which the SLIPA was inserted. One group underwent the conventional method of insertion (Group C), while the modified group received a SLIPA that was bent120° at the 'bridge' point with an intubating stylet (Group M). The primary outcome was insertion success rate, and the secondary outcomes included insertion time, incidence of complications and hemodynamic responses to insertion.

RESULTS

The insertion success rate was significantly higher in Group M than Group C (94% vs. 73%, Χ² = 10.659, P = 0.001). The insertion time for Group M [29.31 (25.91-35.60) seconds] was shorter than for Group C [34.72 (26.81-42.58) seconds] (Z = -2.381, P = 0.017). Trends in heart rate (F = 0.260, P = 0.794), mean blood pressure (F = 0.167, P = 0.683) did not significantly differ between the two groups over time. In terms of complications, we found no significant differences between groups (P > 0.05).

CONCLUSION

The 120° bend improved SLIPA insertion when performed by novice, as reflected by higher insertion success rates and shorter insertion times, with no statistical differences in hemodynamic response to insertion or the incidence rates of complications between the two groups.

Scandinavian SSAI clinical practice guideline on pre-hospital airway management

Background

The Scandinavian society of anaesthesiology and intensive care medicine task force on pre‐hospital airway management was asked to formulate recommendations following standards for trustworthy clinical practice guidelines.

Methods

The literature was systematically reviewed and the grading of recommendations assessment, development and evaluation (GRADE) system was applied to move from evidence to recommendations.

Results

We recommend that all emergency medical service (EMS) providers consider to: apply basic airway manoeuvres and airway adjuncts (good practice recommendation); turn unconscious non‐trauma patients into the recovery position when advanced airway management is unavailable (good practice recommendation); turn unconscious trauma patients to the lateral trauma position while maintaining spinal alignment when advanced airway management is unavailable [strong recommendation, low quality of evidence (QoE)]. We suggest that intermediately trained providers use a supraglottic airway device (SAD) or basic airway manoeuvres on patients in cardiac arrest (weak recommendation, low QoE). We recommend that advanced trained providers consider using an SAD in selected indications or as a rescue device after failed endotracheal intubation (ETI) (good practice recommendation). We recommend that ETI should only be performed by advanced trained providers (strong recommendation, low QoE). We suggest that videolaryngoscopy is considered for ETI when direct laryngoscopy fails or is expected to be difficult (weak recommendation, low QoE). We suggest that advanced trained providers apply cricothyroidotomy in ‘cannot intubate, cannot ventilate’ situations (weak recommendation, low QoE).

Conclusion

This guideline for pre‐hospital airway management includes a combination of techniques applied in a stepwise fashion appropriate to patient clinical status and provider training.

Pre-warming the Streamlined Liner of the Pharynx Airway (SLIPA) improves fitting to the laryngeal structure: a randomized, double-blind study

Background

The Streamlined Liner of the Pharynx Airway (SLIPA), a type of supraglottic airway, has a non-inflatable cuff that softens at body temperature to fit the laryngeal structure. We investigated whether pre-warming of SLIPA to body temperature may improve insertion parameters.

Methods

Ninety adult patients were assigned equally randomized to either Group W or Group R. Anesthesia was induced using propofol, fentanyl, and rocuronium. In Group W, the SLIPA was warmed to 37 ° C before insertion, whereas in Group R, it was inserted at room temperature. The insertion time, oropharyngeal leak pressure, postoperative throat pain, blood staining, regurgitation, number of attempts at insertion, and difficulty of insertion were compared between the two groups.

Results

The insertion time was shorter in Group W than in Group R (3.60 [3.15–4.06] s vs. 6.00 [4.45–7.50] s; P < 0.001). Oropharyngeal leak pressure from the time of insertion until 3 min after insertion was significantly higher in Group W than in Group R (P < 0.05). Postoperative throat pain, measured using the visual analog scale, was lower in Group W than in Group R (0.00 [0.00–2.50] vs. 2.00 [0.00–4.50]; P = 0.006). The difficulty of insertion was lower in Group W than in Group R (P < 0.004). There were no significant differences in terms of blood staining, regurgitation, and number of attempts.

Conclusions

Pre-warming the SLIPA to body temperature has significant benefits compared to maintaining the device at room temperature. Specifically, insertion was easier, both insertion and fitting to the laryngeal structure could be performed more quickly, and the incidence of sore throat was reduced.

Trial registration

Clinical Research Information Identifier NCT01209000