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Laryngeal mask airway insertion by classic and thumb insertion technique: a comparison.

ABSTRACT: We evaluated the efficacy of an alternative technique, for insertion of the silicone laryngeal mask airway (LMA) Classic™ in 40 American Society of Anesthesiologists grade ASA I and II patients scheduled for elective surgery. In group I (Index Finger group), the LMA was inserted by the classic index finger technique and, in group T (Thumb Insertion group), the thumb insertion technique was used. Ease of insertion, fiberoptic laryngoscopic position, cuff pressures and laryngopharyngeal morbidity were assessed in both study groups. On statistical analysis, both groups were comparable in all respects. From our study it can be concluded that thumb insertion is an effective insertion technique for the LMA Classic™.

SUBMITTER: Goyal M

PROVIDER: S-EPMC3790608 | biostudies-literature | 2013

REPOSITORIES: biostudies-literature

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Laryngeal mask airway insertion by classic and thumb insertion technique: a comparison.

Goyal Monica M Dutt Akanksha A Khan Joad Anjum S AS

F1000Research 20130509

We evaluated the efficacy of an alternative technique, for insertion of the silicone laryngeal mask airway (LMA) Classic™ in 40 American Society of Anesthesiologists grade ASA I and II patients scheduled for elective surgery. In group I (Index Finger group), the LMA was inserted by the classic index finger technique and, in group T (Thumb Insertion group), the thumb insertion technique was used. Ease of insertion, fiberoptic laryngoscopic position, cuff pressures and laryngopharyngeal morbidity ...[more]

PMID: 24358868

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Project description:BackgroundProSeal (PLMA) and Supreme (SLMA) laryngeal mask airways are effective ventilator devices with distinctive designs that may require different anaesthetics for insertion. Sevoflurane induction provides acceptable conditions for laryngeal mask insertion, and remifentanil significantly decreases the minimum alveolar concentration of sevoflurane required for that insertion. The study aimed to evaluate the optimal end-tidal (ET) sevoflurane concentration for successful insertion of PLMA versus SLMA in patients receiving a remifentanil infusion without a neuromuscular blocking agent.MethodsAltogether, 45 patients ASA (American Society Anaesthesiologists) physical status I-II, aged 18-60 years were scheduled for elective ambulatory surgery. Exclusion criteria were a difficult airway, recent respiratory infection, reactive airway, obstructive sleep apnoea syndrome, gastric aspiration's risk factors, pregnancy, and lactation. Patients were randomly allocated to receive the SLMA or the PLMA. Sevoflurane induction with co-administration of remifentanil was performed at an effect-site concentration of 4 ng mL- 1. ET50 was calculated with a modified Dixon's up-and-down method (starting at 2.5% in steps of 0.5%). Predetermined sevoflurane concentration was kept constant during the 10 min before LMA insertion. Patient's response to LMA insertion was classified as "movement" or "no movement". Sevoflurane ET50 was determined as the midpoint concentration of all the independent pairs that manifested crossover from "movement" to "no movement".ResultsThe ET50 sevoflurane concentration co-administered with remifentanil required for PLMA insertion was 1.20 ± 0.41% (95% confidence interval 0.76 to 1.63%). For SLMA insertion, it was 0.55 ± 0.38% (95% confidence interval 0.14 to 0.95%) (p = 0.019).ConclusionsThe end-tidal sevoflurane concentration with co-administered remifentanil required to allow insertion of the SLMA was 54% lower than that needed for inserting the PLMA.Trial registrationClinicaltrials.gov identifier: NCT03003377. Retrospectively registered. Date of registration: December 28, 2016.

Project description:The Guardian Laryngeal Mask Airway (G-LMA) is a new silicone-based single-use extraglottic device with the drainage port and a cuff pilot valve with pressure indicator. The aim of this study is to compare the clinical performance of this laryngeal mask airway with ProSeal laryngeal mask airway (P-LMA).In this prospective randomized study, we included adult patients with ASA grading I and II scheduled for elective surgery requiring supine position under total intravenous anesthesia. The patients were randomly allocated to two groups, 40 in each. G-LMA and P-LMA were used in groups G and P respectively. The cuff of each device was air inflated to 60 cmH2O. The primary outcome was to compare the airway sealing pressure and the secondary outcome was to compare the efficacy and safety of these two devices with respect to insertion success, insertion time, ease of insertion, volume of air for cuff inflation to 60 cmH2O, intracuff pressure measurement, gastric tube insertion attempt, gastric tube insertion time, Fiberoptic laryngeal view, and postoperative pharyngolaryngeal morbidity.The airway sealing pressure at 60 cmH2O cuff pressure was significantly greater in G-LMA than P-LMA (p?=?0.04).The first successful attempt of both groups were comparable (p?=?1.000). Insertion time was significantly shorter in G-LMA than P-LMA (p?<?0.0001). The first successful attempt for the gastric tube insertion in both groups was comparable (p?=?0.431). Gastric tube insertion time was less in G-LMA than in P-LMA (p?<?0.0001). The volume of air for cuff inflation to 60 cmH2O was more in G-LMA than in P-LMA (<0.0001). The intracuff pressure measurement at 30, 60, 90 and 120 minutes were comparable (p?=?0.823, 0.182, 0.870, 0.658).We did not find differences in ease of insertion (p?=?0.60); Fiber-optic positions of airway devices were comparable (p?=?0.83). In addition, blood staining (p?=?1.00), sore throat and dysphagia at 1, 2 and 24 hour (p?=?1.00) were comparable in both groups.The Guardian laryngeal mask airway was associated with high airway sealing pressure with a quicker insertion of the device as well as gastric tube.Clinical Trial.gov Identifier: NCT02063516. Date: June 2013.

Project description:BackgroundInsertion of laryngeal mask airway (LMA) requires an adequate depth of anesthesia. Optimal insertion conditions and hemodynamic stability during LMA insertion are mainly influenced by the choice of the intravenous induction agent. Propofol was recommended as a standard induction agent for LMA insertion. Due to unavailability and cost for treatment Propofol is not easily availed, thus this study aimed at assessing the effect of thiopentone with lidocaine spray compared to Propofol on hemodynamic change and LMA insertion on the patient undergoing elective surgery.MethodsEighty-four participants were followed in a prospective cohort study based on the induction type of either thiopentone-lidocaine group (TL) or Propofol (P). Hemodynamic variables, LMA insertion condition, apneic time, and cost of treatment during the perioperative time were recorded. Data were checked for normality using the Shapiro-Wilk test. Numeric data were analyzed unpaired student's t-test or Manny Whitney test. Categorical data were analyzed by the chi-square test. A p-value ≤ 0.05 was considered a statistically significant difference.ResultThe comparison of data showed that a significant reduction in mean arterial blood pressure (MAP) in the Propofol group during the first 10 min. The MAP at first minute after LMA insertion was 78.4 ± 5.5 in the Propofol group compared to 81.8 ± 5.6 in thiopentone-lidocaine group p < 0.001. the mean MAP at 5th and 10th minutes after LMA insertion is also significantly lower in the Propofol group compared to the thiopentone-lidocaine group, p < 0.05. There were no statistically significant differences regarding the heart rate change and insertion conditions between the two groups. Mean apneic time was 138 ± 45.8 s in the Propofol group and 85 ± 13.8 s in thiopentone-lidocaine group p < 0.001. Thiopentone-lidocaine group had a lower treatment cost compared to the Propofol group.ConclusionThiopentone with 10% topical Lignocaine is an alternative for the insertion of LMA to Propofol, with better hemodynamic stability and cost-effectiveness.

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Laryngeal mask airway insertion by classic and thumb insertion technique: a comparison.

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Laryngeal mask airway insertion by classic and thumb insertion technique: a comparison.

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