Summary of findings for the main comparison. Early removal of the LMA versus late removal of the LMA after general anaesthesia.
| Early removal of the LMA versus late removal of the LMA after general anaesthesia | ||||||
| Patient or population: patients with general anaesthesia Settings: operating room Intervention: early removal of the LMA | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control | Early removal of the LMA | |||||
| Laryngospasm (immediate) | Study population1 | RR 1.23 (0.74 to 2.03) | 1615 (11 studies) | ⊕⊕⊝⊝ low2,3 | ||
| 27 per 1000 | 33 per 1000 (20 to 55) | |||||
| Low1 | ||||||
| 6 per 1000 | 8 per 1000 (5 to 13) | |||||
| High1 | ||||||
| 85 per 1000 | 105 per 1000 (63 to 173) | |||||
| Desaturation (immediate) | Study population4 | RR 0.68 (0.40 to 1.16) | 2037 (13 studies) | ⊕⊝⊝⊝ very low2,3,5 | ||
| 101 per 1000 | 69 per 1000 (40 to 117) | |||||
| Low4 | ||||||
| 9 per 1000 | 6 per 1000 (4 to 11) | |||||
| High4 | ||||||
| 280 per 1000 | 190 per 1000 (112 to 325) | |||||
| Airway obstruction (immediate) | Study population6 | RR 2.69 (1.32 to 5.50) | 1313 (8 studies) | ⊕⊕⊝⊝ low2,5 | ||
| 46 per 1000 | 122 per 1000 (60 to 250) | |||||
| Low6 | ||||||
| 11 per 1000 | 30 per 1000 (15 to 61) | |||||
| High6 | ||||||
| 80 per 1000 | 215 per 1000 (106 to 440) | |||||
| Coughing (immediate) | Study population6 | RR 0.52 (0.29 to 0.94) | 1430 (11 studies) | ⊕⊝⊝⊝ very low2,7 | ||
| 194 per 1000 | 101 per 1000 (56 to 182) | |||||
| Low6 | ||||||
| 76 per 1000 | 40 per 1000 (22 to 71) | |||||
| High6 | ||||||
| 293 per 1000 | 152 per 1000 (85 to 275) | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1 The assumed risk for laryngospasm is derived from the included studies, Splinter 1997 and Sinha 2006, who reported second lowest and second highest control group risks, respectively, for laryngospasm. 2 Quality of evidence downgraded by one level due to lack of allocation concealment and blinding. 3 Quality of evidence was downgraded by one level as the pooled estimate of effect includes both no effect and appreciable benefit/harm. 4 The assumed risk for desaturation is derived from the included studies, Thomas 2012 and Baird 1999, who reported second lowest and second highest control group risks, respectively, for both outcomes. 5 Quality of evidence downgraded by one level due to moderate unexplainable heterogeneity (I2 = 52%). 6 The assumed risk for airway obstruction and coughing are derived from the included studies, Varughese 1994 and Baird 1999, who reported second lowest and second highest control group risks, respectively, for this outcome. 7 Quality of evidence downgraded by two levels due to significant heterogeneity (I2 = 75%).