Minerva anestesiologica · 2026
Comparison of oropharyngeal leak pressures between blind versus under-vision insertion of supraglottic airways in adults undergoing surgery under general anesthesia: a systematic review and meta-analysis.
СтатьяСистематический обзорМетаанализСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Bihani Pooja, Paliwal Naveen, Jaju Rishabh, Das Devishree, Misra Satyajeet
Аннотация
INTRODUCTION: Oropharyngeal leak pressure (OPLP) is an objective measure of the airway seal provided by a supraglottic airway (SGA) around the glottis. While under-vision insertion techniques improve the anatomic placement of SGAs vs. blind insertion techniques, evidence regarding their impact on OPLP remains inconclusive.
EVIDENCE ACQUISITION: Electronic databases were searched until 31st March 2025. Randomized controlled trials (RCTs) comparing blind insertion techniques vs. under-vision placement of SGAs in anesthetized adults reporting OPLP were included. The primary objective was to compare the OPLP between under-vision and blind placement of SGAs. Secondary objectives included comparison of SGA positioning, insertion time, first-attempt success rates, peak inspiratory pressures (PIP), ease of SGA and gastric tube insertion, and postoperative complications.
EVIDENCE SYNTHESIS: Ten RCTs involving 1,089 patients were included. Under-vision placement of SGAs was associated with significantly higher OPLP (27.88 vs. 24.7 cmH<inf>2</inf>O; mean difference: 3.18 cmH<inf>2</inf>O; 95% confidence interval (CI): 2.42 to 3.94; P<0.00001; I2=44.33%). Under-vision techniques also demonstrated better anatomical positioning with fiberoptic bronchoscopy (log odds ratio: 1.90; 95% CI: 0.76 to 3.03; P<0.00001). Meta-regression to quantify heterogeneity of OPLP was not significant for either the type of SGAs (P=0.205) or the type of laryngoscope used (P=0.404). Lower PIP and improved ease of gastric tube insertion were noted in the under-vision groups, though a longer time was required to place the SGAs. No differences were noted in other outcomes.
CONCLUSIONS: Under-vision placement of SGAs results in higher OPLP vs. blind insertion techniques, but the clinical significance remains uncertain.
EVIDENCE ACQUISITION: Electronic databases were searched until 31st March 2025. Randomized controlled trials (RCTs) comparing blind insertion techniques vs. under-vision placement of SGAs in anesthetized adults reporting OPLP were included. The primary objective was to compare the OPLP between under-vision and blind placement of SGAs. Secondary objectives included comparison of SGA positioning, insertion time, first-attempt success rates, peak inspiratory pressures (PIP), ease of SGA and gastric tube insertion, and postoperative complications.
EVIDENCE SYNTHESIS: Ten RCTs involving 1,089 patients were included. Under-vision placement of SGAs was associated with significantly higher OPLP (27.88 vs. 24.7 cmH<inf>2</inf>O; mean difference: 3.18 cmH<inf>2</inf>O; 95% confidence interval (CI): 2.42 to 3.94; P<0.00001; I2=44.33%). Under-vision techniques also demonstrated better anatomical positioning with fiberoptic bronchoscopy (log odds ratio: 1.90; 95% CI: 0.76 to 3.03; P<0.00001). Meta-regression to quantify heterogeneity of OPLP was not significant for either the type of SGAs (P=0.205) or the type of laryngoscope used (P=0.404). Lower PIP and improved ease of gastric tube insertion were noted in the under-vision groups, though a longer time was required to place the SGAs. No differences were noted in other outcomes.
CONCLUSIONS: Under-vision placement of SGAs results in higher OPLP vs. blind insertion techniques, but the clinical significance remains uncertain.