Fiberoptic assessment of laryngeal mask airway placement: a comparison of blind insertion and insertion with the use of a laryngoscope

N, Chandan S; Sharma, Sunil; Raveendra, U S; Prasad, B. Rajendra

doi:10.1007/s12663-009-0025-8

Cited by 27 publications

(28 citation statements)

References 11 publications

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“…Our low ideal view rates of fiberoptic bronchoscopy using standard cLMA insertion techniques are similar to previous reports [17,18], but much lower than lightwand-guided cLMA insertion, although our anesthesiologists have more than 80 times of standard cLMA insertion experience compared to only 10 times of lightwand-guided cLMA insertion experience. Our study further demonstrated that the depths of LMA insertion using standard cLMA insertion technique are significantly deeper than lightwand-guided LMA insertion technique, which might contribute to the low ideal view rates of fiberoptic bronchoscopy using standard cLMA insertion techniques.…”

Section: Discussionsupporting

confidence: 87%

“…Correct LMA positioning is not only important for providing satisfactory ventilation during LMA management but also for reducing the risk of air leak, airway mucus membrane injury, regurgitation, and aspiration [18,20]. However, the recommended LMA insertion technique is blind insertion, and the accuracy depends heavily on a subjective feeling of resistance from when an anesthesiologist pushes the LMA down the palatopharyngeal curve and the phenomenon that the LMA "pop up" slightly when the LMA cuff is inflated after insertion [21,22].…”

Section: Discussionmentioning

confidence: 99%

“…The glottic view was only classified into 2 categories, ideal view (Fig. 1f, full vocal cords with or without posterior epiglottis) and un-ideal view (other situations) [17,18]. Up to 3 attempts were allowed before tracheal intubation was performed.…”

Section: Methodsmentioning

confidence: 99%

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A comparison of classic laryngeal mask airway insertion between lightwand- and standard index finger–guided techniques

Zheng

Gao

et al. 2016

Journal of Clinical Anesthesia

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

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A comparison of classic laryngeal mask airway insertion between lightwand- and standard index finger–guided techniques

Zheng

Gao

et al. 2016

Journal of Clinical Anesthesia

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“…Suggested techniques for LMA Flexible insertion include the use of the stylet [9], spatula introducer [10], Bosworth introducer [11] and the Flexiguide introducer [12]. There have been no randomised studies examining successful placement of the LMA Flexible with different [14]. However, both studies focused on the use of the LMA Classic in patients presenting for head and neck surgery.…”

Section: Discussionmentioning

confidence: 99%

A randomised controlled trial comparing two insertion techniques for the Laryngeal Mask Airway Flexible™ in patients undergoing dental surgery

2012

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SummaryThe Laryngeal Mask Airway Flexible TM (LMA Flexible) has been widely utilised for dental, ophthalmology and otorhinolaryngology-related procedures. Our study evaluates two different techniques of inserting the LMA Flexible for patients undergoing day-case dental surgery. One hundred and eight patients were randomly assigned into two groups based on the LMA Flexible insertion technique -either laryngoscopy-guided (n = 54) or digital manipulation (standard technique; n = 54). Patient and airway characteristics were recorded before induction of anaesthesia. The primary outcome was success rate at first insertion. Other outcomes assessed included fibreoptic assessment of laryngeal mask airway placement, haemodynamic changes, need for airway adjustment during surgery and sore throat. The success rate of insertion on the first attempt was higher for the laryngoscopy-assisted technique compared with the standard technique (96.3% vs 81.5%, respectively, p < 0.05). Fibreoptic assessment showed that the former group had better placement of the laryngeal mask airway than the latter (59.3% vs 37% p < 0.05). There were no significant differences between the two groups for haemodynamic changes. Sore throat was more common in the group with the standard technique (35.2% vs 16.7%, p < 0.05). Our study suggests the use of the laryngoscope to guide insertion of the LMA Flexible for dental surgery is a better option compared with the standard technique of digital manipulation. Laryngeal Mask Co. Limited, Mahe, Seychelles) has been widely used for dental, head and neck-related surgery [1][2][3]. The cuff portion is identical to the classic version of the LMA, but the LMA Flexible has a long and nonrigid flexometallic tube, which may make insertion more challenging. This unique design allows greater movement of the tube without displacement of the cuff or loss of seal. The head and neck may be turned with a decreased risk of airway dislodgement during surgery. Studies have detailed its usefulness compared with tracheal intubation in dental day surgery patients [4,5], but few studies have examined different techniques of insertion. Therefore, we evaluated the use of a laryngoscopy-guided technique as an alternative to the standard technique of digital manipulation for insertion of the LMA Flexible, in adult patients presenting for day-case dental surgery.

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“…The blind insertion technique described by Brain is most widely used [3], but insertion of the LMA is not always smooth and anaesthetic gas leakage and gastric insufflation may occur [1, 4]. For achieving the ideal anatomical position of the LMA, various techniques, including insertion with the use of a laryngoscope, have been described [5, 6]. This technique was designed to control the tongue and displace the epiglottis superiorly so that the LMA can be placed over the tongue at a position below the epiglottis, with minimal resistance from the oral soft tissues [5].…”

Section: Introductionmentioning

confidence: 99%

Conditions for laryngeal mask airway placement in terms of oropharyngeal leak pressure: a comparison between blind insertion and laryngoscope-guided insertion

Kim

et al. 2019

BMC Anesthesiol

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BackgroundInsertion under laryngoscopic guidance has been used to achieve ideal positioning of the laryngeal mask airway (LMA). However, to date, the efficacy of this technique has been evaluated only using fiberoptic evaluation, and the results have been conflicting. Other reliable tests to evaluate the efficacy of this technique have not been established. Recently, it has been suggested that the accuracy of LMA placement can be determined by clinical signs such as oropharyngeal leak pressure (OPLP). The aim of this study was to assess the efficacy of LMA insertion under laryngoscopic guidance using OPLP as an indicator.MethodsAfter approved by the institutional ethics committee, a prospective comparison of 100 patients divided into 2 groups (50 with blind technique and 50 with the laryngoscope technique) were evaluated. An LMA (LarySeal™, Flexicare medical Ltd., UK) was inserted using the blind approach in the blind insertion group and using laryngoscopy in the laryngoscope-guided insertion group. The OPLP, fiberoptic position score, whether the first attempt at LMA insertion was successful, time taken for insertion, ease of LMA insertion, and adverse airway events were recorded.ResultsData were presented as mean ± standard deviation. The OPLP was higher in the laryngoscope-guided insertion group than in the blind insertion group (21.4 ± 8.6 cmH2O vs. 18.1 ± 6.1 cmH2O, p = 0.031). The fiberoptic position score, rate of success in the first attempt, ease of insertion, and pharyngolaryngeal adverse events were similar between both groups. The time taken for insertion of the LMA was significantly longer in the laryngoscope-guided insertion group, compared to blind insertion group (35.9 ± 9.5 s vs. 28.7 ± 9.5 s, p < 0.0001).ConclusionLaryngoscope-guided insertion of LMA improves the airway seal pressure compared to blind insertion. Our result suggests that it may be a useful technique for LMA insertion.Trial registrationcris.nih.go.kr, identifier: KCT0001945 (2016-06-17).

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Fiberoptic assessment of laryngeal mask airway placement: a comparison of blind insertion and insertion with the use of a laryngoscope

Abstract: Blind insertion technique is easier and simpler method for insertion of LMA and has a reasonable success during insertion, so it is recommended to be used.

Cited by 27 publications

References 11 publications

A comparison of classic laryngeal mask airway insertion between lightwand- and standard index finger–guided techniques

A comparison of classic laryngeal mask airway insertion between lightwand- and standard index finger–guided techniques

A randomised controlled trial comparing two insertion techniques for the Laryngeal Mask Airway Flexible™ in patients undergoing dental surgery

Conditions for laryngeal mask airway placement in terms of oropharyngeal leak pressure: a comparison between blind insertion and laryngoscope-guided insertion

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