Disposable laryngeal tube suction--a randomized comparison of two insertion techniques performed by novice users in anaesthetised patients

Abstract

Objective: Laryngeal tubes are supraglottic airway devices that can be used in alternative to a tracheal tube to provide ventilation during cardiopulmonary resuscitation. The product line has recently been expanded by the disposable laryngeal tube suction (LTS-D). We tested the hypothesis that, with a modified insertion technique (MIT), the rate of correct placement attempts within 45 s could be significantly increased compared to the standard insertion technique (SIT) recommended by the manufacturer.

Methods: Fifty-four adult patients undergoing trauma surgery under general anaesthesia had an LTS-D inserted by first-time users, randomly assigned to the SIT or a MIT. A brief manikin-based demonstration of the device and the assigned technique was given before insertion. In the MIT the tip of the LTS-D was rotated by 180 degrees prior to insertion. Forced chin lift to create sufficient retropharyngeal space was performed with the other hand. Introduced to one-third of its length, the LTS-D was again rotated by 180 degrees and pushed down the pharynx. The rate of successful tube placements within 45 s was the main outcome variable.

Results: Insertion took 73+/-41 s (SIT) and 40+/-8s (MIT, P<0.01). Insertion within 45 s was possible in n=7/27 patients (26%, SIT) and in n=20/27 patients (74%, MIT, P<0.01). In one patient of the MIT group, placement failed. Non-anaesthesia personnel, such as nurses and emergency medical technicians (n=27), performed comparably to board-certified anaesthesiologists or those in training (n=27).

Conclusion: Applying a MIT significantly reduced the time for successful insertion of an LTS-D by first-time users. Insertion within 45 s was significantly more frequent with this technique. Further studies need to be conducted to determine if the LTS-D can be recommended as a first-line airway during cardiopulmonary resuscitation.