Comparison of Clinical Performance of I-gel and Fastrach Laryngeal Mask Airway as an Intubating Device in Adults: A Systematic Review and Meta-Analysis.

Autor:	Machado Assis ML; From the Department of Anesthesia, Mayo Clinic, Jacksonville, Florida., Batistella Zasso F; Department of Anesthesiology and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada., Pedrotti Chavez M; Department of Medicine, Federal University of Santa Catarina, Florianópolis, Brazil., Cirne Toledo E; Department of Anesthesia and Intensive Care, Tufts Medical Center, Boston, Massachusetts., Motta G; Department of Medicine, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil., Duarte Moraes L; Department of Anesthesia, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, Brazil., Pasqualotto E; Department of Medicine, Federal University of Santa Catarina, Florianópolis, Brazil., Oliva Morgado Ferreira R; Department of Medicine, Federal University of Santa Catarina, Florianópolis, Brazil., Siddiqui N; Department of Anesthesiology and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada., You-Ten KE; Department of Anesthesiology and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
Jazyk:	angličtina
Zdroj:	Anesthesia and analgesia [Anesth Analg] 2024 Sep 11. Date of Electronic Publication: 2024 Sep 11.
DOI:	10.1213/ANE.0000000000007000
Abstrakt:	Background: The supraglottic airway device (SGD) was introduced as a breakthrough in airway management. The Fastrach emerged as the first commercially available intubating SGD, drawing extensive investigation. I-gel is a more recent device that has gained popularity, can be used as an intubating SGD, and replaced Fastrach in many institutions. However, there is uncertainty regarding the comparison between these devices in terms of efficacy for intubation and ventilation, and safety in an airway rescue situation. Methods: PubMed, EMBASE, Scopus, and Cochrane databases were searched for randomized controlled trials (RCTs) comparing I-gel and Fastrach SGD in adult patients undergoing intubation. The primary outcome was the first-pass success rate for tracheal intubation. Secondary outcomes were tracheal intubation time, SGD insertion time and success, and complications. We computed risk ratios (RRs) to assess binary end points and weighted mean differences (WMDs) for continuous outcomes, with corresponding 95% confidence intervals (CIs) for the primary outcome and its subgroup analysis (P < .05 was considered statistically significant) and 99% CI after Bonferroni correction for the secondary outcomes (P < .01 was considered statistically significant). Results: This study included a total of 14 RCTs encompassing 1340 patients. The results indicated a significant difference in the first-pass success rate favoring Fastrach (RR, 0.81; 95% CI, 0.67-0.98; P = .03; I² = 91%). In the subgroup analysis, when a flexible scope was utilized through I-gel, providers achieved a better tracheal intubation first-pass success rate (RR, 1.05; 95% CI, 1.01-1.11; P = .03; I² = 0%), compared with the Fastrach. Overall intubation success rates (RR, 0.92; 99% CI, 0.82-1.04; P = .08, I² = 92%) and time (WMD - 1.03 seconds; 99% CI, -4.75 to 2.69; P = .48; I² = 84%) showed no significant difference irrespective of the device used. There was no significant difference regarding device insertion time by the providers (WMD -6.48 seconds; 99% CI, -13.23 to 0.27; P = .01; I2 = 98%). Success rates of the providers' initial SGD insertion and complications such as sore throat (RR, 1.01; 99% CI, 0.65-1.57; P = .95, I² = 33%) and blood presence post-SGD removal (RR, 0.89; 99% CI, 0.42-1.86; P = .68, I² = 0%) showed no significant difference. Conclusions: Based on our findings, a higher first-pass success rate was observed with the use of Fastrach when compared to I-gel. However, the use of I-gel might result in a better intubation success rate with the flexible scope-guided intubation. There are no significant differences in performance in terms of the success rate for intubation overall, time for device insertion, or time to intubation or complications regardless of the device used. Competing Interests: The authors declare no conflicts of interest. (Copyright © 2024 International Anesthesia Research Society.)
Databáze:	MEDLINE
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