Suction catheter guided insertion of ProSeal laryngeal mask airway: Experience by untrained physicians

Abstract

Background:The use of suction catheter (SC) has been shown to improve success rate during ProSeal laryngeal mask airway (PLMA) insertion in expert users.Aims:The aim of this study was to compare insertion of PLMA performed by untrained physicians using a SC or the digital technique (DT) in anaesthetised non-paralysed patients.Methods:In this prospective randomised double-blind study, conducted in the operating setting, 254 patients (American Society of Anaesthesiologists I-II, aged 18-65 years), undergoing minor surgery were enrolled. Exclusion criteria were body mass index >35 kg/m2, laryngeal or oesophageal varices, risk of aspiration or difficult face mask ventilation either referred or suspected (Langeron's criteria ≥2) and modified Mallampati classification score >2. Participants were randomly allocated to one of the two groups in which PLMA was inserted using DT (DT-group) or SC (SC-group).Statistical Analysis:Chi-square test with Yates’ correction, Mann-Whitney U-test or Student's t-test were carried-out as appropriate.Results:The final insertion success rate was greater in SC-groupcompared with DT-group 90.1% (n = 109) versus 74.4% (n = 99) respectively (P = 0.002). Mean airway leak pressure was higher in SC-group compared to DT-group (23.7 ± 3.9 vs. 21.4 ± 3.2 respectively; (P = 0.001). There were no differences in insertion time, post-operative airway morbidity and complications.Conclusion:The findings of this study suggest that SC-technique improves the success rate of PLMA insertion by untrained physicians.

Complications Associated with the Use of Supraglottic Airway Devices in Perioperative Medicine

“…It is recommended that the position should be checked by following the manufacturer's recommendations or by the passage of a gastric tube. Novel techniques have been described for insertion using the gum-elastic bougie [ 35 ], gastric tubes [ 36 ], and suction catheters [ 37 ]. Less experienced users may benefit from the gastric tube-guided insertion of the PLMA [ 38 ].…”

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

“…Different insertion techniques have been studied to find an optimal method for LMA ProSeal insertion. A variety of techniques have been developed to facilitate insertion of the LMA ProSeal including priming the drain tube with a guiding instrument such as a suction catheter,[ 8 ] a gastric tube,[ 9 ] a gum elastic bougie,[ 10 ] a Flexi-Slip Stylet,[ 1 ] and even a FOB. [ 2 3 ]…”

Looped suction catheter in an i-gel™; something to worry about or much ado about nothing?

“…They showed the main cause of failed PLMA insertion with suction catheter technique was misplacement of the suction catheter. [5] Our patient did not have any gastric regurgitation but a looped suction catheter increases risk of aspiration of gastric contents because i-gel™ has lower sealing pressures among the second generation supraglottic airway devices, making it less safe for patients at increased risk of aspiration. This report brings to light that such unexpected complications may occur and thus a prompt visual inspection of the transparent body of the i-gel™ after insertion should be made to recognize any malpositioning of the suction catheter.…”