Comparison of standard versus 90° rotation technique for LMA Flexible™ insertion: a randomized controlled trial

Bon-Wook Koo, Ah-Young Oh, Jung-Won Hwang, Hyo-Seok Na, Seong-Won Min, Bon-Wook Koo, Ah-Young Oh, Jung-Won Hwang, Hyo-Seok Na, Seong-Won Min

Abstract

Background: Insertion of a flexible laryngeal mask airway (LMA Flexible) is known to be more difficult than that of a conventional laryngeal mask airway. The 90° rotation technique can improve the success rate with a conventional laryngeal mask airway but its effect with the LMA Flexible remains unknown. We assessed whether the 90° rotation technique increased the first-attempt success rate of LMA Flexible insertion versus the standard technique.

Methods: In total, 129 female patients undergoing breast surgery were analyzed. The primary endpoint was success at the first attempt. The insertion time, number of trials, number of manipulations required, and oropharyngeal leak pressure were also evaluated. Heart rate and mean blood pressure were recorded 1 min before and 1 min after insertion. Blood staining on the LMA Flexible after removal and postoperative sore throat were checked.

Results: The first-attempt success rates were comparable between the groups (93% vs. 98.3%, P = .20). The insertion time, number of trials and manipulations, hemodynamic variables, and complications, such as blood staining and sore throat, did not differ between the groups.

Conclusions: The 90° rotation technique is a good alternative to the standard technique for insertion of the LMA Flexible.

Trial registration: ClinicalTrials.gov ( NCT03028896 ). It was registered retrospectively at Jan 19th, 2017.

Keywords: LMA flexible.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
CONSORT diagram

References

    1. Drake-Brockman TF, Ramgolam A, Zhang G, Hall GL, von Ungern-Sternberg BS. The effect of endotracheal tubes versus laryngeal mask airways on perioperative respiratory adverse events in infants: a randomised controlled trial. Lancet. 2017;389:701–708. doi: 10.1016/S0140-6736(16)31719-6.
    1. Yu SH, Beirne OR. Laryngeal mask airways have a lower risk of airway complications compared with endotracheal intubation: a systematic review. J Oral Maxil Surg. 2010;68:2359–2376. doi: 10.1016/j.joms.2010.04.017.
    1. Patki A. Laryngeal mask airway vs the endotracheal tube in paediatric airway management: a meta-analysis of prospective randomised controlled trials. Indian J Anaesth. 2011;55:537–541. doi: 10.4103/0019-5049.89900.
    1. Apfelbaum JL, Hagberg CA, Caplan RA, et al. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2013;118:251–270. doi: 10.1097/ALN.0b013e31827773b2.
    1. Welsh BE. Use of a modified Magill's forceps to place a flexible laryngeal mask. Anaesthesia. 1995;50:1002–1003. doi: 10.1111/j.1365-2044.1995.tb05897.x.
    1. Shimoda O, Yoshitake A. Stylet for reinforced laryngeal mask airway. Anaesthesia. 2002;57:1140–1141. doi: 10.1046/j.1365-2044.2002.288110.x.
    1. Bosworth A, Jago RH. The Bosworth introducer for use with the flexible reinforced laryngeal mask airway. Anaesthesia. 1997;52:281–282.
    1. Kil HK, Koo BN, Park JH, Kim WO. The spatula introducer for insertion of the flexible reinforced laryngeal mask airway (RLMA) Can J Anaesth. 2005;52:117–118. doi: 10.1007/BF03018598.
    1. Brimacombe J, Keller C. Comparison of the flexible and standard laryngeal mask airways. Can J Anaesth. 1999;46:558–563. doi: 10.1007/BF03013546.
    1. Keller C, Brimacombe J. The influence of head and neck position on oropharyngeal leak pressure and cuff position with the flexible and the standard laryngeal mask airway. Anesth Analg. 1999;88:913–916. doi: 10.1213/00000539-199904000-00042.
    1. Hwang JW, Park HP, Lim YJ, Do SH, Lee SC, Jeon YT. Comparison of two insertion techniques of ProSeal laryngeal mask airway: standard versus 90-degree rotation. Anesthesiology. 2009;110:905–907. doi: 10.1097/ALN.0b013e31819b5d40.
    1. Jeon YT, Na HS, Park SH, et al. Insertion of the ProSeal laryngeal mask airway is more successful with the 90 degrees rotation technique. Can J Anaesth. 2010;57:211–215. doi: 10.1007/s12630-009-9241-4.
    1. Kim HC, Yoo DH, Kim HJ, Jeon YT, Hwang JW, Park HP. A prospective randomised comparison of two insertion methods for i-gel placement in anaesthetised paralysed patients: standard vs rotational technique. Anaesthesia. 2014;69:729–734. doi: 10.1111/anae.12680.
    1. Yun MJ, Hwang JW, Park SH, et al. The 90 degrees rotation technique improves the ease of insertion of the ProSeal laryngeal mask airway in children. Can J Anaesth. 2011;58:379–383. doi: 10.1007/s12630-010-9452-8.
    1. Dhulkhed PV, Khyadi SV, Jamale PB, Dhulkhed VK. 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 degrees rotation technique. Turk J Anaesthesiol Reanim. 2017;45:98–102. doi: 10.5152/TJAR.2017.70298.
    1. Instruction for use-LMA Classic™, LMA Flexible™, LMA Flexible™ Single Use & LMA Unique™. Ireland: Teleflex Medical, 2013.
    1. Choo CY, Koay CK, Yoong CS. A randomised controlled trial comparing two insertion techniques for the laryngeal mask airway flexible in patients undergoing dental surgery. Anaesthesia. 2012;67:986–990. doi: 10.1111/j.1365-2044.2012.07167.x.
    1. Flynn P, Ahmed FB, Mitchell V, Patel A, Clarke S. A randomised comparison of the single use LMA flexible with the reusable LMA flexible in paediatric dental day-case patients. Anaesthesia. 2007;62:1281–1284. doi: 10.1111/j.1365-2044.2007.05234.x.
    1. Kuna ST. Respiratory-related activation and mechanical effects of the pharyngeal constrictor muscles. Respir Physiol. 2000;119:155–161. doi: 10.1016/S0034-5687(99)00110-3.
    1. Fujiwara A, Komasawa N, Nishihara I, et al. Muscle relaxant effects on insertion efficacy of the laryngeal mask ProSeal((R)) in anesthetized patients: a prospective randomized controlled trial. J Anesth. 2015;29:580–584. doi: 10.1007/s00540-015-1982-3.
    1. Grady DM, McHardy F, Wong J, Jin F, Tong D, Chung F. Pharyngolaryngeal morbidity with the laryngeal mask airway in spontaneously breathing patients: does size matter? Anesthesiology. 2001;94:760–766. doi: 10.1097/00000542-200105000-00012.
    1. Kim MH, Hwang JW, Kim ES, Han SH, Jeon YT, Lee SM. Comparison of the size 3 and size 4 ProSeal laryngeal mask airway in anesthetized, non-paralyzed women: a randomized controlled trial. J Anesth. 2015;29:256–262. doi: 10.1007/s00540-014-1916-5.
    1. Aghdashi MM, Hasanloei MAV, Abbasivash R, Shokohi S, Gharrehvaran S. Comparison of the success rate of laryngeal mask airway insertion in classic & rotatory methods in pediatric patients undergoing general anesthesia. Anesth Pain Med. 2017;7:e38899. doi: 10.5812/aapm.38899.
    1. L'Hermite J, Dubout E, Bouvet S, et al. Sore throat following three adult supraglottic airway devices: a randomised controlled trial. Eur J Anaesthesiol. 2017;34:417–424. doi: 10.1097/EJA.0000000000000539.
    1. El-Boghdadly K, Bailey CR, Wiles MD. Postoperative sore throat: a systematic review. Anaesthesia. 2016;71:706–717. doi: 10.1111/anae.13438.
    1. Ramachandran SK, Mathis MR, Tremper KK, Shanks AM, Kheterpal S. Predictors and clinical outcomes from failed laryngeal mask airway unique: a study of 15,795 patients. Anesthesiology. 2012;116:1217–1226. doi: 10.1097/ALN.0b013e318255e6ab.
    1. Jaensson M, Gupta A, Nilsson U. Gender differences in sore throat and hoarseness following endotracheal tube or laryngeal mask airway: a prospective study. BMC Anesthesiol. 2014;14:56. doi: 10.1186/1471-2253-14-56.
    1. Keller C, Puhringer F, Brimacombe JR. Influence of cuff volume on oropharyngeal leak pressure and fibreoptic position with the laryngeal mask airway. Br J Anaesth. 1998;81:186–187. doi: 10.1093/bja/81.2.186.
    1. Qamarul Hoda M, Samad K, Ullah H. ProSeal versus classic laryngeal mask airway (LMA) for positive pressure ventilation in adults undergoing elective surgery. Cochrane Database Syst Rev. 2017;7:CD009026.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel