Insertion of the ProSeal™ laryngeal mask airway is more successful with the 90° rotation technique

Abstract

Purpose The 90°rotation technique for inserting the ProSeal TM laryngeal mask airway (PLMA) in anesthetized paralyzed patients was compared with the index finger insertion technique. Methods One hundred twenty Asian adult patients were randomly allocated to either a standard technique group or a rotation technique group. A PLMA size 4 was used for women and size 5 was used for men. In the standard technique group (n = 60), the PLMA was inserted using the index finger. In the rotation technique group (n = 60), the entire cuff of the PLMA was placed in the patient's mouth in a midline approach without finger insertion, rotated 90°c ounter clockwise around the patient's tongue, advanced and then rotated back until resistance was felt. The primary outcome was success at first insertion. Secondary outcome measures were insertion time and complications. Results The success rate at first insertion was greater for the rotation technique group than for the standard technique group (100% vs 83%, respectively; P = 0.003), and less time was required (11 ± 3 sec vs 19 ± 16 sec, respectively; P = 0.03). The incidence of postoperative sore throat was lower for the rotation technique group than for the standard technique group (12% vs 33%, respectively; P = 0.009), and blood staining on the PLMA was less (8% vs 40%, respectively; P \ 0.001).Conclusion The 90°rotation technique for inserting the PLMA is more successful than the standard index finger insertion technique. It is associated with fewer side effects, such as blood on the PLMA and sore throat, which suggests it causes less pharyngeal trauma. (Clinical trial registration number: NCT00966186). RésuméObjectif La technique de rotation a`90°pour inse´rer le masque larynge´ProSeal TM (PLMA) chez des patients anesthe´sie´s curarise´s a éte´compare´e à la technique d'insertion avec l'index. Méthode Cent vingt patients adultes asiatiques ont e´teá le´atoirement re´partis en deux groupes, soit un groupe avec technique d'insertion standard et l'autre avec technique de rotation. Un masque PLMA de taille 4 a e´te´utilise´chez les femmes et un masque de taille 5 chez les hommes. Dans le groupe avec technique d'insertion standard (n = 60), le PLMA a e´te´inse´re´a`l'aide de l'index. Dans le groupe avec technique de rotation (n = 60), la manchette du PLMA a e´te´place´e en entier dans la bouche du patient a`l'aide d'une approche par ligne me´diane sans insertion de doigt, tourne´e de 90°dans le sens inverse des aiguilles d'une montre autour de la langue du patient, avance´e puis retourne´e jusqu'a`ressentir une re´sistance. Le crite`re d'e´valuation principal e´tait la re´ussite a`la premie`re insertion. Les crite`res d'e´valuation secondaires comprenaient le temps d'insertion et les complications. Résultats Le taux de re´ussite a`la premie`re insertion e´tait plus e´leve´dans le groupe avec technique de rotation que dans le groupe avec technique d'insertion standard (100 %

A prospective randomised comparison of two insertion methods for i-gel™placement in anaesthetised paralysed patients: standard vs rotational technique

“…This success rate is consistent with previous reports, in which the primary success rate for i-gel insertion with the standard technique was 78-93% [8,10,17]. Our previous reports comparing two insertion techniques for the ProSeal LMA showed that the success rate at the first attempt was significantly higher in the rotation group than in the standard technique group [13][14][15], similar to the present study using the i-gel. Our findings suggest that the standard digital technique to insert supraglottic airway devices such as the i-gel or ProSeal LMA should be replaced with the rotational technique to increase the first-attempt insertion success rate.…”

“…A recent case report showed that the reverse technique for i-gel insertion, with the device inserted into the mouth upside-down, may be useful to improve the insertion success rate when the first attempt by the standard technique fails [12]. Our previous studies demonstrated that the rotational technique provides a higher success rate at the first attempt with less pharyngeal mucosal trauma than the standard technique for insertion of the ProSeal TM laryngeal mask airway (LMA) [13][14][15]. To our knowledge, there have been no previous reports regarding the efficacy of the rotational technique for i-gel insertion.…”

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

“…Sample size: A previous study reported 17% higher success rate with the 90 degree rotation technique (19). Expecting a minimum difference of 17% in the success rate we chose a sample size of 60 patients per group.…”

“…The technique simply consists of insertion of the PLMA into the oral cavity, 90° rotation around the tongue and advancement (19). It may seem that rotating the large cuff inside the mouth may be difficult, but it is easy to insert PLMAs using the rotation insertion technique.…”

Comparison of two insertion techniques of classic laryngeal mask airway: standard versus 90-degree rotation

“…This result was similar to the previous study conducted by Hwang et al in 160 patients and Jeon et al in 120 patients. 9,14 It was observed that there were multiple attempts in standard technique. Four patients in ST group had two insertion attempts & nine patients had three insertion attempts.…”