Summary

The study evaluated whether five commonly used 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)—accurately predict optimal supraglottic airway (SGA) positioning after blind insertion in adult patients under general anaesthesia. Despite most devices passing these bedside tests (91.4% passed all five), all tests demonstrated high specificity (95–100%) but consistently low sensitivity for identifying suboptimal placement, meaning they rarely flagged poorly positioned SGAs even when visual confirmation showed malposition. OLP had the highest sensitivity at only 28.6%, whereas Ryle’s tube insertion identified none of the suboptimal positions. Receiver operating characteristic analyses showed weak predictive ability for all tests (AUC < 0.7), indicating limited diagnostic value beyond confirming well-placed devices. The authors conclude that while these tests can be used as confirmatory adjuncts, they are not reliable screening tools for detecting malposition, and reliance on them without direct visual confirmation (e.g., video laryngoscopy) may leave many suboptimal placements unnoticed, potentially compromising airway safety.

Chaw, S., Shariffuddin, I., Md Yusof, M. et al. Predicting optimal supraglottic airway device placement: do placement and performance tests measure up?. BMC Anesthesiol 25, 494 (2025). https://doi.org/10.1186/s12871-025-03278-6