Laryngeal mask airway ProSeal provides higher oropharyngeal leak pressure than i-gel in adult patients under general anesthesia: a meta-analysis

Souvik Maitra, Dalim K Baidya, Mahesh K Arora, Sulagna Bhattacharjee, Puneet Khanna
Journal of Clinical Anesthesia 2016, 33: 298-305

STUDY OBJECTIVE: i-gel is a single-use supraglottic airway device that has a gastric drain tube similar to laryngeal mask airway (LMA) ProSeal. Randomized trials, when compared i-gel with LMA ProSeal, reported a differing results. Primary objective of this study is to compare LMA ProSeal and i-gel in terms of oropharyngeal leak pressure.

DESIGN: Meta-analysis of randomized controlled trials where i-gel has been compared to LMA ProSeal in adult airway management during general anesthesia.

SETTING: Teaching institutions.

MEASUREMENTS: PubMed, PubMed Central, and Cochrane databases were searched with search words "i-gel," "i-gel laryngeal mask airway," "i-gel ProSeal," and "i-gel LMA ProSeal" to find out the randomized controlled trials that compared i-gel with LMA ProSeal in terms of safety and efficacy. A total of 10 prospective randomized trials have been included in this meta-analysis.

MAIN RESULTS: LMA ProSeal provides higher oropharyngeal leak pressure than i-gel (mean difference, 3.37 cm H2O; 95% confidence interval, 1.80-4.95 cm H2O; P< .0001). Time to insert the device, first insertion success rate, and ease of gastric tube insertion are similar with both the devices, but i-gel may be easier to insert. Although the reported complications are not frequent and not very serious, a significantly higher blood staining on the mask has been noted with LMA ProSeal (odds ratio, 0.27; 95% confidence interval, 0.13-0.56; P= .0004).

CONCLUSION: LMA ProSeal may still remain the supraglottic device of choice over i-gel in adult patients during general anesthesia as it provided better seal against leak pressure with comparable device insertion characteristics.

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