Kumar Tushar, Suman Saurabh, Kumar Sanjay, Acharya Gaurav, Lakra Ladhu
Department of Anaesthesiology- Trauma, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India.
Department of Anaesthesiology - Superspeciality, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India.
Indian J Anaesth. 2023 May;67(5):409-419. doi: 10.4103/ija.ija_398_22. Epub 2023 May 11.
Laparoscopic surgeries are among the most frequent procedures done worldwide. There is a gradual shift in the method of airway securement from endotracheal intubation to supraglottic airway devices (SAD). The objective of the current work was to perform a systematic review and meta-analysis of published RCTs on airway complications in laparoscopic surgery performed with a SAD or endotracheal intubation (ETT).
The research was registered in PROSPERO, and a literature search was conducted in Google Scholar and PubMed until August 2022. Out of 78 studies, 31 studies were screened and 21 were included for analysis. RevMan 5.4 was used to analyse data on sore throat, hoarseness, nausea, vomiting, stridor and cough.
Twenty-one randomised controlled trials, enrolling a total of 2213 adult patients, were included in the quantitative analysis. A significant incidence of sore throat and hoarseness was seen at post-operative period in ETT group with risk ratio (RR) 0.44, < 0.00001 [0.30, 0.65], = 72% and RR 0.38, < 0.001 [0.21, 0.69], = 72%, respectively. However, incidence of nausea, vomiting and stridor was not significant with RR 0.83, = 0.26 [0.60, 1.15], = 52% for nausea and RR 0.55, = 0.03 [ 0.33, 0.93], = 14% for vomiting. Incidence of cough was more in ETT group with RR 0.11, < 0.00001 [ 0.06, 0.20], = 42%, as compared to SAD group.
There was a substantial variation between SADs and ETTs with respect to the incidence of hoarseness, sore throat, nausea and cough. The existing literature is reinforced by the evidence uncovered in this updated systematic review.
腹腔镜手术是全球范围内最常见的手术之一。气道管理方法正逐渐从气管内插管转向声门上气道装置（SAD）。本研究的目的是对已发表的关于使用SAD或气管内插管（ETT）进行腹腔镜手术气道并发症的随机对照试验（RCT）进行系统评价和荟萃分析。
该研究已在国际前瞻性系统评价注册库（PROSPERO）登记，并在谷歌学术和PubMed上进行文献检索，直至2022年8月。在78项研究中，筛选出31项研究，纳入21项进行分析。使用RevMan 5.4分析咽痛、声音嘶哑、恶心、呕吐、喘鸣和咳嗽的数据。
21项随机对照试验纳入了定量分析，共纳入2213例成年患者。ETT组术后咽痛和声音嘶哑的发生率显著，风险比（RR）分别为0.44，P<0.00001[0.30，0.65]，I²=72%和RR 0.38，P<0.001[0.21，0.69]，I²=72%。然而，恶心、呕吐和喘鸣的发生率无显著差异，恶心的RR为0.83，P=0.26[0.60，1.15]，I²=52%，呕吐的RR为0.55，P=0.03[0.33，0.93]，I²=14%。与SAD组相比，ETT组咳嗽的发生率更高，RR为0.11，P<0.00001[0.06，0.20]，I²=42%。
SAD和ETT在声音嘶哑、咽痛、恶心和咳嗽的发生率方面存在显著差异。本更新的系统评价所发现的证据进一步证实了现有文献。
