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. 2017 Apr;45(2):98-102.
doi: 10.5152/TJAR.2017.70298. Epub 2017 Apr 1.

A Prospective Randomised Clinical Trial for the Comparison of Two Techniques for the Insertion of Proseal Laryngeal Mask Airway in Adults-Index Finger Insertion Technique versus 90° Rotation Technique

Pavan V Dhulkhed  1 , Sunil V Khyadi  2 , Parbati B Jamale  3 , Vithal K Dhulkhed  3
Affiliations

A Prospective Randomised Clinical Trial for the Comparison of Two Techniques for the Insertion of Proseal Laryngeal Mask Airway in Adults-Index Finger Insertion Technique versus 90° Rotation Technique

Pavan V Dhulkhed et al. Turk J Anaesthesiol Reanim. 2017 Apr.

Abstract

Objective: The 90° rotation technique for inserting the Proseal laryngeal mask airway (PLMA) is reported to be better than the standard index finger insertion technique to improve the insertion success rate. The objective of this study was to evaluate and compare the ease of insertion through the 90° rotation and standard insertion techniques in terms of number of attempts, duration of insertion and occurrence of complications.

Methods: One hundred and twenty adult patients were allocated to either a standard technique group or rotation technique group with 60 patients in each. In the rotation technique group, the entire cuff of the PLMA was placed in the patient's mouth in a midline approach without finger insertion, rotated 90° counter-clockwise around the patient's tongue, advanced and rotated back until resistance was felt.

Results: The success rate of the rotation technique group at the first insertion attempt was greater than that of the standard index finger insertion technique (98% vs. 78%; p=0.001), and less time for insertion was required (11.88±3.62 s vs. 25.98±10.92 s; p<0.0001). The incidence of post-operative sore throat was lower (15% vs. 38.34%; p=0.0067), and blood staining on the PLMA was less (11.7% vs. 45%; p<0.0001). The increase in the mean arterial pressure was more in the standard technique group.

Conclusion: The 90° rotation technique has a higher success rate at first insertion attempt for inserting the ProSeal LMA than the index finger insertion technique with less time for insertion and fewer side effects.

Keywords: 90° rotation technique; LMA insertion techniques; ProSeal LMA; airway management; laryngeal masks.

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Conflict of interest statement

Conflict of Interest: No conflict of interest was declared by the authors.

Figures

Figure 1
Figure 1
Haemodynamic changes MAP: mean arterial pressure; HR: heart rate; BMP: beats per minute
See this image and copyright information in PMC

References

    1. Brain AIJ, Verghese C, Strube PJ. The LMA ‘ProSeal’--a laryngeal mask with an oesophageal vent. Br J Anaesth. 2000;84:650–4. https://doi.org/10.1093/bja/84.5.650. - DOI - PubMed
    1. Keller C, Brimacombe J. Mucosal pressure and oropharyngeal leak pressure with the proseal versus the classic laryngeal mask airway in anaesthetized paralysed patients. Br J Anaesth. 2000;85:262–6. https://doi.org/10.1093/bja/85.2.262. - DOI - PubMed
    1. Nakayama S, Osaka Y, Yamashita M. The rotational technique with a partially inflated laryngeal mask airway improves the ease of insertion in children. Paediatr Anaesth. 2002;12:416–9. https://doi.org/10.1046/j.1460-9592.2002.00847.x. - DOI - PubMed
    1. Koay CK, Yoong CS, Kok P. A randomized trial comparing two laryngeal mask airway insertion techniques. Anaesth Intensive Care. 2001;29:613–5. - PubMed
    1. Soh CR, Ng ASB. Laryngeal mask airway insertion in paediatric anesthesia: comparison between the reverse and standard techniques. Anaesth Intense Care. 2001;29:515–9. - PubMed

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