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Published on: January 17, 2011
Supraglottic airway devices vs tracheal intubation in children: a quantitative meta-analysis of respiratory
Virginie Luce1, Hakim Harkouk, Christopher Brasher
1Department of Anesthesia, Intensive Care, RobertDebré University Hospital, Paris, France; University Paris Diderot, Paris VII. Paris Sorbonne Cité, Paris, France.
Insights
Laryngeal mask airway use in pediatric anesthesia significantly reduces respiratory complications like desaturation and laryngospasm compared to tracheal intubation. This meta-analysis highlights its value for safer pediatric airway management.
Area of Science:
- Anesthesiology
- Pediatric Medicine
- Respiratory Care
Background:
- The comparative safety of laryngeal mask airway versus tracheal intubation for pediatric anesthesia regarding respiratory complications is not well-established.
- Understanding these risks is crucial for optimizing airway management in children.
Purpose of the Study:
- To conduct a meta-analysis comparing perioperative respiratory complications between laryngeal mask airway and tracheal intubation in pediatric anesthesia.
- To provide evidence-based guidance for airway device selection in pediatric patients.
Main Methods:
- A systematic meta-analysis of controlled studies comparing laryngeal mask airway and tracheal intubation.
- Exclusion of studies involving patients with pre-existing airway infections.
- Pooled analysis of data to calculate odds ratios and mean differences with 95% confidence intervals.
Main Results:
- The meta-analysis included 19 studies, with varying muscle relaxation and ventilation control.
- Lower incidence of desaturation, laryngospasm, cough, and breath-holding observed with laryngeal mask airway use.
- No significant differences in postoperative sore throat, bronchospasm, aspiration, or blood staining on the device between the two airway methods.
Conclusions:
- Laryngeal mask airway use in pediatric anesthesia is associated with a reduced incidence of several common postanesthetic respiratory complications.
- The laryngeal mask airway is a valuable and potentially safer device for managing the pediatric airway.
Background:
Rate of perioperative respiratory complications between tracheal intubation (TI) and laryngeal mask airway remains unclear during pediatric anesthesia.
Objectives:
The aim of the present meta-analysis was to compare the perioperative respiratory complications between laryngeal mask airway and TI.
Methods:
A meta-analysis of available controlled studies comparing laryngeal mask airway to TI was conducted. Studies including patients with airway infection were excluded. Data from each trial were combined to calculate the pooled odds ratios (OR) or mean difference (MD) and 95% confidence intervals.
Results:
The meta-analysis was performed on 19 studies. In 12 studies, patients were given muscle relaxation, and in 16 studies, ventilation was controlled. During recovery from anesthesia, the incidence of desaturation (OR = 0.34 [0.19-0.62]), laryngospasm (OR = 0.34 [0.2-0.6]), cough (OR = 0.18 [0.11-0.27]), and breath holding (0.19 [0.05-0.68]) was lower when laryngeal mask airway was used to secure the airway. Postoperative incidences of sore throat (OR = 0.87 [0.53-1.44]), bronchospasm (OR = 0.56 [0.25-1.25]), aspiration (1.33 [0.46-3.91]) and blood staining on the device (OR = 0.62 [0.21-1.82]) did not differ between laryngeal mask airway and TI. Results were homogenous across the studies, with the exceptions of blood staining on the device.
Conclusions:
This meta-analysis found that the use of laryngeal mask airway in pediatric anesthesia results in a decrease in a number of common postanesthetic complications. It is therefore a valuable device for the management of the pediatric airway.
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