Abstract
A meta-analysis was performed on randomised prospective trials comparing the laryngeal mask airway (LMA) with other forms of airway management to determine if the LMA offered any advantages over the tracheal tube (TT) or facemask (FM). Of the 858 LMA publications identified to December 1994, 52 met the criteria for the analysis. Thirty-two different issues were tested using Fisher’s method for combining the P values. The LMA has 13 advantages over the TT and four over the FM. The LMA had two disadvantages over the TT and one over the FM. There were 12 issues where neither device had an advantage. Advantages over the TT included: increased speed and ease of placement by inexperienced personnel; increased speed of placement by anaesthetists; improved haemodynamic stability at induction and during emergence; minimal increase in intraocular pressure following insertion; reduced anaesthetic requirements for airway tolerance; lower frequency of coughing during emergence; improved oxygen saturation during emergence; and lower incidence of sore throat in adults. Advantages over the FM included: easier placement by inexperienced personnel; improved oxygen saturation; less hand fatigue; and improved operating conditions during minor paediatric otological surgery. Disadvantages over the TT were lower seal pressures and a higher frequency of gastric insufflation. The only disadvantage compared with the FM was that oesophageal reflux was more likely. The importance of these findings in terms of patient outcome could not be determined from the published data.
Résumé
Une méta-analyse d’études randomisés et prospectives comparant le masque laryné (ML) avec les autres modes de gestion des voies aériennes a été réalisée dans le but de déterminer si le ML présentait des avantages sur le tube trachéal (TT) et le masque facial (MF). Des 858 publications portant sur le ML compilées jusqu’en décembre 1994, 52 ont rencontré les critères de l’analyse. Trente-deux parutions différentes ont été analysées avec la méthode de Fisher pour la combinaison des valeurs de P. Le ML possédait 13 avantages sur le TT et quatre sur le MF. Le ML possédait deux désavantages sur le TT et un sur le MF. Dans douze parutions, aucun des dispositifs n’offrait un seul avantage sur les autres dispositifs. Les avantages du ML sur le TT comprenaient: l’augmentation de la vitesse et de la facilité d’insertion par du personnel inexpérimenté; l’augmentation de la vitesse d’insertion par l’anesthésiste; l’amélioration de la stabilité hémodynamique à l’induction et au réveil; l’amélioration de la saturation en oxygéne à la phase de réveil; et une plus faible incidence de maux de gorge. Les avantages sur le MF étaient: la facilité de mise en place par le personnel inexpérimenté; l’amélioration de la saturation en oxygène; une fatigue moindre pour la main; l’amélioration de conditions chirurgicales pendant la chirurgie pédiatrique mineure. Les désavantages sur le TT étaient la baisse de la pression d’étanchéité et une augmentation de la fréquence de l’insufflation gastrique. Le seul désavantage sur le MF était une plus grande susceptibilité au reflux oesophagien. L’importance de ces constatations sur le devenir du patient n’a pu être déterminée à partir des données publiées.
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Brimacombe, J. The advantages of the LMA over the tracheal tube or facemask: a meta-analysis. Can J Anaesth 42, 1017–1023 (1995). https://doi.org/10.1007/BF03011075
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DOI: https://doi.org/10.1007/BF03011075