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

Diagnostic performances of 4 biomarkers for each biomarker and for every combination using 2–4 biomarkers for HCC diagnosis with LC control in subgroup showing a low AFP level (<20 ng/mL).

<p>Diagnostic performances of 4 biomarkers for each biomarker and for every combination using 2–4 biomarkers for HCC diagnosis with LC control in subgroup showing a low AFP level (<20 ng/mL).</p

ROC curves of AFP, PIVKA-II, OPN, and DKK-1 for the diagnosis of HCC with LC control.

<p>(A) In entire population (B) In the subgroup with AFP levels < 20 ng/mL.</p

ROC curves of AFP, PIVKA-II, OPN, and DKK-1 for the diagnosis of HCC with LC control in subgroups categorized by BCLC stage and AFP levels.

<p>(A) In the subgroup with BCLC 0/A (B) In the subgroup with BCLC 0/A and with plasma AFP level < 20 ng/mL (C) In the subgroup with BCLC B/C/D (D) In the subgroup with BCLC B/C/D and with plasma AFP level < 20 ng/mL. The AUC values are presented in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0151069#pone.0151069.s002" target="_blank">S2 Table</a>.</p

Clinical characteristics of the study population.

<p>Clinical characteristics of the study population.</p

AUCs (with 95% confidence interval) for HCC diagnosis using AFP, PIVKA-II, OPN, and DKK-1 in subgroups categorized by clinical and tumor characteristics.

<p>AUCs for HCC diagnosis using AFP (A), PIVKA-II (B), OPN (C), and DKK-1 (D) were schematized to compare the effect of clinical and tumor factors on each biomarker’s diagnostic performance. The diamonds and solid bars represent the AUC and 95% CI of each marker in the total population. The squares and solid bars are the AUC and 95% CI of the first subgroup in each category (Age ≤ 60-years-old, male, HBV, CTP class A, non-diffuse HCC, PVI (-), and BCLC stage 0/A, respectively). The squares and short lined bars denote the AUC and 95% CI of the second subgroup in each category (Age > 60-years-old, female, HCV, CTP class B/C, diffuse HCC, PVI (+), and BCLC stage B/C/D, respectively). The squares and dotted bars are the AUC and 95% CI of the third subgroup in the each category (NBNC). AUC values were not obtained from multivariable analysis. Detailed AUC values with 95% CI and a direct comparison between the AUC of the four markers are presented in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0151069#pone.0151069.s002" target="_blank">S2 Table</a>.</p