Perméabilité oesophagienne améliorée lors de l’insertion du ProSeal™ laryngeal mask airway à l’aide de la bougie de Eschmann™

Abstract

Purpose We hypothesized that a more accurate alignment of the tip of the drain tube with the upper esophageal opening would be achieved in adult patients, as confirmed by fibreoptic bronchoscopy, by placing the ProSeal TM laryngeal mask airway (PLMA) by means of guiding it over an Eschmann TM tracheal tube introducer, commonly know as a gum elastic bougie (GEB), that was previously inserted into the esophagus, rather than by placing the PLMA with a curved metal introducer (IT). Methods Seventy-five adult elective surgery patients, whose airway management involved a PLMA, were randomly allocated to either the GEB-or IT-guided techniques. After inserting the PLMA, alignment of the tip of the drain tube relative to the esophageal opening was verified by a fibrescope introduced through the drain tube. Placing the fibrescope through the PLMA identified the glottic structures. The primary endpoint indicating the proper alignment of the tip of the drain tube of the PLMA with the upper esophageal opening was the ability to pass the fibrescope into the esophagus through the drain tube by a distance [35 cm without obstruction and the ability to simultaneously visualize the esophageal mucosa.Results The overall success rates of PLMA insertion were similar in the GEB and IT groups. However, the mean airway insertion times were longer with the GEB than with the IT-PLMA. The GEB group achieved proper alignment of the drain tube and the upper esophageal opening more frequently than the IT group (97% confidence interval (CI 95 ) 91.5-100% vs 81% CI 95 68.5-93.5% of subjects, respectively; P = 0.027). When the GEB was used to place the PLMA, the patients' vocal cords were visualized more frequently than when the IT technique was used (100% vs 73% CI 95 58.9-87.1% of subjects, respectively; P = 0.003). Conclusion Fibreoptic bronchoscopy confirmed that GEB is superior to the IT technique in ensuring precise alignment of the tip of the drain tube of the PLMA with the upper esophageal opening. Accurate positioning may better preserve gastroesophageal drainage function of the PLMA. RésuméObjectif Nous avons e´mis l'hypothe`se qu'il serait possible de parvenir a`un alignement plus pre´cis entre la pointe du tube de drainage du masque larynge´et l'ouverture supe´rieure de l'oesophage chez les patients adultes, e´value´par bronchoscopie par fibres optiques, en

Comparison of videolaryngoscope-guided versus standard digital insertion techniques of the ProSeal™ laryngeal mask airway: a prospective randomized study

“…The insertion time was longer (by approximately 10 s) in the videolaryngoscope-guided insertion group than in the standard digital insertion group (38 vs 28 s) in the present study. Several studies determined that the insertion time with direct laryngoscopy or laryngoscope-assisted guided techniques was longer than the time required for the standard digital technique [7, 14]. Our results are also similar to these.…”

Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults

“… 230 231 Bougie-aided placement provides better alignment of the drain port and a better fibre-optic view of the cords through the PLMA than the introducer tool method. 232 Patients with a history of difficult tracheal intubation or predicted difficulty were excluded from these studies, making it unclear how effective this technique would be in this situation. The technique has been used effectively in a simulated difficult airway in patients wearing a hard collar, 233 but again patients with predicted difficulty were excluded.…”

Preparation for and Management of “Failed” Laryngoscopy and/or Intubation

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