Comparison of laryngeal mask airway Supreme and laryngeal mask airway Pro-Seal for controlled ventilation during general anaesthesia in adult patients: systematic review with meta-analysis.

BACKGROUND: Laryngeal mask airway (LMA) Supreme is a newly introduced single-use supraglottic device, which shares common features of both the LMA Pro-Seal and the intubating LMA (ILMA). Clinical studies have compared the safety and efficacy of the LMA Supreme over the 'gold standard' LMA Pro-Seal in different patient populations. However, the clinical relevance of the potential advantage which one device may offer over the other remains unclear.

OBJECTIVE: To quantify the potential advantage that the LMA Supreme may offer over the LMA Pro-Seal on oropharyngeal leak pressures in adult patients.

DESIGN: A systematic review and meta-analysis of randomised controlled trials.

DATA SOURCE: Three authors independently searched PubMed, PubMed Central, Scopus, Central Register of Clinical Trials of the Cochrane Collaboration, Google Scholar and Directory of open access journals.

ELIGIBILITY CRITERIA: Randomised trials comparing the LMA Supreme and the LMA Pro-Seal in adults in supine position, reporting on safety outcomes and published in English.

RESULTS: Seven randomised controlled trials met the eligibility criteria and were included in the meta-analysis. Pooled data from 666 patients showed that the LMA Supreme provided lower oropharyngeal leak pressures than the LMA Pro-Seal [mean difference -2.48 cmH2O, 95% confidence interval (CI) -4.45 to -0.52]. First insertion success rate was higher for the LMA Supreme than for the LMA Pro-Seal when a muscle relaxant was not used [relative risk 1.17, 95% CI 1.03 to 1.35; number needed to treat (NNT) 6, 95% CI 4 to 12]. Time taken to insert the LMA was similar for the two devices. Complications associated with the use of either of the devices are infrequent and similar.

CONCLUSION: Although the single-use LMA Supreme provides lower oropharyngeal leak pressures in comparison with the LMA Pro-Seal for controlled ventilation in supine adult patients, the clinical relevance of this small difference may be debatable and should be weighed against the potential risks of transmission of communicable diseases with the LMA Pro-Seal.