When using supraglottic airways for laparoscopic surgery, the Ambu AuraGain® offers the highest oropharyngeal leak pressure before pneumoperitoneum, and the i-gel® the highest after pneumonperitoneum.

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• Sang Won Yoon, Hyun Kang, Geun Joo Choi, Choongun Ryu, Yong Hee Park, Chong Wha Baek, Yong Hun Jung, and Young Cheol Woo.
• Department of Anesthesiology and Pain Medicine, Chung-Ang University, College of Medicine, Seoul, Republic of Korea.
• J Clin Anesth. 2019 Aug 1; 55: 52-66.

Study ObjectiveTo review all randomized controlled trials (RCTs) on supraglottic airway devices (SADs) used in laparoscopy and compare their oropharyngeal leak pressure (OLP) and peak inspiratory pressure (PIP) before and after pneumoperitoneum, and success rate of gastric tube insertion rate.DesignSystematic review and network meta-analysis of RCTs.SettingLaparoscopic surgeries using SADs.PatientsWe searched MEDLINE, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar databases to detect all relevant RCTs on SADs for laparoscopic surgery published until March 2018.InterventionsUse of different SADs.MeasurementsThe primary endpoint was OLP before and after pneumoperitoneum. The secondary endpoints were PIP before and after pneumoperitoneum and gastric tube insertion success rate.Main ResultsTwenty-six studies involving 2142 patients with eight different SADs were evaluated. According to surface under the cumulative ranking curve value, the OLP before pneumoperitoneum was the highest in Ambu AuraGain (95.7%), followed by Laryngeal Mask Airway ProSeal (77.3%) and Streamlined Liner of the Pharynx Airway (75.6%); after pneumoperitoneum, the pressure was the highest in i-gel (95.8%). PIP was the highest in Ambu AuraGain (80.9%) before pneumoperitoneum and i-gel (69.4%) after pneumoperitoneum.ConclusionAlthough all SADs available were not evaluated, and further studies are needed to establish our results, OLP was the highest in Ambu AuraGain before pneumoperitoneum and i-gel after pneumoperitoneum.Copyright © 2018 Elsevier Inc. All rights reserved.

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