PDF(Pubmed)
Abstract：
BACKGROUND: Adenotonsillectomy is one of the most common surgical procedures worldwide. The current standard for securing the airway in patients undergoing adenotonsillectomy is endotracheal tube (ETT) intubation. Several studies have investigated the use of the laryngeal mask airway (LMA) in this procedure. We conducted a systematic review and meta-analysis to compare the safety and efficacy of the LMA versus ETT in adenotonsillectomy.
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.
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.
摘要：
背景：腺样体扁桃体切除术是全世界最常见的外科手术之一。在进行腺样体扁桃体切除术的患者中固定气道的当前标准是气管内导管（ETT）插管。一些研究已经调查了喉罩气道（LMA）在此过程中的使用。我们进行了系统评价和荟萃分析，以比较LMA和ETT在腺扁桃体切除术中的安全性和有效性。
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。
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。
