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

 Jin Ha Park  ;  Jong Seok Lee  ;  Sang Beom Nam  ;  Jin Wu Ju  ;  Min-Soo Kim 
 YONSEI MEDICAL JOURNAL, Vol.57(4) : 987-997, 2016 
Journal Title
Issue Date
Device Removal ; Humans ; Intubation, Intratracheal/instrumentation ; Intubation, Intratracheal/methods* ; Intubation, Intratracheal/standards ; Laryngeal Masks* ; Randomized Controlled Trials as Topic ; Reference Standards ; Risk ; Rotation*
Airway management ; complications ; laryngeal masks ; supraglottic airways
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.
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1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Min Soo(김민수) ORCID logo https://orcid.org/0000-0001-8760-4568
Nam, Sang Beom(남상범) ORCID logo https://orcid.org/0000-0002-9704-1866
Park, Jin Ha(박진하) ORCID logo https://orcid.org/0000-0002-1398-3304
Lee, Jong Seok(이종석) ORCID logo https://orcid.org/0000-0002-7945-2530
Ju, Jin Wu(주진우)
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