Title: Comparison of Standard Brain Technique & 900 Rotational Technique of Proseal LMA Insertion in Adults
Authors: Narasimhanmk, Chitra Devi, Karthik Prakasam, Mohamed Ashiq.M, Gowri Shankar Anjaneyan, Satish Logidasan, Kanimozhi Rathinasamy, Arulraj Panchatcharam, Prasana Vadhanan, SR Karthik, Satish C
DOI: https://dx.doi.org/10.18535/jmscr/v6i1.76
Abstract
Introduction
The laryngeal mask airway (LMA) is a supraglottic airway device, developed by Dr. ARCHIE BRAIN of the United Kingdom in 1981. He describes it as an alternative device to either the endotracheal tube or the face mask for either spontaneous or positive pressure ventilation1.The most important feature of the LMA is that it provides a rapid control over the airway. It is faster and easier to insert LMA than the endotracheal intubation1. The Proseal Laryngeal mask airway (Proseal LMA) was designed by Dr. Archie Brain in 2000 which he describes as an LMA with an oesophageal vent2. The Proseal LMA is a revolutionary new airway device with modifications to separate the respiratory and gastrointestinal tracts thereby providing an improved seal and reducing the risk of aspiration, regurgitation and gastric insufflation.
The manufacturer recommends using two methods for inserting the Proseal LMA3; using digital insertion technique like LMA classic (index finger or thumb technique) or with an introducer tool like the intubating LMA. Several techniques have hence been described to improve the insertion success rate. Drolet and Girard4 described the use of a gastric tube, Brimacombe and Keller5 the use of fibreoptic bronchoscopy, Howarth et al 6the use of a gum elastic bougie and Garcia Aguado et al 7 the use of a suction catheter for Proseal LMA insertion. The main cause of failed insertion was identified as impaction at the back of the mouth 8, and a slight lateral approach has been used to manoeuvre around when a tactile resistance was felt at the back of the mouth. Another technique used to insert the Proseal LMA, the 900 rotational technique, has been described in several studies. In these studies they hypothesized that insertion of Proseal LMA with a 90-degree rotation would reduce the contact surface between the Proseal LMA and the pharyngeal wall and make it easy to advance the Proseal LMA around the lateral surface of the tongue and over the smooth angle against the posterior pharyngeal wall into the hypopharynx.
Keywords-laryngeal mask airway (lma), supraglottic airway device, proseallma
