Comparison of oropharyngeal leak pressures between blind versus under-vision insertion of supraglottic airways in adults undergoing surgery under general anesthesia: a systematic review and meta-analysis

INTRODUCTION: Oropharyngeal leak pressure (OPLP) is an objective measure of the airway seal provided by a supraglottic airway (SGA) around the glottis. While under-vision insertion techniques improve the anatomic placement of SGAs vs. blind insertion techniques, evidence regarding their impact on OPLP remains inconclusive. EVIDENCE ACQUISITION: March 2025. Randomized controlled trials (RCTs) comparing blind insertion techniques vs. under-vision placement of SGAs in anesthetized adults reporting OPLP were included. The primary objective was to compare the OPLP between under-vision and blind placement of SGAs. Secondary objectives included comparison of SGA positioning, insertion time, first-attempt success rates, peak inspiratory pressures (PIP), ease of SGA and gastric tube insertion, and postoperative complications. EVIDENCE SYNTHESIS: =44.33%). Under-vision techniques also demonstrated better anatomical positioning with fiberoptic bronchoscopy (log odds ratio: 1.90; 95% CI: 0.76 to 3.03; P