Editorial Type:
Article Category: Research Article
 | 
Online Publication Date: Dec 15, 2021

Airway Complications in Intubated Versus Laryngeal Mask Airway–Managed Dentistry: A Meta-Analysis

DDS, MSc,
DDS, MSc,
DDS,
DDS, MSc, EdD, and
DDS, MSc, PhD
Page Range: 193 – 205
DOI: 10.2344/anpr-68-04-02
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Objective:

Serious airway complications can occur with inadequate airway management during general anesthesia (GA). This meta-analysis investigated randomized controlled trials that compared perioperative technique failures and airway complications, including hypoxia, during GA for dentistry using endotracheal intubation or a laryngeal mask airway (LMA) for airway management.

Methods:

A systematic search of electronic databases and gray literature was completed. Independent reviewers assessed eligibility, performed data extraction, completed risk of bias assessment, and judged the quality of results through Grading of Recommendations, Assessment, Development, and Evaluation. Risk ratios (RRs) for airway complications, with 95% CIs, were calculated. Heterogeneity was quantified using the I2 statistic. Sensitivity and age-subgroup analyses were explored.

Results:

Six trials were deemed eligible from a total of 9076 identified reports. The airway management intervention for these trials was LMA. Technique failures or effect differences in airway complications were not detected except for postoperative hypoxia, where LMA use had a decreased risk (RR, 0.22; 95% CI, 0.06-0.77; I2 = 0%; moderate quality). A similar effect was seen in the pediatric analysis (RR, 0.10; 95% CI, 0.01-0.84; I2 = 0%; moderate quality). Additionally, LMA use reduced pediatric sore throat risk (RR, 0.08; 95% CI, 0.04-0.15; I2 = 0%; moderate quality).

Conclusion:

Use of an LMA in dentistry may have the potential to reduce the risk of postoperative hypoxia, particularly in pediatric patients, although further study is required.

Keywords: Intubation; LMA; Laryngeal mask airway; Airway management; Airway complications
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Copyright: © 2021 by the American Dental Society of Anesthesiology
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Figure 1.
Figure 1.

Study flow diagram.

Figure 2.
Figure 2.

(A) Risk of bias summary: judgments from authors on risk of bias domains among individual included studies. (B) Risk of bias summary: judgements from authors on risk of bias domains across all included studies

Figure 3.
Figure 3.

Forest plot for airway complications from all included studies.

Figure 4.
Figure 4.

Sensitivity analysis forest plot for airway complications from all included studies.

Figure 5.
Figure 5.

Age subgroup meta-analyses of airway complications presented in forest plot.

Contributor Notes

Address correspondence to Dr Amir Azarpazhooh, 455–124 Edward Street, Toronto, ON, M5G 1G6, Canada; amir.azarpazhooh@dentistry.utoronto.ca
Received: Dec 07, 2019
Accepted: Nov 16, 2020