Comparison of the ease of laryngeal mask airway ProSeal insertion and the fiberoptic scoring according to the head position and the presence of a difficult airway

Abstract

BackgroundThe sniffing position is recommended for conventional laryngeal mask airway (LMA) insertion. However, there has been a high success rate of LMA insertion with the head in the neutral position. The effect of a difficult airway on the ease of LMA insertion is not clear. In this study, we compared the ease of LMA ProSeal™ (PLMA) insertion and the fiberoptic scoring according to the head position and the presence of a difficult airway.MethodsAfter obtaining informed consent from the subjects, we enrolled 144 adult patients (age range: 18-65) with an ASA physical status 1 or 2. After evaluation of the airway, all the patients were grouped into the EA (easy airway) group (n = 68) and the DA (difficult airway) group (n = 76). According to the head position, each group was divided into the EA-SE (extension) group (n = 35), the EA-SN (sniffing) group (n = 33), the DA-SE group (n = 39) and the DA-SN group (n = 37). The success rate and insertion time at the first attempt were evaluated. The position of the PLMA was fiberoptically scored from the mask aperture of the airway tube in the original head position. After the head position was changed to the sniffing and neutral positions in the SE and SN group, respectively, the position of PLMA was re-evaluated fiberoptically.ResultsThe success rate and insertion time at the first attempt and the fiberoptic score showed no significant difference among the groups. After head position was changed, there were no significant changes in the fiberopitc scores.ConclusionsA difficult airway and the head position had no influence on the ease of PLMA insertion and the fiberopic score. Therefore, the head position can be selected according to the individual patient's situation.

Comparison of the Proseal, Supreme, and I‐Gel SAD in Gynecological Laparoscopic Surgeries

“…There was no difference among the groups in terms of imaging classification. Jun et al [ 12 ] recorded the head position of patients and reported that the fiberoptic image does not change.…”

Airway Assessment for Office Sedation/Anesthesia

“…15 Unfortunately, there are no universally recognized or adopted predictors of the difficulty of insertion of advanced supraglottic airways that are important airway adjuncts as part of the airway rescue algorithm. 16,17 There appears to be no correlation between the success of laryngeal mask placement and the Mallampati scoring system. 18 Some physical findings that may predict a difficult airway are listed in Table 6.…”

Head elevation and laryngeal mask airway Supreme insertion: A randomized controlled trial

“…A success of laryngeal mask airway insertion was defined as normal chest movement and a square wave of capnograph 20‐22 . If the third attempt failed, it was regarded as a failure.…”

“…The LMA Supreme was pressed against the hard palate and advanced into the hypopharynx until resistance was felt. The success of LMA Supreme insertion was defined as normal chest movement and a square wave of capnograph 20‐22 . Only one attempt was allowed before insertion was considered a first attempt success.…”