Comparison of LMA Supreme™ with i-gel™ and LMA ProSeal™ in children for airway management during general anaesthesia: A meta-analysis of randomized controlled trials

Abstract

Study objective: A few randomized trials have compared LMA Supreme™ with LMA ProSeal™ and i-gel™ in children but their conclusions varied widely. This systematic review and meta analysis has compared the former device with the latter two devices.

Design: Meta-analysis and systematic review using the Mantel-Haenszel method and pooled mean difference using inverse variance method.

Setting: Meta-analysis of published prospective randomized controlled trials.

Patients: Paediatric patients undergoing surgery under general anaesthesia.

Intervention: LMA Supreme™ with LMA ProSeal™ or i-gel™ as airway management device.

Results: Electronic database searching revealed four randomized trials where LMA Supreme™ has been compared with LMA ProSeal™ and three trials where a comparison was made between LMA Supreme™ and i-gel™ in paediatric population. LMA Supreme™ provided similar oropharyngeal leak pressure when compared to LMA ProSeal™ [mean difference (95% CI) 1.57 (-1.33, 4.47)cm H₂O; p=0.29] and i-gel™ [mean difference (95% CI) 1.18 (-2.11, 4.47)cm H₂O; p=0.48]. First insertion success rate is also similar when LMA Supreme™ is compared to LMA ProSeal™ [RR (95% CI) 1.03 (0.97, 1.1); p=0.74] and i-gel™ [RR (95% CI) 0.99 (0.95, 1.03); p=0.51]. Device insertion is significantly faster with LMA Supreme™ than i-gel™ [mean difference (95% CI) 1.87 (0.93, 2.81) s; p<0.0001].

Conclusion: We suggest that LMA Supreme™ may be an alternative to LMA ProSeal™ and i-gel™ in children for airway management during general anaesthesia.

Keywords: Airway; Children; LMA; LMA Supreme; Paediatric; ProSeal; Supraglottic; i-gel.