Evidence map›Paper›PMID 41087887›Full record

Observational studyBMC anesthesiology2025

Predicting optimal supraglottic airway device placement: do placement and performance tests measure up?

Sook Hui Chaw, Ina Ismiarti Shariffuddin, Md Ariff Md Yusof, Cheng Weng Wong, Shairil Rahayu Ruslan, Nur Azreen Hussain, Mohd Fitry Zainal Abidin, André van Zundert

Registry-linked trialAbstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in BMC anesthesiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03643029 (The Accuracy of the Performance and Placement Test for Predicting Supraglottic Airway Device), which is not on this map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03643029 naunknown statusnot on this map

The Accuracy of the Performance and Placement Test for Predicting Supraglottic Airway Device (SAD) Position in the Hypopharynx as Confirmed With Video Laryngoscopy

TypeinterventionalSponsorUniversity of MalayaRan2018 to 2020Enrolled50ConditionsGeneral Anesthesia, Supraglottic Airway Device, Laryngeal Mask AirwayArmsVideo-laryngoscopy following SAD insertion
3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Trial
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Sook Hui ChawDepartment of Anaesthesiology, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
Ina Ismiarti ShariffuddinDepartment of Anaesthesiology, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia. ismiarti@ummc.edu.my.
Md Ariff Md YusofDepartment of Anaesthesiology, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
Cheng Weng WongDepartment of Anaesthesiology, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
Shairil Rahayu RuslanDepartment of Anaesthesiology, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
Nur Azreen HussainDepartment of Anaesthesiology, University Malaya Medical Centre, 59100, Kuala Lumpur, Malaysia.
Mohd Fitry Zainal AbidinDepartment of Anaesthesiology, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
André van ZundertDepartment of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital and The University of Queensland, Brisbane, Queensland, Australia.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundBlind insertion of Supraglottic airway device (SGA) frequently results in suboptimal positioning, with reported incidence rate of 50–80%. Improper placement can lead to perioperative complications such as hypoxia and aspiration. This study evaluates the diagnostic accuracy of five clinical placement and performance tests – oropharyngeal leak pressure (OLP), suprasternal notch test (SNT), bubble test (BT), Ryle’s tube insertion test, and maximum minute ventilation (MMV) – as surrogates for assessing SGA position in the hypopharynx following blind insertion.

methodsThis single-centre, non-randomised observational study included seventy adult patients (ASA I–III) undergoing elective surgery under general anaesthesia with SGA (Ambu® AuraGain™ or LMA® Supreme™). After induction of anaesthesia, the SGA was inserted with a blind technique. Placement and performance tests were conducted, followed by video laryngoscopic (VL) confirmation of the SGA position. Diagnostic accuracy was assessed using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and receiver operating characteristic (ROC) analysis.

resultsOf the seventy patients, 91.4% passed all five tests. All tests demonstrated high specificity (95–100%), with MMV and SNT achieving 100% specificity. Sensitivity for detecting suboptimal placement was low across all tests, with OLP showing the highest sensitivity (28.6%), followed by SNT, BT, MMV (14.3% each), and Ryle’s Tube Insertion (0%). ROC analysis indicated weak predictive ability for all tests (AUC < 0.7). Postoperative complications were minimal, with 37.1% showing blood-stained SGAs and 7.1% reporting minor sore throat.

conclusionWhile OLP, SNT, BT and MMV tests exhibit high specificity for confirming optimal SGA positioning, these tests are not reliable screening tools for detecting suboptimal placement. Their high specificity supports their use only as confirmatory adjuncts, not as stand-alone diagnostics. Clinical reliance on these tests may give a false sense of security, especially in the absence of visual confirmation.

trial registrationThe study was registered in ClinicalTrials.gov (ClinicalTrials.gov identifier: NCT03643029) on 20 August 2018.

Indexed as

Airway ManagementIntubation, IntratrachealLaryngeal MasksAdultAgedAnesthesia, GeneralElective Surgical ProceduresFemaleHumansLaryngoscopyMaleMiddle AgedPredictive Value of TestsSensitivity and SpecificityAirway managementDiagnostic accuracyLaryngeal maskSupraglottic airway devices

Identifiers

PMID41087887
PMCPMC12523069

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.