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° Rotation Technique

Dhulkhed, Pavan; Khyadi, Sunil; Jamale, P. B.; Dhulkhed, Vithal K

doi:10.5152/tjar.2017.70298

Cited by 11 publications

(19 citation statements)

References 16 publications

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“…The 90° rotation technique was first described by Hwang et al and involves the following steps: the entire cuff of the LMA is inserted inside the mouth, rotated counter-clockwise through 90° and advanced until the resistance of the hypopharynx is felt [11]. The use of this method is known to increase the success rate of insertion and decrease the incidence of blood staining of the LMA and sore throat compared to standard technique when inserting a Proseal LMA and i-gel [11–15]. The 90° rotation technique has the advantage over the previously reported methods that it does not require a separate tool and reduces pharyngeal mucosal trauma.…”

Section: Introductionmentioning

confidence: 99%

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

Koo

Hwang

et al. 2019

BMC Anesthesiol

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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.

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Section: Introductionmentioning

confidence: 99%

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

Koo

Hwang

et al. 2019

BMC Anesthesiol

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“…82 , 83 • Consider rotating the SGA 90° during advancement around the tongue. 84 – 87 • Use an alternate size 88 , 89 or design of SGA, including one with a different cuff material. 90 • In the context of failed tracheal intubation, release any applied cricoid pressure for SGA insertion.…”

Section: Response To Difficulty With Airway Management In the Unconscious Patientmentioning

confidence: 99%

Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 1. Difficult airway management encountered in an unconscious patient

Law

Duggan

Asselin

et al. 2021

Can J Anesth/J Can Anesth

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Purpose Since the last Canadian Airway Focus Group (CAFG) guidelines were published in 2013, the literature on airway management has expanded substantially. The CAFG therefore re-convened to examine this literature and update practice recommendations. This first of two articles addresses difficulty encountered with airway management in an unconscious patient. Source Canadian Airway Focus Group members, including anesthesia, emergency medicine, and critical care physicians, were assigned topics to search. Searches were run in the Medline, EMBASE, Cochrane Central Register of Controlled Trials, and CINAHL databases. Results were presented to the group and discussed during video conferences every two weeks from April 2018 to July 2020. These CAFG recommendations are based on the best available published evidence. Where high-quality evidence was lacking, statements are based on group consensus. Findings and key recommendations Most studies comparing video laryngoscopy (VL) with direct laryngoscopy indicate a higher first attempt and overall success rate with VL, and lower complication rates. Thus, resources allowing, the CAFG now recommends use of VL with appropriately selected blade type to facilitate all tracheal intubations. If a first attempt at tracheal intubation or supraglottic airway (SGA) placement is unsuccessful, further attempts can be made as long as patient ventilation and oxygenation is maintained. Nevertheless, total attempts should be limited (to three or fewer) before declaring failure and pausing to consider “exit strategy” options. For failed intubation, exit strategy options in the still-oxygenated patient include awakening (if feasible), temporizing with an SGA, a single further attempt at tracheal intubation using a different technique, or front-of-neck airway access (FONA). Failure of tracheal intubation, face-mask ventilation, and SGA ventilation together with current or imminent hypoxemia defines a “cannot ventilate, cannot oxygenate” emergency. Neuromuscular blockade should be confirmed or established, and a single final attempt at face-mask ventilation, SGA placement, or tracheal intubation with hyper-angulated blade VL can be made, if it had not already been attempted. If ventilation remains impossible, emergency FONA should occur without delay using a scalpel-bougie-tube technique (in the adult patient). The CAFG recommends all institutions designate an individual as “airway lead” to help institute difficult airway protocols, ensure adequate training and equipment, and help with airway-related quality reviews.

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“…Therefore, 10 RCTs, with 1286 patients, were included in the final meta-analysis (Fig. 1) [7,8,[11][12][13][21][22][23][24][25]. In the study selection, kappa value between two authors was 0.811, indicating excellent agreement.…”

Section: Included and Excluded Studiesmentioning

confidence: 99%

“…In 6 RCTs, the SGA cuff was fully deflated before insertion and was inflated after placement [7,8,[11][12][13]24]. The cuff was partially inflated before insertion in another 2 RCTs [22,23]. The remaining 2 RCTs employed the i-gel TM , which has no cuff [21,25].…”

Section: Included and Excluded Studiesmentioning

confidence: 99%

Standard digit-based versus 90° rotation technique for supraglottic airway device insertion: a meta-analysis of randomized controlled trials

Koo

Jeon

et al. 2022

Korean J Anesthesiol

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Background: Prompt insertion and placement of the supraglottic airway (SGA) devices in the correct position are required to secure the airway. This meta-analysis was performed to validate the usefulness of the 90° rotation technique as compared with the standard digit-based technique for the insertion of SGA devices in anesthetized patients in terms of success rate, insertion time, and postoperative complications.Methods: A literature search of PubMed, EMBASE, CENTRAL, CINAHL, Scopus, and Web of Science was conducted. Randomized controlled trials, without limitations on publication period, language, journal, or region, until July 2021, that compared the 90° rotation and the standard digitbased techniques for insertion of SGA devices in anesthetized patients were included. Results:The first-attempt (risk ratio [RR] 1.16, 95% confidence interval [CI] 1.09 to 1.25, p < 0.001) and overall success rates (RR 1.06, 95% CI 1.03 to 1.09, p < 0.001) were significantly higher in the 90° rotation group. The insertion time was shorter in the 90° rotation group (mean difference -4.42 s, 95% CI -6.90 s to -2.15 s, p < 0.001). The incidences of postoperative sore throat (OR 0.63, 95% CI 0.49 to 0.83, p < 0.001) and blood staining (RR 0.28, 95% CI 0.20 to 0.39, p < 0.001) were lower in the 90° rotation group. Conclusions:The use of the 90° rotation technique increases the success rate of SGA device insertion and decreases pharyngeal mucosal trauma as compared with that of the standard digit-based technique in anesthetized patients.

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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° Rotation Technique

Cited by 11 publications

References 16 publications

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

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

Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 1. Difficult airway management encountered in an unconscious patient

Standard digit-based versus 90° rotation technique for supraglottic airway device insertion: a meta-analysis of randomized controlled trials

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