J Clin Anesth. 2019 Sep;56:134-135

# Airway management with a supraglottic airway for laparoscopic surgery: Does device selection matter?

King M, Jagannathan N

QUOTE:"To date, randomized studies have suggested that aspiration is no more common during procedures with an SGA when compared to an endotracheal tube. Due to the rarity of an aspiration event, however, designing a randomized study with enough power to determineequivalence of aspiration rates between SGAs and endotracheal tubes is prohibitively difficult. A definitive answer to this question will likely require the utilization of large data sets to determine rates of success and complications during laparoscopic and other procedures and, assuch, an analysis would require hundreds of thousands of patients in a multi-center effort. The advocacy of using second-generation SGAs for dynamic procedures such as laparoscopic surgery by airway specialty societies such as the Difficult Airway Society, Society for AirwayManagement, or European Airway Management Society may also encourage anesthesiologists to be more accepting of this practice, but further evidence would be needed to support an official endorsement.

In summary, Yoon and colleagues' analysis has provided greater insight for clinicians to select a specific type of SGA for laparoscopic procedures in order to optimize obtainable airway pressures needed to adequately ventilate the lungs. Their work joins a growing body ofliterature that increasingly supports the safe use of second-generation SGAs in suitable patients having laparoscopic surgery. While available randomized studies demonstrate low risks of aspiration when using an SGA for laparoscopy, the rarity of the event makes it difficult to fullycharacterize its use in this setting. In the future, the use of large data sets may provide adequate numbers of patients required to delineate the overall complication rates when using SGAs versus tracheal intubation."