ReviewComparison of laryngeal mask airway vs tracheal intubation: a systematic review on airway complications☆
Introduction
The laryngeal mask airway (LMA) was introduced in 1988 in the United States [1], [2]. The LMA gained wide acceptance as an alternative to traditional tracheal tube (TT) intubation due to ease of insertion and a possible lower risk of trauma to the trachea [3], [4]. However, for surgical procedures requiring muscle relaxation, mechanical positive-pressure ventilation is required to secure airway ventilation. To achieve PPV with an LMA, a higher cuff pressure can be used but this does not provide an airtight seal and creates a risk of regurgitation and pulmonary aspiration [5], [6]. Obesity, laparoscopic surgery, and gastroesophageal reflux may be relative contraindication for the use of LMA. Second-generation supraglottic airway devices have been introduced enabling a higher positive pressure, reducing the risk of aspiration, and lowering the risk on respiratory complications. Continuously, the advantages and disadvantages of LMA and the TT concerning the incidence of airway complications are debated in literature [7], [8]. So far, there is no consensus on the advantage of a single device concerning complications on the direct surrounding tissues related to the type of ventilation technique such as cough, sore throat, laryngospasm, dysphagia, dysphonia, or blood on device. A meta-analysis concluded that the LMA is related to a lower risk on several postoperative airway complications when compared with the TT but the selection and handling of the device were not taken in account [7]. Significant risk factors for postoperative airway complications related to the use of LMA or TT, such as proper device size to patient size and the cuff volume, are of influence when interpreting study findings. With this systematic review, we aim to investigate the risk on airway complications in adult patients after general anesthesia comparing LMA and TT taken risk factors as device size and cuff pressure into account.
Section snippets
Materials and methods
We performed a systematic search in PubMed, Embase, and the Cochrane Library (the Cochrane Collaboration's Register of Clinical Trials) in August 2015; this was updated in September 2016. Relevant synonyms included “laryngeal mask,” “laryngeal mask airway,” “LMA,” “endotracheal,” “intubation,” and “intratracheal” (see details on search strategy in Appendix 1). In addition, PubMed and Web of Science were searched for related articles, and references of the selected articles were handsearched for
Results
The initial search yielded 2797 titles, of which 1718 unique studies were screened. We manually searched all these articles for eligibility whereas 109 were selected for full text screening. Cross-reference checking revealed no additional relevant articles. A total of 19 articles compared LMA or an LMA subtype with TT. The individual study characteristics are shown in Table 1. Results after the risk of bias assessment are shown in Table 2. In all 19 studies [12], [13], [14], [15], [16], [17],
Explanation of results
The principal aim of this systematic review was to compare the incidence of airway complications after LMA ventilation, including several subtypes, compared with TT ventilation after general anesthesia. After we selected studies which used a clear method for selecting the size of the device and cuff inflation into account, 8 [12], [13], [18], [20], [22], [24], [27], [28] studies could be selected. Compared with TT, we found comparable incidence rates for sore throat after use of the LMA Classic
Authors Contribution
BFE, writing, data collection, data analysis, interpretation, drafting and revision, approval of final version; IS, data collection, data analysis, interpretation, drafting and revision, approval of final version; ALS, design, drafting and revision, approval final version, supervision.
Acknowledgments
The authors thank B Kramer, PhD and P Wiersma medical sciences specialists at Utrecht University Library for their help to develop the search strategy.
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Competing interest: No external funding and no competing interests declared.
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University Medical Center Utrecht, Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberglaan 100, 3508 AB Utrecht, The Netherlands. Tel.: +31 88 75 55 8375.