• Muthuraj Kanakaraj, Adithya D Bhat, Narinder P Singh, Sennaraj Balasubramanian, Abhay Tyagi, Rohan Aathreya, and Preet M Singh.
• Washington University in Saint Louis, Anaesthesiology Barnes Jewish Hospital, Saint Louis, MO, USA.
• Br J Anaesth. 2024 Dec 1; 133 (6): 128413061284-1306.

BackgroundOver the last two decades, significant research interest has led to the development of a wide variety of supraglottic airways (SGAs) for anaesthesia providers to choose from.MethodsIn this network meta-analysis, we analysed 111 studies, enrolling 12 045 patients undergoing airway management with 29 SGAs. We targeted outcomes that contribute to clinicians' choice of one SGA over another. The primary outcome was the incidence of postoperative sore throat (POST). Secondary outcomes were first-attempt insertion success, bleeding complications, and oropharyngeal leak pressure (OLP). Based on credible intervals, we created a 'rank order' to guide decision-making for clinicians.ResultsThe highest-ranking devices based on credible intervals for POST, bleeding complications, first-attempt insertion success, and OLP were LMA Ambu, Jcerity Endoscoper, LMA Blockbuster, and LMA Baska Mask, respectively. Air-Q and i-gel ranked favourably across multiple outcomes, with i-gel being the only device to rank within the top six SGAs for POST, bleeding, and first-attempt success despite ranking poorly for OLP.ConclusionsOur data support the use of LMA-Ambu, Jcerity-Endoscoper, Air-Q, and i-gel when considering patient-centred outcomes. Clinician familiarity with these devices and their continued expansion into anaesthetic practice will have important implications on the perioperative patient experience.Systematic Review ProtocolPROSPERO (CRD42022383136).Copyright © 2024 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

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