Meta-Analysis
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 6, 2022; 10(4): 1242-1254
Published online Feb 6, 2022. doi: 10.12998/wjcc.v10.i4.1242
Comparison of the clinical performance of i-gel and Ambu laryngeal masks in anaesthetised paediatric patients: A meta-analysis
Di Bao, Yun Yu, Wei Xiong, Ya-Xin Wang, Yi Liang, Lu Li, Bin Liu, Xu Jin
Di Bao, Yun Yu, Wei Xiong, Ya-Xin Wang, Yi Liang, Lu Li, Bin Liu, Xu Jin, Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
Author contributions: Wang YX, Liang Y, and Li L participated in the extraction and collection of the data; Xiong W participated in the quality assessment; Bao D contributed to the design and draft the manuscript; Liu B helped to draft the manuscript; Yu Y, Jin X contributed to perform statistical analyses and manuscript revision; all authors read and approved the final manuscript.
Supported by the Beijing Municipal Hospital Scientific Research Training Program, No. PX2017011.
Conflict-of-interest statement: The authors declare that they have no competing interests.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xu Jin, PhD, Doctor, Professor, Teacher, Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 119 Nansihuan West Road, Fengtai District, Beijing 100070, China. jxsys2020@gmail.com
Received: September 26, 2021
Peer-review started: September 26, 2021
First decision: October 18, 2021
Revised: October 26, 2021
Accepted: December 25, 2021
Article in press: December 25, 2021
Published online: February 6, 2022
Processing time: 119 Days and 19.3 Hours
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 cmH2O for Ambu vs 23.98 cmH2O for i-gel, P = 0.003, 95% confidence interval (CI): -3.58 to -0.75, I2 = 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, I2 = 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.

Keywords: I-gel; Ambu laryngeal masks; Pediatric; Clinical performance

Core Tip: The inflatable Ambu laryngeal masks and non-inflatable i-gel are two improvements of supraglottic airway devices based on classic laryngeal masks. The clinical performance and safety of these two devices in paediatric patients are still unclear and warrant further investigation. We performed a systematic review and meta-analysis on the clinical performance and safety of Ambu laryngeal masks and i-gel in anaesthetised paediatric patients. The results of this study showed that the i-gel airway may provide a better seal with a lower risk of adverse events and is therefore probably more suitable than the Ambu laryngeal mask airway in anaesthetised paediatric patients.