ProSeal laryngeal mask airway placement: A comparison of blind versus direct laryngoscopic insertion techniques

Abstract

Background and Objectives:The laryngeal mask airway (LMA) ProSeal is most commonly used supraglottic airway device; it is routinely inserted by blind technique. Although blind insertion technique is most widely used, there are many techniques which are available such as priming the drain tube with a guiding instrument such as a suction catheter, a gum elastic bougie, a Flexi-Slip Stylet, direct laryngoscopy, and even a fiber-optic bronchoscope (FOB). The present study was undertaken to compare and assess the placement of LMA ProSeal using blind versus direct laryngoscopy techniques using FOB.Materials and Methods:A prospective randomized comparative study of 110 patients divided into two groups of 55 each as Group I (blind insertion) and Group II (direct laryngoscopic insertion) after satisfying the inclusion criteria. The anatomical position was assessed by flexible FOB and evaluated based on fiber-optic scoring system.Results:In the present study, demographic characteristics, vital parameters, Mallampati score, and Wilson's score were comparable in both the groups (P > 0.05). The fiber-optic score (FOS) 1 in Group II was 78.18% compared to 60% in Group I, but the difference was statistically not significant (P > 0.05). Furthermore, the mean FOS in Group II was slightly high (3.84 ± 0.87) compared to Group II (1.62 ± 0.87), but the difference was statistically not significant (P > 0.05). Further hemodynamic parameters (P > 0.05) and complications (P > 0.05) were comparable in both the groups.Conclusion:The LMA placement scoring was similar in both blind and direct laryngoscopic techniques. Blind insertion technique is a simpler, easier, and has stood the test of time.

Usefulness of bougie-preloaded proseal laryngeal mask airway versus digital insertion technique in correct placement of the device

“…[ 2 ] This could be due to the larger cuff seal, impaction at the back of the mouth, cuff folding over, and failure of the distal cuff to reach its correct position in the hypopharynx, leading to inadequate ventilation. [ 2 ] In order to avoid these problems of digital insertion technique, several newer techniques of PLMA insertion have been devised, such as 90° intraoral rotational technique,[ 4 ] laryngoscopy and FOB-assisted placement,[ 5 ] placement with the assistance of suction catheter,[ 6 ] gastric tube,[ 7 ]and GEB with laryngoscopy assistance. [ 8 ] It is documented that among these techniques, the success rate of PLMA placement with GEB is higher.…”

Comparison of leakage test and ultrasound imaging to validate ProSeal supraglottic airway device placement

“…Various methods described to assess SAD placement include auscultation; leak test; soap-bubble test; suprasternal notch tap test; gel displacement test; thread test; and self-inflating bulb technique. [ 17 18 19 ] On correct placement, ProSeal should make a good seal in the laryngopharynx for adequate ventilation. Seal pressure measurement, invasive bronchoscopic visualization, and USG neck examination can confirm the seal.…”