Conditions for laryngeal mask airway placement in terms of oropharyngeal leak pressure: a comparison between blind insertion and laryngoscope-guided insertion

Abstract

BackgroundInsertion under laryngoscopic guidance has been used to achieve ideal positioning of the laryngeal mask airway (LMA). However, to date, the efficacy of this technique has been evaluated only using fiberoptic evaluation, and the results have been conflicting. Other reliable tests to evaluate the efficacy of this technique have not been established. Recently, it has been suggested that the accuracy of LMA placement can be determined by clinical signs such as oropharyngeal leak pressure (OPLP). The aim of this study was to assess the efficacy of LMA insertion under laryngoscopic guidance using OPLP as an indicator.MethodsAfter approved by the institutional ethics committee, a prospective comparison of 100 patients divided into 2 groups (50 with blind technique and 50 with the laryngoscope technique) were evaluated. An LMA (LarySeal™, Flexicare medical Ltd., UK) was inserted using the blind approach in the blind insertion group and using laryngoscopy in the laryngoscope-guided insertion group. The OPLP, fiberoptic position score, whether the first attempt at LMA insertion was successful, time taken for insertion, ease of LMA insertion, and adverse airway events were recorded.ResultsData were presented as mean ± standard deviation. The OPLP was higher in the laryngoscope-guided insertion group than in the blind insertion group (21.4 ± 8.6 cmH2O vs. 18.1 ± 6.1 cmH2O, p = 0.031). The fiberoptic position score, rate of success in the first attempt, ease of insertion, and pharyngolaryngeal adverse events were similar between both groups. The time taken for insertion of the LMA was significantly longer in the laryngoscope-guided insertion group, compared to blind insertion group (35.9 ± 9.5 s vs. 28.7 ± 9.5 s, p < 0.0001).ConclusionLaryngoscope-guided insertion of LMA improves the airway seal pressure compared to blind insertion. Our result suggests that it may be a useful technique for LMA insertion.Trial registrationcris.nih.go.kr, identifier: KCT0001945 (2016-06-17).

Comparison of videolaryngoscope-guided versus standard digital insertion techniques of the ProSeal™ laryngeal mask airway: a prospective randomized study

“…Kim et al showed that the rate of success at the first attempt was similar between standard digital and laryngoscope-guided insertion [14]. However, many other studies that used different LMA types indicated that the laryngoscope-guided insertion technique is more successful than were the digital or rotational techniques [8, 11, 14, 15, 23]. Additionally, the laryngoscope-guided, gum elastic bougie-guided technique was superior to the digital and introducer technique [4].…”

“…It was first reported by Lee that the laryngoscope can improve the placement of LMA in an adult [10]. Then, direct laryngoscopy alone or laryngoscope-assisted guided techniques were used for this purpose [4, 8, 11–14]. These methods do have theoretical disadvantages, such as haemodynamic and airway stimulation and pharyngeal or oesophageal trauma [4, 8].…”

Perbandingan Teknik Insersi Triple Airway Maneuver dengan Teknik Laringoskopi Terhadap Keberhasilan Insersi dan Profil Hemodinamik Pemasangan Laryngeal Mask Airway (LMA) Klasik pada Operasi Elektif

“…21 20,22 Penelitian Kim dkk (2019) menyebutkan bahwa hal ini berkaitan teknik laringoskopi untuk memfasilitasi insersi LMA dengan cara mengangkat dengan lembut (gentle) epiglotis dan tidak diperlukan untuk membuka rongga trakeal atau pita suara (glotis). 23,24 Selain daripada itu, keuntungan teknik insersi LMA laringoskopi tidak memerlukan bantuan asisten untuk melakukan insersi. Sedangkan pada teknik insersi TAM diperlukan asisten untuk melakukan manipulasi TAM.…”

Frequency of excellent Laryngeal mask airway insertion conditions in children undergoing elective surgery: A comparison of propofol with ketofol.

“…2 LMAs have been used widely during general anesthesia, they have certain benefits over conventional bag mask ventilation in terms of freeing anesthetist′s hands and lesser complications. 3 Rather than crossing the vocal cords like endotracheal tube it sits over the cords. It is equally useful both in elective and emergency surgeries as well in adults and children.…”