Laryngeal mask airway: a more successful method of insertion

Matta, Basil F.; Marsh, Deborah S.; Nevin, M.

doi:10.1016/0952-8180(94)00027-2

Cited by 57 publications

(48 citation statements)

References 24 publications

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“…The success rate for firsttime insertion is lower for the PLMA than for the LMA, and more time is required to achieve an effective airway, even when it is inserted by a well-trained physician. [1][2][3] Strategies, such as partial inflation of the cuff 4 and the use of an introducer 5 and a laryngoscope 6 guide, have been investigated to improve the ease of insertion of PLMAs. The 90°rotation technique was introduced to improve success with inserting the PLMA.…”

Section: Résumémentioning

confidence: 99%

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

Jeon

Park

et al. 2010

Can J Anesth/J Can Anesth

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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 %

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Section: Résumémentioning

confidence: 99%

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

Jeon

Park

et al. 2010

Can J Anesth/J Can Anesth

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“…A The issue of whether to insert the device with a partially or fully inflated cuff has not been addressed directly for the FT-LMA; however, the issue has been discussed for the C-LMA. Some investigators 6,7 have found inserting the C-LMA easier and generating less oropharyngeal trauma with a partially or fully inflated cuff.…”

Section: General Insertion Techniquementioning

confidence: 99%

The FastrachTM Intubating Laryngeal Mask Airway®: an overview and update

Gerstein

Braude

Hung

et al. 2010

Can J Anesth/J Can Anesth

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Purpose To provide an evidence-based overview and update on the use of the Fastrach TM Intubating Laryngeal Mask AirwayÒ (FT-LMA) when used within operative and non-operative settings. Principal findings The FT-LMA is available in three sizes to provide ventilation and the ability to pass an endotracheal tube (ETT) into the trachea blindly, semi-blindly, or with indirect visualization for patients over 30 kg. The Chandy maneuver is recommended routinely; the first maneuver optimizes ventilation, and the second maneuver increases success at endotracheal intubation (ETI). The manufacturer's reinforced tube or a pre-warmed or reversed standard ETT may be utilized. Insertion and ventilation are successful in almost all patients. Blind ETI is highly successful; adjuncts are generally not necessary. The FT-LMA has a proven role in the airway management of anticipated difficult operating room (OR) intubations, unanticipated OR intubations, cervical spine injuries, and limited airway access situations. Literature in the pre-hospital and emergency department settings is limited but favourable. The FT-LMA has compared favourably with fibreoptic intubation, the LMA-Classic TM , the laryngeal tube, and the CobraPLA TM . Initially, the more expensive LMA CTrach TM appeared to be more successful, but overall it is not. The FT-LMA airway seal pressures are excellent; serious complications are uncommon, and the FT-LMA figures prominently in most difficult airway guidelines. Conclusions The FT-LMA has proven to be a useful difficult airway device both within and outside of the operating room. Effective ventilation is established in nearly all cases, and blind ETI is possible in the vast majority of cases if the optimal techniques described are used. Serious complications are uncommon. Constatations principales Le FT-LMA est disponible en trois tailles pour permettre la ventilation et le passage d'une sonde endotrache´ale (SET) dans la trache´e de façon aveugle, semi-aveugle ou avec visualisation directe chez les patients pesant plus de 30 kg. La manoeuvre de Chandy est recommande´e de façon routinie`re; la premie`re manoeuvre optimise la ventilation, et la seconde augmente le succe`s lors d'une intubation endotrache´ale (IET). La sonde arme´e du fabricant ou une SET standard pre´chauffe´e ou inverse´e peut eˆtre utilise´e. L'insertion et la ventilation re´ussissent chez presque tous les patients. L'IET en aveugle a un taux de re´ussite e´leve´; en re`gle ge´ne´rale, les accessoires ne sont pas ne´cessaires. Le FT-LMA joue un rôle e´prouve´dans la prise en charge des voies ae´riennes lors d'intubations anticipe´es comme difficiles dans la salle d'ope´ration (SOP), d'intubations impre´vues en SOP, de le´sions de la colonne cervicale et dans les situations oul 'acce`s aux voies ae´riennes est limite´. La litte´rature portant sur son utilisation dans des contextes pre´-hospitaliers et dans le de´partement des urgences est restreinte mais favorable. Le FT-LMA a e´te´favorablement compare´al 'intubation par fibroscopie, au LMA...

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“…It does not involve the use of additional introducer aids. The reported first attempt success rate is 67%-90% with the standard cLMA insertion technique (13,14), whereas it is 86% in adults and 99% in children with the rotation insertion technique (3,15). With regard to the success rate and ease of cLMA insertion, the 90° rotation insertion technique has not been widely studied in adult populations (16,17).…”

mentioning

confidence: 99%

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

Dhulkhed¹,

Khyadi²,

Jamale³

et al. 2017

Turk J Anaesth Reanim

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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: LMA insertion techniques, 90° rotation technique, airway management, laryngeal masks, ProSeal LMA Amaç: Proseal laringeal maske havayolunun (PLMA) takılma-sında 90° rotasyonla takma tekniğinin başarı oranının standart işaret parmağıyla takma tekniğinden daha yüksek olduğu bildirilmektedir. Bu çalışmanın amacı 90° rotasyonla takma tekniğini ve standart teknikleri, takma girişimi sayısı, işlemin süresi ve komplikasyonlar açısından değerlendirmek ve karşı-laştırmaktır.Yöntemler: Yüz yirmi yetişkin hasta standart teknik grubu veya rotasyon tekniği grubuna, her grupta 60 hasta olacak şekilde dağıtıldı. Rotasyon tekniği grubunda, PLMA kafı tamamen hastanın ağzına parmak sokulmadan orta hat yaklaşımıyla yerleştirildi, hastanın dilinin çevresinde saat yönü tersine 90° döndürüldü, ilerletildi ve direnç hissedilene kadar geri dön-dürüldü. Bulgular:Rotasyon tekniği grubunun ilk girişimdeki başa-rı oranı standart işaret parmağıyla takma tekniğinden daha yüksekti (%98'e karşı %78; p=0,001) ve işlem süresi daha kısaydı (11,88±3,62 sn'ye karşı 25,98±10,92 sn; p<0,0001). Ameliyat sonrası boğaz ağrısı insidansı daha düşüktü (%15'e karşı %38,34; p=0,0067) ve PLMA'da kan lekesi daha azdı (%11,7'ye karşı %45; p<0,0001). Ortalama arter basıncındaki artış, standart teknik grubuna göre daha fazla bulundu.Sonuç: Proseal LMA'nın takılması açısından, 90° rotasyon tekniğinin ilk girişimdeki başarı oranı işaret parmağıyla takma tekniğinden daha yüksekti. İşlem süresi daha kısaydı ve yan etkileri daha azd...

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Laryngeal mask airway: a more successful method of insertion

Cited by 57 publications

References 24 publications

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

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

The FastrachTM Intubating Laryngeal Mask Airway®: an overview and update

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

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