METHODS: Databases were searched from inception to 2022 for randomized controlled trials and comparative studies. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The primary outcome is the rate of perioperative respiratory adverse events (PRAEs). Secondary outcomes included the rate of conversion to ETT, desaturations, nausea/vomiting, and surgical time. A subgroup analysis, risk of bias, publication bias, and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) assessments were also performed.
RESULTS: Twelve studies were included in the analysis (4176 patients). The mean overall conversion to ETT was 8.36% [95% confidence interval (CI) = 8.17, 8.54], and for the pediatric group 8.27% (95% CI = 8.08, 8.47). The mean rate of conversion to ETT secondary to complications was 2.89% (95% CI = 2.76, 3.03) while the rest was from poor surgical access. Overall, there was no significant difference in PRAEs [odds ratio (OR) 1.16, 95% CI = 0.60, 2.22], desaturations (OR 0.79, 95% CI = 0.38, 1.64), or minor complications (OR 0.89, 95% CI = 0.50, 1.55). The use of LMA yielded significantly shorter operative time (mean difference -4.38 minutes, 95% CI = -8.28, -0.49) and emergence time (mean difference -4.15 minutes, 95% CI = -5.63, -2.67).
CONCLUSIONS: For adenotonsillectomy surgery, LMA is a safe alternative to ETT and requires less operative time. Careful patient selection and judgment of the surgeon and anesthesiologist are necessary, especially given the 8% conversion to ETT rate.
方法:从开始到2022年检索数据库中的随机对照试验和比较研究。遵循系统审查和荟萃分析(PRISMA)指南的首选报告项目。主要结果是围手术期呼吸不良事件(PRAEs)的发生率。次要结果包括转换为ETT的比率,去饱和,恶心/呕吐,和手术时间。亚组分析,偏见的风险,出版偏见,和建议评估的分级,发展,还进行了评估(GRADE)。
结果:12项研究纳入分析(4176例患者)。ETT的平均总转化率为8.36%[95%置信区间(CI)=8.17,8.54],儿科组为8.27%(95%CI=8.08,8.47)。继发于并发症的ETT的平均转化率为2.89%(95%CI=2.76,3.03),其余患者来自手术入路不良。总的来说,PRAE没有显着差异[比值比(OR)1.16,95%CI=0.60,2.22],去饱和(OR0.79,95%CI=0.38,1.64),或轻微并发症(OR0.89,95%CI=0.50,1.55)。使用LMA可显著缩短手术时间(平均差-4.38分钟,95%CI=-8.28,-0.49)和出现时间(平均差-4.15分钟,95%CI=-5.63,-2.67)。
结论:对于腺样体扁桃体切除术,LMA是ETT的安全替代品,需要更少的手术时间。仔细的病人选择和外科医生和麻醉师的判断是必要的,特别是考虑到8%的ETT转化率。