Safety and Efficacy of the Use of Supraglottic Airway Devices in Children and Adolescents Undergoing Adenotonsillectomy—A Systematic Review and Meta-Analysis

Author:

Nair Abhijit1,Borkar Nitinkumar2ORCID,Murke Sunil Subhash3,Dudhedia Ujjwalraj4

Affiliation:

1. Department of Anesthesiology, Ibra Hospital, Ibra 413, Oman

2. Department of Pediatric Surgery, All India Institute of Medical Sciences, Raipur 492001, India

3. Department of Anesthesiology, Shri Ramchandra Institute of Medical Sciences, Aurangabad 431001, India

4. Department of Anesthesiology, Dr. L.H. Hiranandani Hospital, Mumbai 400001, India

Abstract

(1) Background: Supraglottic airway devices (SAD) have been used in children and adolescents undergoing adenotonsillectomies under general anesthesia. This systematic review and meta-analysis investigate the safety and efficacy of using SADs when compared to an endotracheal tube (ETT). (2) Methods: After registering with PROSPERO, databases like PubMed, Scopus, OviD, CINAHL, and Cochrane Library were searched using relevant keywords from the year 2000. We used RoB-2 for risk-of-bias assessment, GRADE for assessing the quality of evidence, RevMan 5.2 for qualitative meta-analysis, and trial sequential analysis (TSA) to corroborate the significant findings of meta-analysis. (3) Results: Out of 200 studies, 5 randomized-controlled trials fulfilled inclusion criteria. The quality of evidence was moderate for laryngospasm, low for airway device failure, and very low for recovery time. The incidence of laryngospasm was comparable between SADs and ETT (RR: 0.80, 95% CI-0.36, 1.80, p = 0.59). The incidence of airway device failure was significantly higher with SADs than ETT (RR: 11.29, 95% CI: 2.73, 46.66, p = 0.0008). The postoperative recovery time was significantly less with SADs than with ETT use (MD: −4.33, 95% CI: −5.28, −3.39, p < 0.0001), which was confirmed by the TSA. (4) Conclusions: The results of this review suggests that use of SADs can provide a lesser postoperative recovery time and comparable incidence of laryngospasm, with a higher incidence of failure of SAD when compared to ETT. Use of SAD for pediatric and adolescent adenotonsillectomies should be individualized based on patient characteristics, and on the expertise of the anesthesiologist and the surgeons involved.

Publisher

MDPI AG

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