Airtraq® reduces the hemodynamic response to tracheal intubation using single-lumen tubes in adults compared with the Macintosh laryngoscope: A systematic review and meta-analysis of randomized control trials

Study objective: To investigate whether Airtraq® attenuate the hemodynamic responses to tracheal intubation using single-lumen tubes in adults as compared with the Macintosh laryngoscope. Design: Meta-analysis. Setting: Operating room. Measurements: The primary outcome of this meta-analysis was to determine whether laryngoscopy using the Airtraq® reduced hemodynamic responses—heart rate (HR) and mean blood pressure (MBP)—at 60 s (s) after tracheal intubation compared to laryngoscopy with the Macintosh laryngoscope. Pooled differences in these hemodynamic responses between the two devices were expressed as weighted mean difference with 95% confidence intervals. We then conducted trial sequential analysis (TSA). The secondary outcome was to investigate whether the Airtraq® reduce the hemodynamic response at 120 s, 180 s, and 300 s after tracheal intubation compared to the Macintosh laryngoscope. We also conducted sensitivity analysis of the hemodynamic responses to tracheal intubation with the laryngoscopes using a multivariate random effects model accounting for within-study correlation of the longitudinal data. Main results: From electronic databases, we selected 11 randomized controlled trials for studies that enrolled subjects satisfying our inclusion criteria. Compared with the Macintosh laryngoscope, the Airtraq® significantly reduced both HR and MBP at 60 s after tracheal intubation. In secondary outcome, the Airtraq® significantly reduced both HR and MBP at all measurement points, excluding HR at 300 s after tracheal intubation. TSA showed that total sample size reached the required information size for both HR and MBP. The sensitivity analysis revealed that the Airtraq® reduced both HR and MBP at all measurement points, excluding HR at 300 s after tracheal intubation. Conclusions: The Airtraq® attenuates the hemodynamic response at 60 s after tracheal intubation compared with the Macintosh laryngoscope. (GRADE: Low) These results were supported by the sensitivity analysis. TSA suggested that the total sample size was exceeded TSA monitoring boundary both HR and MBP.