Comparison of the I-Gel and the Laryngeal Mask Airway Proseal during General Anesthesia: A Systematic Review and Meta-Analysis

<div><p>Objectives</p><p>Conflicting results have been reported for the i-gel and the laryngeal mask airway proseal (LMA-P) during general anesthesia. The objective of the current investigation was to compare the efficacy and safety of the i-gel vs. the LMA-P during general anesthesia.</p><p>Methods</p><p>Two authors performed searches of MEDLINE, EMBASE, CENTRAL, and Google Scholar to identify randomized clinical trials that compared the LMA-P with the i-gel during general anesthesia. A meta -analysis was performed using both random and fixed-effect models. Publication bias was evaluated using Begg's funnel plot and Egger's linear regression test.</p><p>Results</p><p>Twelve randomized clinical trials met the eligibility criteria. There were no significant differences in insertion success rate at the first attempt (risk ratio [RR] 1.01, 95% confidence interval [CI] 0.97, 1.06), ease of insertion (RR 1.14, 95% CI 0.93, 1.39), oropharyngeal leak pressure (OLP) (MD -1.98, 95% CI -5.41, 1.45), quality of fiberoptic view (RR 1.00, 95% CI 0.91, 1.10) and success rate of gastric tube insertion (RR 1.07, 95% CI 0.98, 1.18) between the i-gel and the LMA-P, respectively. The i-gel had a shorter insertion time than the LMA-P (MD -3.99, 95% CI -7.13, -0.84) and a lower incidence of blood staining on the device (RR 0.26, 95% CI 0.14, 0.49), sore throat (RR 0.28, 95% CI 0.15, 0.50) and dysphagia (RR 0.27, 95% CI 0.10, 0.74).</p><p>Conclusions</p><p>Both devices were comparable in ease of insertion to insert and both had sufficient OLP to provide a reliable airway. Only a few minor complications were reported. The i-gel was found to have fewer complications (blood staining, sore throat, dysphagia) than the LMA-P and offers certain advantages over the LMA-P in adults under general anesthesia.</p></div

Funnel showing the incidence of blood staining on the devices: i-gel versus LMA-P.

<p>White circles: comparisons included. Black circles: inputted comparisons using the trim-and-fill method. White diamond: pooled observed log risk ratio. Black diamond: pooled inputted log risk ratio.</p

Forest plot showing oropharyngeal leak pressure: i-gel versus LMA-P.

<p>Subgroup analysis according to overall and using of neuromuscular blocking agents (paralyzed vs. non-paralyzed)</p

Flow diagram showing the number of abstracts and articles identified and evaluated during the review

<p>Flow diagram showing the number of abstracts and articles identified and evaluated during the review</p

Forest plot showing insertion time: i-gel versus LMA-P.

<p>Subgroup analysis according to using of neuromuscular blocking agents (paralyzed vs. non-paralyzed).</p