Comparison of Ultrasound Examination and Fiberoptic Laryngoscopy for Confirmation of Laryngeal Mask Airway Placement

Abstract

Objectives 1) To compare ultrasound (US) examination and fiberoptic laryngoscopy (FOL) for confirmation of laryngeal mask airway (LMA) placement. 2) To evaluate the necessity for reinsertion of LMA based on FOL. Methods This prospective observational study included 100 adult patients of American Society of Anesthesiologists (ASA) Grade I and II, undergoing elective surgery under General Anesthesia requiring Proseal LMA™ placement as an airway device. LMA placement was first confirmed by clinical tests. Clinically acceptable patients were further assessed by US and categorized as acceptable (US‐A) or unacceptable (US‐U) and again by FOL as (FOL‐A and FOL‐U). Categorical variables presented in number, percentage (%), and continuous variables presented as mean ± SD and median. Inter‐rater kappa agreement was used to find out the strength of agreement of acceptability between FOL and US. Results The LMA placement was clinically acceptable in 82% of patients on first attempt. FOL had 63% (FOL‐A) acceptable LMA placement as compared with US examination which had 56% (US‐A). In 85% of patients, US and FOL findings were in good agreement with each other for LMA placement (κ = 0.690 and P < .05). In all patients of FOL of unacceptable (FOL‐U) category (37%), LMA was replaced with endotracheal tube. Conclusion US provides a safe, non‐invasive, and real‐time dynamic assessment with 85% diagnostic accuracy for confirmation of LMA placement as compared with FOL.