Yonsei Med J.  2016 Jul;57(4):987-997. 10.3349/ymj.2016.57.4.987.

Standard versus Rotation Technique for Insertion of Supraglottic Airway Devices: Systematic Review and Meta-Analysis

• Park JH
• Lee JS
• Nam SB
• Ju JW
• Kim MS

• KMID: 2374134
• DOI: http://doi.org/10.3349/ymj.2016.57.4.987

Abstract

PURPOSE
Supraglottic airway devices have been widely utilized as an alternative to tracheal intubation in various clinical situations. The rotation technique has been proposed to improve the insertion success rate of supraglottic airways. However, the clinical efficacy of this technique remains uncertain as previous results have been inconsistent, depending on the variable evaluated.
MATERIALS AND METHODS
We systematically searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials in April 2015 for randomized controlled trials that compared the rotation and standard techniques for inserting supraglottic airways.
RESULTS
Thirteen randomized controlled trials (1505 patients, 753 with the rotation technique) were included. The success rate at the first attempt was significantly higher with the rotation technique than with the standard technique [relative risk (RR): 1.13; 95% confidence interval (CI): 1.05 to 1.23; p=0.002]. The rotation technique provided significantly higher overall success rates (RR: 1.06; 95% CI: 1.04 to 1.09; p<0.001). Device insertion was completed faster with the rotation technique (mean difference: -4.6 seconds; 95% CI: -7.37 to -1.74; p=0.002). The incidence of blood staining on the removed device (RR: 0.36; 95% CI: 0.27 to 0.47; p<0.001) was significantly lower with the rotation technique.
CONCLUSION
The rotation technique provided higher first-attempt and overall success rates, faster insertion, and a lower incidence of blood on the removed device, reflecting less mucosal trauma. Thus, it may be considered as an alternative to the standard technique when predicting or encountering difficulty in inserting supraglottic airways.

Keyword

Airway management; complications; laryngeal masks; supraglottic airways

MeSH Terms

Device Removal
Humans
Intubation, Intratracheal/instrumentation/*methods/standards
*Laryngeal Masks
Randomized Controlled Trials as Topic
Reference Standards
Risk
*Rotation

Figure

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  Fig. 1 Flow diagram showing the trial selection process.

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  Fig. 2 Investigations of the risk of bias in the included studies (light grey: low risk of bias, ash: uncertain risk of bias, grey: high risk of bias).

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  Fig. 3 Forest plots of the first attempt (A) and overall (B) insertion success rate comparing the rotation and standard techniques. M-H, Mantel-Haenszel; CI, confidence interval.

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  Fig. 4 Forest plots of insertion time (A) and blood staining on the removed devices (B) comparing the rotation and standard techniques. M-H, Mantel-Haenszel; CI, confidence interval.

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