Xu Rui, Zhu Yun, Fan Qing, Shen Xia, Li Wen Xian
From the *Department of Anesthesiology, the Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai Medical College of Fudan University, Shanghai, China; and †Department of Oro-maxillofacial Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China.
Anesth Analg. 2017 Sep;125(3):958-966. doi: 10.1213/ANE.0000000000002316.
The complication rate and efficacy of the Cobra Perilaryngeal Airway (CobraPLA) and laryngeal mask airways (LMAs®) have been evaluated in the published literature, but the conclusions have been inconsistent. The aim of this systematic review and meta-analysis was thus to assess the performance of the CobraPLA and LMAs under general anesthesia. We searched PubMed, Embase, and the Cochrane Library for randomized controlled trials comparing the CobraPLA with LMAs under general anesthesia. The LMAs used for comparison were the classic LMA (CLMA) and the unique LMA (ULMA). The random effect model was used if heterogeneity was observed, otherwise the fixed effect model was used. Seventeen randomized controlled trials were included; number of studies analyzed for each result are different and were up to 10. The current result suggests that no significant difference between the devices in the insertion success rate at the first attempt. The success rate of first insertion of the CobraPLA was not different from the rates for the CLMA and the ULMA (relative risk: 0.95, 95% confidence interval [CI], 0.91-1.00). CobraPLA insertion was not different from CLMA and ULMA insertion. The CobraPLA provided an oropharyngeal leak pressure higher than that provided by the CLMA (weight mean difference: 3.90, 95% CI, [1.59-6.21] cmH2O) and ULMA (weight mean difference: 6.57, 95% CI, [4.30-8.84] cmH2O). We also found a higher likelihood of blood staining in the airway with the CobraPLA than with the CLMA. In our research, the principal finding of our meta-analysis is that the success rate of first insertion of the CobraPLA was not different from the rate for each of the CLMA and the ULMA, which featured a short learning curve implying its ease of insertion. There was also no significant difference in the incidence of the best view (with a score of 4) obtained with the CobraPLA compared with the other 2 devices. The CobraPLA does seem to be superior to the CLMA and ULMA in providing a higher oropharyngeal leak pressure. The data were insufficient to establish differences in airway adverse events between the groups except for blood staining in the devices, although mucosal trauma occurred more frequently with the Cobra PLA device than with the CLMA and the ULMA.
已在已发表的文献中评估了眼镜蛇喉周气道（CobraPLA）和喉罩气道（LMA®）的并发症发生率及有效性，但结论并不一致。因此，本系统评价和荟萃分析的目的是评估CobraPLA和喉罩气道在全身麻醉下的性能。我们检索了PubMed、Embase和Cochrane图书馆，以查找比较全身麻醉下CobraPLA与喉罩气道的随机对照试验。用于比较的喉罩气道为经典喉罩（CLMA）和独特喉罩（ULMA）。若观察到异质性，则使用随机效应模型，否则使用固定效应模型。纳入了17项随机对照试验；每个结果分析的研究数量不同，最多为10项。当前结果表明，在首次尝试插入成功率方面，各器械之间无显著差异。CobraPLA首次插入成功率与CLMA和ULMA的成功率无差异（相对风险：0.95，95%置信区间[CI]，0.91 - 1.00）。CobraPLA的插入与CLMA和ULMA的插入无差异。CobraPLA提供的口咽漏气压高于CLMA（加权平均差：3.90，95%CI，[1.59 - 6.21]cmH₂O）和ULMA（加权平均差：6.57，95%CI，[4.30 - 8.84]cmH₂O）。我们还发现，与CLMA相比，使用CobraPLA时气道内出现血染的可能性更高。在我们的研究中，荟萃分析的主要发现是，CobraPLA首次插入成功率与CLMA和ULMA各自的成功率无差异，其学习曲线较短，这意味着其易于插入。与其他两种器械相比，使用CobraPLA获得最佳视野（评分为4分）的发生率也无显著差异。CobraPLA在提供更高的口咽漏气压方面似乎确实优于CLMA和ULMA。除器械内血染外，数据不足以确定各组之间气道不良事件的差异，尽管CobraPLA器械导致黏膜创伤的发生率高于CLMA和ULMA。
