The Soft Seal disposable laryngeal mask airway in adults: comparison of two insertion techniques without intra‐oral manipulation

Abstract

SummaryWe investigated whether insertion of the disposable Soft Seal laryngeal mask airway (SSLM) was successful without intra-oral digital manipulation. One hundred patients undergoing anaesthesia using the SSLM were randomly assigned into two groups. Insertion was performed by either a direct or a rotational technique, both without intra-oral digital manipulation. The primary outcome measure was successful insertion at first attempt. Other outcomes included insertion time, fibreoptic assessment of the airway view and airway morbidity. The first attempt success rate was higher (98%) with the direct technique than with the rotational technique (75%; p = 0.002) but insertion time was faster with the latter method (mean [range] 15 [8-50] s) than with the direct method (20 [8-56] s; p = 0.035). Fibreoptic assessment and airway morbidity were similar in both groups. We conclude that the SSLM can be successfully inserted without intra-oral digital manipulation.

Insertion of LMA Classic™ with and without digital intraoral manipulation in anesthetized unparalyzed patients

“…[1] The success rate with the direct insertion technique without digital intraoral manipulation for Soft Seal™ LMA was 100%. [2] Although the overall success rate in our study was comparable between the two groups, the first attempt success rate was significantly higher with the standard technique. In our study, the anesthesiologists inserting the LMA Classic™ had considerable experience with the standard technique, but nil to minimal experience with the modified technique.…”

“…[12] These techniques have been described with LMA Unique™ and Soft Seal™ LMA, which cannot be directly extrapolated to the use of LMA Classic™. [12] The material of LMA Classic™, LMA Unique™, and Soft Seal™ LMA is different.…”

“…[12] These techniques have been described with LMA Unique™ and Soft Seal™ LMA, which cannot be directly extrapolated to the use of LMA Classic™. [12] The material of LMA Classic™, LMA Unique™, and Soft Seal™ LMA is different. Hence, we felt that the technique of LMA Classic™ insertion without digital intraoral manipulation, as described by Brimacombe and Keller, with minor modifications (holding the LMA Classic™ in the proximal one third rather than middle one third to obviate the need for finger repositioning as mouth is reached during insertion), needs to be evaluated against the “gold standard” standard technique of insertion.…”

“…The clinical relevance of these is not clear because it has been recognized that lung ventilation is often adequate and clinical signs of improper placement are rarely observed even when the LMA Classic™ is not in the optimal position. [2] Kuvaki et al . found that in 67% of patients in the direct insertion group, only vocal cords were visible.…”

“…Studies with recent prototypes of laryngeal mask airway (LMA) like LMA Unique™ and LMA Soft Seal™ have shown that these LMAs can be satisfactorily positioned without digital intraoral manipulation. [12] However, the standard recommended insertion technique for LMA Classic™ still requires the insertion of index finger into the oral cavity. Several anesthesiologists are reluctant to do this.…”