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

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.

SUBMITTER: Koo BW

PROVIDER: S-EPMC6555754 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

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

Koo Bon-Wook BW Oh Ah-Young AY Hwang Jung-Won JW Na Hyo-Seok HS Min Seong-Won SW

BMC anesthesiology 20190607 1

<h4>Background</h4>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.<h4>Methods</h4>In total, 129 female patien ...[more]

PMID: 31170926

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Project description:BackgroundDuring laparoscopic gynecological surgery, increased peak airway pressure (PAWP) can cause airway leak upon ventilation with the LMA® ProSeal™. We hypothesized that compared with the use of volume-controlled ventilation (VCV), the use of the AutoFlow® mode would decrease PAWP and airway leak during laparoscopic gynecological surgery with LMA ProSeal.MethodsThis single-center, randomized, controlled trial allocated 80 adult women undergoing elective laparoscopic gynecological surgery to one of two groups, namely, the AutoFlow group or the VCV group. Ventilation settings for both groups were 8 ml/kg of tidal volume and 5 cmH2O of positive end-expiratory pressure, and respiratory rate was adjusted to maintain end-tidal carbon dioxide at 35-40 mmHg. Airway leak, PAWP, and other ventilatory parameters and vital signs were recorded at four timepoints (1, 1 min after insertion of the gastric tube; 2, 2 min after intravenous administration of rocuronium 0.6-0.8 mg/kg; 3, 1 min after initiation of pneumoperitoneum; and 4, 1 min after changing to the Trendelenburg position). The primary outcome was PAWP during pneumoperitoneum and in the Trendelenburg position, whereas the secondary outcomes included PAWP at other timepoints and airway leak development. We used the Mann-Whitney U test for PAWP and Fisher's exact test for comparing airway leak among the groups.ResultsData from 40 patients in the AutoFlow group and 39 in the VCV group were used for analysis. PAWP at pneumoperitoneum pressure and in the Trendelenburg position was significantly lower in the AutoFlow group than in the VCV group [median (interquartile range), 16 (15-18) cmH2O vs. 18 (17-19) cmH2O; P < 0.001]. Similarly, patients in the AutoFlow group showed lower PAWP at the other three timepoints measured. Airway leak occurred in four patients in the AutoFlow group and in two patients in the VCV group; however, this incidence was not significantly different (P = 0.68).ConclusionsEven though AutoFlow ventilation decreased PAWP, it did not reduce the incidence of airway leak compared with VCV during laparoscopic gynecological surgery with the LMA ProSeal.Trial registrationUMIN Clinical Trials Registry, identifier UMIN000023173 .

Dataset Information

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

Publications

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

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