Laryngeal mask airway insertion in children: comparison between rotational, lateral and standard technique

Ghai, Babita; Makkar, Jeetinder Kaur; Bhardwaj, Neerja; Jd, Wig

doi:10.1111/j.1460-9592.2008.02434.x

Cited by 48 publications

(61 citation statements)

References 22 publications

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“…This may be because of our technique as we inserted the LMA with inflated cuff while its lumen facing laterally forces the mouth to open wider and keeps the tongue from being pushed back into the air passage which results in easy insertion. Ghai et al in a review showed that there is a high success rate at first attempt whereas time required for successful insertion and incidence of trauma are less in rotational technique compared to lateral and standard technique in children which is not similar to our study [20]. It may be because of the anatomical difference of airway between adult and children: a relatively large tongue, a relatively large and flappy epiglottis, a cephalad and more anterior larynx and more acute angle of posterior pharyngeal wall to the floor of mouth [23].…”

Section: Many Anesthesiologists Do Not Use the Brain Technique Properlycontrasting

confidence: 90%

Comparison of Three Methods for Laryngeal Mask Airway Insertion in Adults: Standard, Lateral and Rotational

Mahmoodpoor¹

2015

Ann Clin Anal Med

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ÖzetAmaç: Laringeal Maske Havayolu (LMH) yerleştirilmesinde, başarısız, uzamış ve birden fazla deneyimler, solunum yan etkileri ve travmaya sebep olabilirler. Bu nedenle, en uygun yerleştirilme tekniğini belirlemek çok önem taşımakta-dır. Bu çalışmanın amacı, laringeal maske havayolu yerleştirilme kolaylığın-da, standart yöntem ile yatay ve dönüşümlü (rotasyonel) teknikleri karşılaştı-rılmaktır. Gereç ve Yöntem: LMH ile genel anestezi planlanan 150 erişkin hastaya, randomize şekilde ileride belirtilen üç teknikten biri uygulandi: Standart, dönüşümlü (rotasyonel) ve yatay. LMH yerleştirilme süresi, deneme sayısı ve başarı oranı tüm hastalar için kaydedildi. Bulgular: Üç grup arasında, hastaların demografik özellikleri arsında anlamlı bir fark saptanmamıştır. LMH yerleştirilme süresi ve hastaların tahriş edilmesi yatay tekniğinde önemli ölçüde daha az idi (P <0.001). LMH yerleştirilme genel başarı oranı karşılaştırılma-sında, üç grup arasında anlamlı bir fark bulunmamıştır (p değeri: 0,06). Ancak, yatay girişim grubuna karşı olumlu bir eğilim vardır. Tartışma: LMH yerleştirilmesinde yatay teknik, kolay uygulanan, ağız arkasina sıkıştırma gerektirmeyen, böylece daha az çaba ve en az komplikasyon oluşturan bir yöntem-dir. Bu yüzden bizim bu çalışmada gösterdiğimiz gibi, 90 derece rotasyonel teknik veya lateral tekniği, LMH yerleştirilmesi için en iyi yol olarak kabul edilebilir gibi görünüyor. Anahtar Kelimeler LMH; Karşılaştırma; Yerleştirilme; Teknik AbstractDetermination of an optimal Laryngeal Mask Airway (LMA) insertion technique is of great importance as unsuccessful prolonged insertion and multiple attempts are associated with adverse respiratory effects and trauma. The purpose of this study was to compare the ease of insertion of LMA using the standard approach with lateral and rotational techniques. 150 adult patients undergoing general anesthesia using LMA were randomized into one of the three mentioned techniques: standard, rotational and lateral. The time for LMA insertion, number of LMA insertion attempts and LMA insertion success rate were noted for all patients. Demographic characteristic of patients between three groups did not have significant difference. Patient movement and time for LMA insertion and time for LMA insertion was significantly less in lateral technique (P<0.001). The overall success rate for LMA insertion between three groups was not of significant difference (P= 0.06); however, there was a positive trend toward the lateral insertion group. Lateral technique is practically easy, does not require pushing toward the back of the mouth and consequently is associated with the least complications. Therefore, it seems that the 90 degrees rotational or lateral techniques might be considered as the best ways for LMA insertion.

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Section: Many Anesthesiologists Do Not Use the Brain Technique Properlycontrasting

confidence: 90%

Comparison of Three Methods for Laryngeal Mask Airway Insertion in Adults: Standard, Lateral and Rotational

Mahmoodpoor¹

2015

Ann Clin Anal Med

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“…The current investigation has addressed this by using the lateral insertion technique [10], which has a higher reported success rate in children [9,10] than the Brain's technique. Despite making this change, the rate of successful LMA insertion remains similar to that we previously reported, and comparable to success rates reported for adult cardiac arrest [16][17][18].…”

Section: Discussionmentioning

confidence: 99%

“…Two main limitations of that study are first, the practitioners were relatively experienced with facemask ventilation and as such may not be representative of first responders to cardiopulmonary arrests in children. Second, the method of LMA insertion that was taught was the method advocated by Brain in adults and this may not be optimal, studies having shown that the lateral insertion technique has a higher success rate in children [9][10][11].In view of these limitations we have repeated our randomised crossover trial, comparing the LMA with the facemask and oropharyngeal airway for manual ventilation of the lungs of apnoeic anaesthetised children. We studied ward based paediatric nurses as our cohort of practitioners as we felt their skills were more likely to be representative of first responders.…”

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confidence: 99%

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confidence: 99%

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A comparison of the laryngeal mask airway with the facemask and oropharyngeal airway for manual ventilation by first responders in children

Blevin¹,

McDouall²,

Rechner³

et al. 2009

Anaesthesia

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In adults, first responders to a cardiopulmonary arrest provide better ventilation using a laryngeal mask airway than a facemask. It is unclear if the same is true in children. We investigated this by comparing the ability of 36 paediatric ward nurses to ventilate the lungs of 99 anaesthetised children (a model for cardiopulmonary arrest) using a laryngeal mask airway and using a facemask with an oropharyngeal airway. Anteroposterior chest wall displacement was measured using an ultrasonic detector. Nurses achieved successful ventilation in 74 (75%) of cases with the laryngeal mask airway and 76 (77%) with facemask and oropharyngeal airway (p = 0.89). Median (IQR [range]) time to first breath was longer for the laryngeal mask airway (48 (39-65 [8-149])) s than the facemask ⁄ airway (35 (25-53 [14-120]) s; p < 0.0001). In 10 cases (10%) the lungs were ventilated using the laryngeal mask airway but not using the facemask ⁄ oropharyngeal airway. We conclude that ventilation is achieved rapidly using a facemask and oropharyngeal airway, and that the laryngeal mask airway may represent a useful second line option for first responders. The laryngeal mask airway (LMA) has been advocated as a device for airway management during the resuscitation of adults following cardiopulmonary arrest [1] but its role in the resuscitation of children is less clear. Tracheal intubation, the gold standard for securing the airway, is a difficult skill to acquire and maintain and can lead to further complications if an unsuccessful intubation is not recognised [2,3]. In contrast, insertion of the LMA can be learnt quickly and easily by inexperienced personnel [2, 4-6]; however, the LMA is not currently recommended for first line airway management in children requiring resuscitation [7].In an attempt to establish the utility of the LMA during resuscitation of children by first responders untrained in tracheal intubation, we have previously studied paediatric critical care nurses [8]. Their ability to ventilate the lungs of an apnoeic, anaesthetised child using an LMA was compared with that using a facemask and oropharyngeal airway. We found no difference in the efficacy of ventilation between the two methods; however, ventilation with the LMA took significantly longer to achieve. Two main limitations of that study are first, the practitioners were relatively experienced with facemask ventilation and as such may not be representative of first responders to cardiopulmonary arrests in children. Second, the method of LMA insertion that was taught was the method advocated by Brain in adults and this may not be optimal, studies having shown that the lateral insertion technique has a higher success rate in children [9][10][11].In view of these limitations we have repeated our randomised crossover trial, comparing the LMA with the facemask and oropharyngeal airway for manual ventilation of the lungs of apnoeic anaesthetised children. We studied ward based paediatric nurses as our cohort of practitioners as we felt their skills were more likely to...

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“…Previous studies have reported success rates of 67-93% for the first attempt at inserting LMA. [4][5][6] In addition, a degree of skill is required to place LMA correctly, and suboptimal positioning of the device can give rise to such problems as air leakage or airway obstruction. Various techniques have been described to ensure a high successful insertion rate.…”

Section: Introductionmentioning

confidence: 99%

Comparison of two insertion techniques of classic laryngeal mask airway: standard versus 90-degree rotation

2017

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Background: Laryngeal mask airway (LMA) devices have been widely utilized as an alternative to tracheal intubation in various clinical situations. The rotation technique has been suggested to improve the insertion success rate of laryngeal masks. The objective of the present study was to compare the ease of insertion of laryngeal mask in terms of, success rate at the first attempt, number of LMA insertion attempts, time duration of LMA insertion and complications like blood stain on LMA and sore throat.Methods: This prospective cohort study was conducted to compare the success rate of insertion at the first attempts between standard technique and 90 degree rotational technique at Department of Anaesthesiology, Amala institute of medical sciences, Thrissur, India during the period from March 2014-september 2015. A total of 160 patients each group consisting of 80 was included in the study after meeting inclusion criteria. Success rate of insertion at first attempts, number of insertion attempts, and insertion time of successful attempt, overall success rate, blood staining of laryngeal mask airway (LMA) and postoperative sore throat were recorded.Results: Significant difference was existed between the two groups with regard to gender. Statistically insignificant differences were observed for demographics like age, weight, ASA grades between the two study groups. Significant differences were observed among the study groups on all findings of LMA insertion. Statistically insignificant difference was detected for the time of duration of LMA insertion and change in heart rate, but mean arterial pressure was found statistically significant between the two groups.Conclusions: This study found that 90 degree rotational technique has high success rate of insertion at first attempt & is less traumatic than standard technique.

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Laryngeal mask airway insertion in children: comparison between rotational, lateral and standard technique

Abstract: A rotational technique with partially inflated cuff is associated with the highest success rate of insertion and lowest incidence of complications and could be the technique of first choice for LMA insertion in pediatric patients.

Cited by 48 publications

References 22 publications

Comparison of Three Methods for Laryngeal Mask Airway Insertion in Adults: Standard, Lateral and Rotational

Comparison of Three Methods for Laryngeal Mask Airway Insertion in Adults: Standard, Lateral and Rotational

A comparison of the laryngeal mask airway with the facemask and oropharyngeal airway for manual ventilation by first responders in children

Comparison of two insertion techniques of classic laryngeal mask airway: standard versus 90-degree rotation

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