Guided Insertion of the ProSeal Laryngeal Mask Airway Is Superior to Conventional Tracheal Intubation by First-Month Anesthesia Residents After Brief Manikin-Only Training

Abstract

In the following pilot study, we compared conventional laryngoscope-guided tracheal intubation (tracheal intubation) and laryngoscope-guided, gum elastic bougie-guided ProSeal laryngeal mask airway insertion (guided ProSeal) for airway management by first-month anesthesia residents after brief manikin-only training. Five first-month residents with no practical experience of airway management were observed performing these techniques in 200 ASA I-II anesthetized, paralyzed adults. Each resident managed 40 patients, 20 in each group, in random order. The number of insertion attempts, effective airway time, ventilatory capability during pressure-controlled ventilation set at 15 cm H2O, airway trauma, and skill acquisition were studied. Data were collected by unblinded observers. Insertion was more frequently successful (100% versus 65%) and effective airway time was shorter (41 +/- 24 s versus 89 +/- 62 s) in the guided ProSeal group (both P < 0.0001). Expired tidal volume was larger (730 +/- 170 mL versus 560 +/- 140 mL) and end-tidal CO(2) lower (33 +/- 4 mm Hg versus 37 +/- 5 mm Hg) in the guided ProSeal group during pressure controlled ventilation (both P < 0.0001). Blood staining was more frequent on the laryngoscope (24% versus 2%; P < 0.0001) in the tracheal intubation group. There was evidence for skill acquisition in both groups. We conclude that laryngoscope-guided, gum elastic bougie-guided insertion of the ProSeal laryngeal mask airway is superior to conventional laryngoscope-guided tracheal intubation for airway management in terms of insertion success, expired tidal volume, and airway trauma by first-month anesthesia residents after brief manikin-only training. The guided ProSeal technique has potential for cardiopulmonary resuscitation by novices when conventional intubation fails.

Airtraq, LMA CTrach and Macintosh Laryngoscopes in Tracheal Intubation Training: A Randomized Comparative Manikin Study

“…However, tracheal intubation attempts performed by inexperienced medical staff have a high failure rate (15,16). Therefore, the authors of this article believe that training on the widely used video-laryngoscopic procedures may be included in the scope of internship programmes.…”

Evaluation der neuen Kehlkopfmasken Ambu AuraOnce™ und Intersurgical i-gel™

“…Sudhir et al [20] konnten mit 92% ein ähnlich gutes Ergebnis für die AuraOnce im Vergleich zu der cL-MA (84%) erzielen. In einer Studie von Hohlrieder et al [14] gelang die Insertion der PLMA unerfahrenen Anästhesis-ten in 65% der Fälle. Wurde jedoch ein "gum elastic bougie" verwendet, konnte der Platzierungserfolg auf 100% gesteigert werden.…”

Einfluss von Kopfposition und Muskelrelaxierung auf die Effektivität der supraglottischen Atemwegssicherung

“…96,3% (LTS). Allerdings werden für wenig erfahrene Anwender in der Literatur deutlich niedrigere Erfolgsraten bei der SAW-Platzierung beschrieben [28,29], sodass trotz einer im Vergleich zur endotrachealen Intubation leichteren Anwendbarkeit der SAWs [1,13,21] auch bei diesen Atemwegshilfen von einer klinisch relevanten Lernkurve ausgegangen werden muss.…”