SummaryTen volunteers evaluated the performance of four currently available manikins: Airway Management Trainer TM , Airway Trainer TM , Airsim TM and Bill 1 TM as simulators for the 16 procedures described in the Difficult Airway Society Guidelines (DAS techniques) and eight other advanced airway techniques (non-DAS techniques), by scoring and ranking each manikin and procedure. Manikin performance was unequal (p < 0.0001 for both SCORE and RANK data for both DAS and non-DAS techniques). Post hoc analysis ranked the manikins for DAS techniques as: 1st Laerdal, 2nd Trucorp, 3rd equal VBM and Ambu. For non-DAS techniques, the ranking was: 1st equal Laerdal and Trucorp, 3rd equal VBM and Ambu. The power to discriminate for individual procedures was considerably lower but for 15 of 16 DAS techniques and 6 of 8 non-DAS techniques, manikin performance differed significantly. Post hoc tests showed significant performance differences between individual manikins for 10 DAS procedures, with the Laerdal manikin performing best.

The new Glidescope performs as well as the Miller laryngoscope under simulated normal and difficult airway conditions.

Even without prior experience and using nonconventional insertion, pediatric PLMAs (including size 1.5) can be easily inserted and provide an effective airway.

Pediatric anesthesiologists appear slow to embrace second-generation SADs. The role of SADs in the management of difficult airways is widely accepted. Research currently has little influence over the choice of which SAD to use, which is more likely determined by personal choice and departmental preference. There is a risk that some SADs are unsafe.

Summary Airway manikins have traditionally been used for teaching mask ventilation and tracheal intubation. There is an increasing need to use manikins for training in procedures such as insertion of the laryngeal mask airway. We have assessed four new airway training manikins (latest versions of the Airway Trainer™ (Laerdal, Norway), Airway Management Trainer™(Ambu, UK), ‘Bill 1’™(VBM, Germany) and Airsim™(Trucorp, Ireland)) as simulators for insertion of the LMA Classic™ laryngeal mask airway. Twenty volunteer anaesthetists inserted a size‐4 laryngeal mask airway five times into each of the four manikins, in random order. Each insertion was assessed using objective and subjective tests. Subjective assessment varied widely but overall assessment indicated that the Airway Management Trainer was the poorest simulator for insertion of the laryngeal mask airway. The ‘Bill 1’ and Airsim manikins performed best as simulators for insertion of the laryngeal mask airway, although realistic ventilation with ‘Bill 1’ was not possible.