The ProSeal Laryngeal Mask Airway is more effective than the LMA-Classic in pediatric anesthesia: a meta-analysis

Study Objective: To determine, in pediatric patients, whether the ProSeal Laryngeal Mask Airway (PLMA) has advantages over the LMA-Classic (cLMA) in leak pressure, placement difficulty, incidence of adverse events, postoperative blood staining, laryngospasm, bronchospasm, and hoarseness. Design: Meta-analysis. Setting: Metropolitan university medical center. Measurements: MEDLINE (1966-2011), EMBASE (1980-2011), and the CENTRAL (1977-2011) databases was searched for randomized controlled trials (RCTs). The relative risk (RR), mean difference (MD), and corresponding 95% confidence intervals (CIs) were calculated using RevMan 5 statistical software for dichotomous and continuous outcomes, respectively. Main Results: Of the 13 RCTs that met study inclusion criteria, 8 trials comprising 557 patients were analyzed. Leak pressure was higher in the PLMA (RR = 5.02, 95% CI = 3.64, 6.4). The difference in rate of successful placement on the first attempt did not differ between the two devices (RR = 1.00, 95% CI = 0.94, 1.06). The incidence of gastric insufflation was lower with the PLMA (RR = 0.20,95% CI = 0.07, 0.61). The incidence of postoperative blood staining on the mask did not differ (RR = 1.08,95% CI = 0.52, 2.21), nor was there any difference between the two devices in incidence of laryngospasm or bronchospasm (RR = 0.75,95% CI = 0.18, 3.21), or hoarseness (RR = 3.00,95% CI = 0.13, 70.83). There was no difference in laryngeal view between the PLMA and cLMA (RR = 1.06, 95% CI = 0.90, 1.26). The maximum tidal volume per kg was greater with the PLMA (MD = 4.16, 95% CI = 3.56, 4.76). Conclusions: The PLMA (in sizes 1,1.5, 2, and 2.5) offers some advantages over the cLMA in pediatric anesthesia (C) 2012 Elsevier Inc. All rights reserved.