Title: Comparison of First Attempt Success Rate between Two Insertion Techniques of Proseal Laryngeal Mask Airway
Authors: Dr Madhusoodanan Pillai.C, Dr Sreeja Hariharan
DOI: https://dx.doi.org/10.18535/jmscr/v5i3.170
Abstract
Background: The Pro Seal laryngeal mask airway (ProSeal LMA) is a relatively new laryngeal mask device designed to improve ventilator characteristics and offer protection against aspiration and gastric insufflation. But there were occasional problems like failed insertion and inadequate ventilation, in placing Pro Seal LMA using the classical digital technique. To overcome these problems, newer placement technique like introducer tool placement and Gum elastic bougie aided placement were advised.
Aim: To compare the first attempt success rate between bougie guided insertion versus introducer guided insertion of Pro Seal LMA.
Methodology: This prospective comparative study was conducted in the Dept. of Anesthesiology, Govt. Medical College , Thiruvananthapuram, a tertiary care centre . A total of 100 patients, requiring general anaesthesia with supraglottic airway device, of age between 20-60 years with ASA I and II were enrolled in the study. The enrolled patients were divided randomly into two groups-Group 1and Group 2.
Group 1 -ProSeal LMA insertion by bougie guided technique.
Group 2 -ProSeal LMA insertion of introducer technique.
Data were collected about ease of insertion, number of attempts and time taken to provide an effective airway, efficacy of seal, ease of gastric tube placement, haemodynamic responses and blood staining. Data also collected about postoperative airway morbidity.
Results: The first attempt success rate was high in bougie guided insertion of Pro Seal LMA (98% vs86%). The effective airway time is longer in patients with bougie guided insertion compared to introducer guided insertion
Conclusion: The bougie guided insertion of Pro Seal LMA has a higher first attempt success rate than the introducer technique.
Keywords: airway, ProSeal LMA, technique.
References
1. Brain AIJ, Verghese C, Strube PJ. The LMA ProSeal-a laryngeal mask with an oesophageal vent. Br J Anaesth. 2000; 84:650–4.
2. Lu PP, Brimacombe J, Yang C, Shyr M: ProSeal versus the Classic laryngeal mask airway for positive pressure ventilation during laparoscopic cholecystectomy. Br J Anaesth. 2002, 88 (6): 824-827.
3. Brimacombe J, Keller C: The ProSeal laryngeal mask airway: a randomized, crossover study with the standard laryngeal mask airway in paralyzed, anesthetized patients. Anesthesiology. 2000, 93 (1): 104-109.
4. Lu PP, Brimacombe J, Yang C, Shyr M: ProSeal versus the Classic laryngeal mask airway for positive pressure ventilation during laparoscopic cholecystectomy. Br J Anaesth. 2002, 88 (6): 824-827.
5. Cook TM, Nolan JP, Verghese C, Strube PJ, Lees M, Millar JM, Baskett PJ: Randomized crossover comparison of the proseal with the classic laryngeal mask airway in unparalysed anaesthetized patients. Br J Anaesth. 2002, 88 (4): 527-533.
6. Garcia-Aguado R, Vinoles J, Brimacombe J, Vivo M, Lopez-Estudillo R, Ayala G: Suction catheter guided insertion of the ProSeal laryngeal mask airway is superior to the digital technique. Can J Anaesth. 2006, 53 (4): 398-403.
7. Drolet P, Girard M: An aid to correct positioning of the ProSeal laryngeal mask. Can J Anaesth. 2001, 48 (7): 718-719.
8. Brimacombe J, Keller C: Gum elastic bougie-guided insertion of the ProSeal Laryngeal Mask Airway. Anaesth Intensive Care. 2004, 32 (5): 681-684.
9. Chen HS, Yang SC, Chien CF, Spielberger J, Hung KC, Chung KC: Insertion of the ProSeal laryngeal mask airway is more successful with the Flexi-Slip stylet than with the introducer. Can J Anaesth. 2011, 58 (7): 617-623.
10. Brimacombe J, Keller C: Awake fibreoptic-guided insertion of the ProSeal Laryngeal Mask Airway. Anaesthesia. 2002, 57 (7): 719.
11. Chiu PC, Cheng KI, Tseng KY, Shih CK, Chen MK: Fibreoptic bronchoscopy to facilitate ProSeal laryngeal mask airway insertion in a patient with ankylosing spondylitis. Anaesthesia. 2011, 66 (2): 138-139.
12. BrimacombeJ,berry. Allampatti classify-cation and LMA insertion ;Anaesthesia 1993;8;347
13. McCrory C R, Moriariarity D C, LMA positioning is releated to Mallamptti grading in adult . AnaesthesiaAnalg1995 ; 81;1001-4
14. Brimacombe J, Analysis of1500 LMA usesby one anaesthesist in adults undergoing routine anaesthesia 1996;51;76-80
15. Kihara S, Brimacombe J: Sex-based ProSeal laryngeal mask airway size selection: a randomized crossover study of anesthetized, paralyzed male and female adult patients. AnesthAnalg. 2003, 97 (1): 280-284. table of contents
16. Anitha Nileshwar, shamsundar goyal . Journal of anaesthesia and Clini. Pharmacology 2008 24 (2) 171-75
17. Martinez –Pons .v.ad Madrid .V ease of placement of the LMA proseal with a gastric tube inserted .Anaesthesia and Analgesia
18. AnandKuppusamy and NaheedAzhar;Comparison of bougie-guided insertion of Proseallaryngeal mask airway with digital technique in adults.Indian J Anaesth. 2010 Jan-Feb; 54(1): 35–39.
19. Lopez-Gil M, Brimacombe J. The ProSeal laryngeal mask airway in children. PaediatrAnaesthesia2005; 15: 229–34
20. Arnon M Joffe ,KristopherM Schroeder, John A shelper, Richard E galgon . July 20120www.ija web .org.Doi . Validation of the unassisted GEB guided inseration of
21. Taneja S, Agarwalt M, Dali JS, Agrawal G: Ease of Proseal Laryngeal Mask Airway insertion and its fibreoptic view after placement using Gum Elastic Bougie: a comparison with conventional techniq-ues. Anaesth Intensive Care. 2009, 37 (3): 435-440.
22. Uppal .v and Gangaiah.S and Fletcher. G And Kinsella .J .Randomised cross over comparison between the I gel and LMA –Unique inAnaesthesizedparalysedadults . British journal of anaesthesia .2009 103(6) 882-885.
23. Howath A, Brimacombe J, Keller C. Gum elastic bougie guided insertion of Proseal laryngeal mask airway: A new technique. Anaesth Intensive Care. 2002;30:624–7.
24. EI GANzouri.A , Avramov. MN, Budac .S et al. Proseal LMA verus endotracheal tube ;ease of insertion haemodynamic responses and emergence characteristics. Anaesthesiology 99 A 571,2003
25. Teoh CY, Lim FS: The Proseal laryngeal mask airway in children: a comparison between two insertion techniques. PaediatrAnaesth. 2008, 18 (2): 119-124.
26. Hohlrieder M, Brimacombe J, von Goedecke A, Keller C. Guided insertion of the ProSeal laryngeal mask airway is superior to conventional tracheal intuba-tion by first-month anesthesia residents after brief manikin-only training. Anesth Analg. 2006;103:458–62.
Dr Madhusoodanan Pillai.C
Additional Professor, Dept: of Anesthesiology
Govt. Medical College, Thiruvananthapuram