The efficacy and safety of laryngeal mask versus endotracheal tubes for laparoscopic surgery: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

YASEN Yari , KEYOUMU Nuerbiyan , AIMAITI Abulikemu ,  WU Jianjiang

The First Affiliated Hospital of Xinjiang Medical University, Urumchi, 830000, P.R.China;

Corresponding author：

WU Jianjiang, Email: 1449845707@qq.com

Keywords：

Laryngeal mask; Endotracheal tubes; Laparoscopic surgery; Efficacy; Safety; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.201705076

Video：

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ObjectiveTo systematically review the efficacy and safety of laryngeal mask versus endotracheal tubes for laparoscopic surgery.MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and CBM databases were electronically searched to collect the randomized controlled trials (RCTs) about the efficacy and safety of laryngeal mask versus endotracheal tubes for laparoscopic surgery from inception to April, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 16 RCTs involving 1 593 patients were included. The results of meta-analysis showed that: there was no significant difference in the success rate of the first insertion (RR=0.99, 95%CI 0.96 to 1.02, P=0.55). The airway pressure of patients whose position were head higher than foot was significantly lower in the laryngeal mask group than in the tracheal intubation group (MD=–1.20, 95%CI –1.81 to –0.59, P=0.000 1), but there was no significant difference between two groups in reverse position patients (MD=0.48, 95%CI –0.90 to 1.87, P=0.49). The incidence of sore throat (RR=0.58, 95%CI 0.46 to 0.74, P<0.000 01), the incidence of blood stain (RR=0.48, 95%CI 0.30 to 0.77, P=0.002), the incidence of laryngeal spasm/bronchial spasm (OR=0.30, 95%CI 0.11 to 0.80, P=0.02) and the incidence of cough/hiccup (RR=0.10, 95%CI 0.07 to 0.15, P<0.000 01) in the laryngeal mask group were significantly lower than those in the tracheal intubation group.ConclusionThe current evidence shows that compared with tracheal intubation, laryngeal mask can effectively reduce airway pressure of patients whose position are head higher than foot. The risks of various complications are significant higher in tracheal intubation in laparoscopic surgery. Laryngeal mask can maintain patients' normal respiratory functions while reduce damage and do not increase the occurrence of reflux aspiration. Due to limited quantity and quality of the included studies, more high quality studies are needed to verify above conclusion.

Citation： YASEN Yari, KEYOUMU Nuerbiyan, AIMAITI Abulikemu, WU Jianjiang. The efficacy and safety of laryngeal mask versus endotracheal tubes for laparoscopic surgery: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2017, 17(8): 941-948. doi: 10.7507/1672-2531.201705076 Copy

1.	Vijayaraghavan N, Sistla SC, Kundra P, et al. Comparison of standard-pressure and low-pressure pneumoperitoneum in laparoscopic cholecystectomy: a double blinded randomized controlled study. Surg Laparosc Endosc Percutan Tech, 2014, 24(24): 127-133.
2.	Le RB, Fetche N, Buc E, et al. Feasibility prospective study of laparoscopic cholecystectomy with suprapubic approach. J Visc Surg, 2016, 153(5): 327-331.
3.	Xu R, Lian Y, Li WX. Airway complications during and after general anesthesia: a comparison, systematic review and meta-analysis of using flexible laryngeal mask airways and endotracheal tubes. Plos One, 2016, 11(7): e0158137.
4.	Kannan S, Harsoor SS, Sowmiya L, et al. Comparison of ventilatory efficacy and airway dynamics between ProSeal laryngeal mask airway and endotracheal tube in adult patients during general anesthesia. J Anaesthesiol Clin Pharmacol, 2015, 31(4): 517-521.
5.	Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0. The Cochrane Collaboration, 2011. Available at: www.cochrane-handbook.org.
6.	Abdi W, Amathieu R, Adhoum A, et al. Sparing the larynx during gynecological laparoscopy: a randomized trial comparing the LMA Supreme^TM and the ETT. Acta Anaesthesiol Scand, 2010, 54(2): 141-146.
7.	Prahladrai BJ, Mohammedi JR, Amrishbhi CV, et al. I-gel as an alternative to endotracheal tube in adult laparoscopic surgeries: A comparative study. J Minim Access Surg, 2015, 11(4): 251-256.
8.	Biswas S, Mandal S, Mitra T, et al. A prospective randomized comparative study to compare the hemodynamic and metabolic stress respone due to endotracheal intubation and i-gel usage during laparoscopic cholecystectomy. Middle East J Anaesthesiol, 2015, 23(3): 315-320.
9.	Carron M, Veronese S, Gomiero W, et al. Hemodynamic and hormonal stress responses to endotracheal tube and proseal laryngeal mask airway^TM for laparoscopic gastric banding. Anesthesiology, 2012, 117(117): 309-320.
10.	Griffiths J, Nguyen M, Lau H, et al. A prospective randomised comparison of the LMA ProSeal^TM versus endotracheal tube on the severity of postoperative pain following gynaecological laparoscopy. Anaesth Intensive Care, 2013, 41(1): 46-50.
11.	Hohlrieder M, Brimacombe J, Von GA, et al. Postoperative nausea, vomiting, airway morbidity, and analgesic requirements are lower for the ProSeal laryngeal mask airway than the tracheal tube in females undergoing breast and gynaecological surgery. Br J Anaesth, 2007, 99(4): 576-580.
12.	Hohlrieder M, Brimacombe J, Eschertzhuber S, et al. A study of airway management using the ProSeal LMA laryngeal mask airway compared with the tracheal tube on postoperative analgesia requirements following gynaecological laparoscopic surgery. Anaesthesia, 2007, 62(9): 913-918.
13.	Hong SJ, Ko KM, Park JH, et al. Effectiveness of the streamlined liner of the pharynx airway (SLIPATM) in allowing positive pressure ventilation during gynaecological laparoscopic surgery. Anaesth Intensive Care, 2011, 39(4): 618-622.
14.	Lai CJ, Liu CM, Wu CY, et al. I-gel is a suitable alternative to endotracheal tubes in the laparoscopic pneumoperitoneum and trendelenburg position. BMC Anesthesiol, 2017, 17(1): 3.
15.	Lim Y, Goel S, Brimacombe JR. The ProSeal laryngeal mask airway is an effective alternative to laryngoscope-guided tracheal intubation for gynaecological laparoscopy. Anaesth Intensive Care, 2007, 35(1): 52-56.
16.	Maharjan SK. I-gel for positive pressure ventilation. JNMA J Nepal Med Assoc, 2013, 52(189): 255-259.
17.	Maltby JR, Beriault MT, Watson NC, et al. Gastric distension and ventilation during laparoscopic cholecystectomy: LMA-classic vs. tracheal intubation. Can J Anaesth, 2000, 47(7): 622-626.
18.	Maltby JR, Beriault MT, Watson NC, et al. The LMA-ProSeal^TM is an effective alternative to tracheal intubation for laparoscopic cholecystectomy. Can J Anaesth, 2002, 49(8): 857-862.
19.	Maltby JR, Beriault MT, Watson NC, et al. LMA-Classic and LMA-ProSeal are effective alternatives to endotracheal intubation for gynecologic laparoscopy. Can J Anaesth, 2003, 50(1): 71-77.
20.	Roth H, Genzwuerker HV, Rothhaas A, et al. The ProSeal laryngeal mask airway and the laryngeal tube Suction for ventilation in gynaecological patients undergoing laparoscopic surgery. Eur J Anaesthesiol, 2005, 22(2): 117-122.
21.	Swann DC, Spens H, Edwards SA, et al. Anaesthesia for gynaecological laparoscopy-a comparison between the laryngeal mask airway and tracheal intubation. Anaesthesia, 1993, 48(5): 431-434.
22.	Becker C, Plymale MA, Wennergren J, et al. Compliance of the abdominal wall during laparoscopic insufflation. Surg Endosc, 2016, 31(4): 1947-1951.
23.	Sharma A, Dahiya D, Kaman L, et al. Effect of various pneumoperitoneum pressures on femoral vein hemodynamics during laparoscopic cholecystectomy. Updates Surg, 2016, 68(2): 163-169.
24.	Robba C, Cardim D, Donnelly J, et al. Effects of pneumoperitoneum and Trendelenburg position on intracranial pressure assessed using different non-invasive methods. Br J Anaesth, 2016, 117(6):783-791.
25.	JBeleña JM, Ochoa EJ, Núñez M, et al. Role of laryngeal mask airway in laparoscopic cholecystectomy. World J Gastrointest Surg, 2015, 7(11): 319-325.
26.	Ralston C, Clutton-Brock TH, Hutton P. Tension pneumoperitoneum. Intensive Care Med, 1989, 15(8): 532-533.

1. Vijayaraghavan N, Sistla SC, Kundra P, et al. Comparison of standard-pressure and low-pressure pneumoperitoneum in laparoscopic cholecystectomy: a double blinded randomized controlled study. Surg Laparosc Endosc Percutan Tech, 2014, 24(24): 127-133.
2. Le RB, Fetche N, Buc E, et al. Feasibility prospective study of laparoscopic cholecystectomy with suprapubic approach. J Visc Surg, 2016, 153(5): 327-331.
3. Xu R, Lian Y, Li WX. Airway complications during and after general anesthesia: a comparison, systematic review and meta-analysis of using flexible laryngeal mask airways and endotracheal tubes. Plos One, 2016, 11(7): e0158137.
4. Kannan S, Harsoor SS, Sowmiya L, et al. Comparison of ventilatory efficacy and airway dynamics between ProSeal laryngeal mask airway and endotracheal tube in adult patients during general anesthesia. J Anaesthesiol Clin Pharmacol, 2015, 31(4): 517-521.
5. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0. The Cochrane Collaboration, 2011. Available at: www.cochrane-handbook.org.
6. Abdi W, Amathieu R, Adhoum A, et al. Sparing the larynx during gynecological laparoscopy: a randomized trial comparing the LMA Supreme^TM and the ETT. Acta Anaesthesiol Scand, 2010, 54(2): 141-146.
7. Prahladrai BJ, Mohammedi JR, Amrishbhi CV, et al. I-gel as an alternative to endotracheal tube in adult laparoscopic surgeries: A comparative study. J Minim Access Surg, 2015, 11(4): 251-256.
8. Biswas S, Mandal S, Mitra T, et al. A prospective randomized comparative study to compare the hemodynamic and metabolic stress respone due to endotracheal intubation and i-gel usage during laparoscopic cholecystectomy. Middle East J Anaesthesiol, 2015, 23(3): 315-320.
9. Carron M, Veronese S, Gomiero W, et al. Hemodynamic and hormonal stress responses to endotracheal tube and proseal laryngeal mask airway^TM for laparoscopic gastric banding. Anesthesiology, 2012, 117(117): 309-320.
10. Griffiths J, Nguyen M, Lau H, et al. A prospective randomised comparison of the LMA ProSeal^TM versus endotracheal tube on the severity of postoperative pain following gynaecological laparoscopy. Anaesth Intensive Care, 2013, 41(1): 46-50.
11. Hohlrieder M, Brimacombe J, Von GA, et al. Postoperative nausea, vomiting, airway morbidity, and analgesic requirements are lower for the ProSeal laryngeal mask airway than the tracheal tube in females undergoing breast and gynaecological surgery. Br J Anaesth, 2007, 99(4): 576-580.
12. Hohlrieder M, Brimacombe J, Eschertzhuber S, et al. A study of airway management using the ProSeal LMA laryngeal mask airway compared with the tracheal tube on postoperative analgesia requirements following gynaecological laparoscopic surgery. Anaesthesia, 2007, 62(9): 913-918.
13. Hong SJ, Ko KM, Park JH, et al. Effectiveness of the streamlined liner of the pharynx airway (SLIPATM) in allowing positive pressure ventilation during gynaecological laparoscopic surgery. Anaesth Intensive Care, 2011, 39(4): 618-622.
14. Lai CJ, Liu CM, Wu CY, et al. I-gel is a suitable alternative to endotracheal tubes in the laparoscopic pneumoperitoneum and trendelenburg position. BMC Anesthesiol, 2017, 17(1): 3.
15. Lim Y, Goel S, Brimacombe JR. The ProSeal laryngeal mask airway is an effective alternative to laryngoscope-guided tracheal intubation for gynaecological laparoscopy. Anaesth Intensive Care, 2007, 35(1): 52-56.
16. Maharjan SK. I-gel for positive pressure ventilation. JNMA J Nepal Med Assoc, 2013, 52(189): 255-259.
17. Maltby JR, Beriault MT, Watson NC, et al. Gastric distension and ventilation during laparoscopic cholecystectomy: LMA-classic vs. tracheal intubation. Can J Anaesth, 2000, 47(7): 622-626.
18. Maltby JR, Beriault MT, Watson NC, et al. The LMA-ProSeal^TM is an effective alternative to tracheal intubation for laparoscopic cholecystectomy. Can J Anaesth, 2002, 49(8): 857-862.
19. Maltby JR, Beriault MT, Watson NC, et al. LMA-Classic and LMA-ProSeal are effective alternatives to endotracheal intubation for gynecologic laparoscopy. Can J Anaesth, 2003, 50(1): 71-77.
20. Roth H, Genzwuerker HV, Rothhaas A, et al. The ProSeal laryngeal mask airway and the laryngeal tube Suction for ventilation in gynaecological patients undergoing laparoscopic surgery. Eur J Anaesthesiol, 2005, 22(2): 117-122.
21. Swann DC, Spens H, Edwards SA, et al. Anaesthesia for gynaecological laparoscopy-a comparison between the laryngeal mask airway and tracheal intubation. Anaesthesia, 1993, 48(5): 431-434.
22. Becker C, Plymale MA, Wennergren J, et al. Compliance of the abdominal wall during laparoscopic insufflation. Surg Endosc, 2016, 31(4): 1947-1951.
23. Sharma A, Dahiya D, Kaman L, et al. Effect of various pneumoperitoneum pressures on femoral vein hemodynamics during laparoscopic cholecystectomy. Updates Surg, 2016, 68(2): 163-169.
24. Robba C, Cardim D, Donnelly J, et al. Effects of pneumoperitoneum and Trendelenburg position on intracranial pressure assessed using different non-invasive methods. Br J Anaesth, 2016, 117(6):783-791.
25. JBeleña JM, Ochoa EJ, Núñez M, et al. Role of laryngeal mask airway in laparoscopic cholecystectomy. World J Gastrointest Surg, 2015, 7(11): 319-325.
26. Ralston C, Clutton-Brock TH, Hutton P. Tension pneumoperitoneum. Intensive Care Med, 1989, 15(8): 532-533.

Chinese Journal of Evidence-Based Medicine

The efficacy and safety of laryngeal mask versus endotracheal tubes for laparoscopic surgery: a meta-analysis

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