A comparison of the performance of the I-gel™ vs. the LMA-S™during anesthesia: a meta-analysis of randomized controlled trials

Xiaoguang Chen, Jinghua Jiao, Xuefeng Cong, Lei Liu, Xiaomei Wu, Xiaoguang Chen, Jinghua Jiao, Xuefeng Cong, Lei Liu, Xiaomei Wu

Abstract

Background and objective: Conflicting results were found between the I-gel™ and the LMA-Supreme™ during anesthesia, so we conducted a meta-analysis of randomized controlled trials (RCTs) to compare the effectiveness and safety of the I-gel™ vs. the LMA-Supreme™during anesthesia.

Methods: A comprehensive search was conducted using Pubmed, EMbase, ISI Web of Knowledge, the Cochrane Library, China Journal Full-text Database, Chinese Biomedical Database, Chinese Scientific Journals Full-text Database, CMA Digital Periodicals, and Google scholar to find RCTs that compare the LMA-S™ with the i-gel™during anesthesia. Two reviewers independently selected trials, extracted data, and assessed the methodological qualities and evidence levels. Data were analyzed by RevMan 5.0 and comprehensive meta-analysis software.

Results: Ten RCTs were included. There were no significant differences in oropharyngeal leak pressures (mean difference [MD] 0.72, 95% confidence interval [CI] -1.10 2.53), device placement time (MD -1.3, 95%CI -4.07 1.44), first attempt insertion success (risk ratio [RR] 1.01, 95% CI 0.9 1.14), grade 3 and 4 fiberoptic view (RR 0.89, 95%CI 0.65 1.21), and blood on removal (RR 0.62, 95%CI 0.32 1.22) between the i-gel™ and the LMA-Supreme™, respectively. However, the LMA-Supreme™was associated with easier gastric tube insertion (RR 1.17, 95%CI 1.07 1.29), and more sore throat (RR 2.56, 95%CI 1.60 4.12) than the i-gel™ group.

Conclusions: The LMA-Supreme™ and i-gel™ were similarly successful and rapidly inserted. However, the LMA-Supreme™ was shown to be easier for gastric tube insertion and associated with more sore throat compared with the i-gel™.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Flow chart demonstrating the process…
Figure 1. Flow chart demonstrating the process for inclusion in the meta-analysis.
Figure 2. Forest plot displaying the pooled…
Figure 2. Forest plot displaying the pooled summary performance of the LMA-Supreme™ versus the i-gel™: A) oropharyngeal leak pressure, B) grade 3 and 4 fiberoptic view, C) device insertion time, D) first attempt insertion success, E) ease of gastric tube insertion.
SD = standard deviation; IV = weighted mean difference; CI = confidence interval; df = degrees of freedom; Chi2 = chi-square statistic; p = p value; I2 = I-square heterogeneity statistic; Z = Z statistic; RR = risk ratio; WMD =  weight mean difference.
Figure 3. Forest plot displaying the pooled…
Figure 3. Forest plot displaying the pooled summary of adverse effects of the LMA-Supreme™ versus the i-gel™: A) sore throat, B) blood on removal.
SD = standard deviation; IV = weighted mean difference; CI = confidence interval; df = degrees of freedom; Chi2 = chi-square statistic; p = p value; I2 = I-square heterogeneity statistic; Z = Z statistic; RR = risk ratio; WMD =  weight mean difference.
Figure 4. Funnel plot of randomized controlled…
Figure 4. Funnel plot of randomized controlled trials.

References

    1. Russo SG, Cremer S, Galli T, Eich C, Brauer A, et al. (2012) Randomized comparison of the i-gel, the LMA Supreme, and the Laryngeal Tube Suction-D using clinical and fibreoptic assessments in elective patients. BMC Anesthesiol 12: 18.
    1. Levitan RM, Kinkle WC (2005) Initial anatomic investigations of the I-gel airway: a novel supraglottic airway without inflatable cuff. Anaesthesia 60: 1022–1026.
    1. Gatward JJ, Cook TM, Seller C, Handel J, Simpson T, et al. (2008) Evaluation of the size 4 i-gel airway in one hundred non-paralysed patients. Anaesthesia 63: 1124–1130.
    1. Teoh WH, Lee KM, Suhitharan T, Yahaya Z, Teo MM, et al. (2010) Comparison of the LMA Supreme vs the i-gel in paralysed patients undergoing gynaecological laparoscopic surgery with controlled ventilation. Anaesthesia 65: 1173–1179.
    1. van Zundert A, Brimacombe J (2008) The LMA Supreme—a pilot study. Anaesthesia 63: 209–210.
    1. Timmermann A, Cremer S, Eich C, Kazmaier S, Brauer A, et al. (2009) Prospective clinical and fiberoptic evaluation of the Supreme laryngeal mask airway. Anesthesiology 110: 262–265.
    1. Cook TM, Gatward JJ, Handel J, Hardy R, Thompson C, et al. (2009) Evaluation of the LMA Supreme in 100 non-paralysed patients. Anaesthesia 64: 555–562.
    1. Chew EFF, Hashim NHM, Wang CY (2010) Randomised comparison of the LMA Supreme(trademark) with the I-Gel(trademark) in spontaneously breathing anaesthetised adult patients. Anaesth Intensive Care 38: 1018–1022.
    1. Van Zundert TC, Brimacombe JR (2012) Similar oropharyngeal leak pressures during anaesthesia with i-gel, LMA-ProSeal and LMA-Supreme Laryngeal Masks. Acta Anaesthesiol Belg 63: 35–41.
    1. Ragazzi R, Finessi L, Farinelli I, Alvisi R, Volta CA (2012) LMA Supreme vs i-gel—a comparison of insertion success in novices. Anaesthesia 67: 384–388.
    1. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 62: 1006–1012.
    1. Higgins J, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. The Cochrane Collaboration website. Available: 2012 Jan 5.
    1. Schunemann HJ, Jaeschke R, Cook DJ, Bria WF, El-Solh AA, et al. (2006) An official ATS statement: grading the quality of evidence and strength of recommendations in ATS guidelines and recommendations. Am J Respir Crit Care Med 174: 605–614.
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327: 557–560.
    1. Doi SA, Thalib L (2008) A quality-effects model for meta-analysis. Epidemiology 19: 94–100.
    1. Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315: 629–634.
    1. Theiler LG, Kleine-Brueggeney M, Kaiser D, Urwyler N, Luyet C, et al. (2009) Crossover comparison of the laryngeal mask supreme and the i-gel in simulated difficult airway scenario in anesthetized patients. Anesthesiology 111: 55–62.
    1. Eschertzhuber S, Brimacombe J, Hohlrieder M, Keller C (2009) The Laryngeal Mask Airway Supreme(TM)- a single use laryngeal mask airway with an oesophageal vent. A randomised, cross-over study with the Laryngeal Mask Airway ProSeal(TM) in paralysed, anaesthetised patients. Anaesthesia 64: 79–83.
    1. CAO J-B, WANG P, MI W-D, ZHANG H (2012) Effect of laryngeal mask i-gel on airway of patients undergoing laparoscopic surgery. J Chinese PLA Postgrad Med Sch 33: 362–366.
    1. Li Y, Liu J, Li C, Zhang W, Yu D (2011) Comparison of effectiveness of the ProSeal laryngeal mask, the Supreme laryngeal mask and the i-gel laryngeal mask with airway management for laparoscopic cholecystectomy in patients. Chin J Anesthesiol 31: 1146–1148.
    1. Yu Z, Hu Z, Zuo M, Shi Y (2011) Efficacy of laryngeal mask airway i-gel in patients undergoing laparoscopic gynecological surgery. Chin J Anesthesiol 31: 223–225.
    1. Tiesmeier J, Emmerich M (2011) Successful use of the I-gel supraglottic airway as a conduit for blind pre-hospital intubation during resuscitation. Resuscitation 82: 1358–1359.
    1. Verghese C, Ramaswamy B (2008) LMA-Supreme—a new single-use LMA with gastric access: a report on its clinical efficacy. Br J Anaesth 101: 405–410.
    1. Sharma V, Verghese C, McKenna PJ (2010) Prospective audit on the use of the LMA-Supreme for airway management of adult patients undergoing elective orthopaedic surgery in prone position. Br J Anaesth 105: 228–232.
    1. Mann V, Spitzner T, Schwandner T, Mann ST, Muller M, et al. (2012) The effect of a cervical collar on the seal pressure of the LMA Supreme: a prospective, crossover trial. Anaesthesia 67: 1260–1265.
    1. Helmy AM, Atef HM, El-Taher EM, Henidak AM (2010) Comparative study between I-gel, a new supraglottic airway device, and classical laryngeal mask airway in anesthetized spontaneously ventilated patients. Saudi J Anaesth 4: 131–136.

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