Comparison of the clinical performance of i-gel and Ambu laryngeal masks in anaesthetised paediatric patients: A meta-analysis

Abstract

Background: Paediatric supraglottic airway devices (SGAs) are widely used in routine anaesthesia and serve as primary or back-up devices for difficult airway management. The inflatable Ambu laryngeal masks and non-inflatable i-gel are two improvements of SGAs based on classic laryngeal masks. The clinical performance and safety of these two devices in paediatric patients are still unclear and warrant further investigation.

Aim: To perform a systematic review and meta-analysis on the clinical performance and safety of Ambu laryngeal masks and i-gel in anaesthetised paediatric patients.

Methods: MEDLINE, Embase, Web of Science and Cochrane Central Register of Controlled Trials were searched from inception dates to April 2020. We identified published randomised controlled trials (RCTs) in which the intervention involved the use of Ambu laryngeal masks and i-gel in anaesthetised paediatric patients (age < 18 years). We assessed the oropharyngeal leak pressure (OLP) as the primary outcome. The secondary outcomes were insertion time, success rate of insertion on the first attempt, and incidence of adverse events.

Results: After searching for all relevant trials published up to April 2020, data from seven RCTs with a total of 667 paediatric patients (323 and 344 participants in the i-gel and Ambu groups, respectively) were evaluated. The mean OLP in anaesthetised paediatric patients was lower in the Ambu group [21.82 cmH₂O for Ambu vs 23.98 cmH₂O for i-gel, P = 0.003, 95% confidence interval (CI): -3.58 to -0.75, I ² = 68%, Mantel-Haenszel random model]. We did not find any clear evidence of differences between the devices in terms of insertion time, success rate of insertion, and incidence of adverse events except for blood staining (risk ratio 5.86, 95%CI: 1.76 to 19.46, P = 0.004, I ² = 0, fixed-effect model).

Conclusion: The i-gel airway may provide a better seal and is therefore probably more suitable than the Ambu laryngeal mask airway in anaesthetised paediatric patients. However, the evidence is insufficient to allow making firm conclusions or to guide clinical practice, owing to the small number of relevant published studies.

Keywords: Ambu laryngeal masks; Clinical performance; I-gel; Pediatric.

Figure 1

PRISMA flowchart.

Figure 2

Risk of bias assessments within the included studies.

Figure 3

Forest plot of oropharyngeal leak pressure: Ambu vs i-gel. The mean leak pressure was higher in the i-gel group than in the Ambu group, with substantial heterogeneity (21.82 cmH₂O for Ambu vs 23.98 cmH₂O for i-gel, P = 0.003, 95% confidence interval: -3.58 to -0.75, I² = 68%, Mantel-Haenszel random model). CI: Confidence interval.

Figure 4

Forest plot of subgroup analysis of oropharyngeal leak pressure according to the mean age of the study population: Ambu vs i-gel. The combined oropharyngeal leak pressure from studies with participants whose mean age was < 3 years was significantly higher for i-gel (mean difference -3.53 cmH₂O, 95% confidence interval: -4.58 to -2.49, P < 0.00001, I² = 0%) while pooled analysis from the other four studies showed no significance between the two devices. CI: Confidence interval.

Figure 5

Forest plot of the sensitivity analysis of oropharyngeal leak pressure. The results were relatively stable, except when Aqil et al[18]’s study was excluded, which resulted in a lower heterogeneity (from 68% to 44%). CI: Confidence interval.

Figure 6

Forest plot of Ambu versus i-gel. A: Insertion time; B: The success of insertion on the first attempt; C: The incidence of blood staining on the removed device; D: The incidence of desaturation; E: The incidence of bronchospasm; F: The incidence of coughing. CI: Confidence interval.