Suction catheter guided insertion of ProSeal laryngeal mask airway: Experience by untrained physicians

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Abstract

Background:

The use of suction catheter (SC) has been shown to improve success rate during ProSeal laryngeal mask airway (PLMA) insertion in expert users.

Aims:

The aim of this study was to compare insertion of PLMA performed by untrained physicians using a SC or the digital technique (DT) in anaesthetised non-paralysed patients.

Methods:

In this prospective randomised double-blind study, conducted in the operating setting, 254 patients (American Society of Anaesthesiologists I-II, aged 18-65 years), undergoing minor surgery were enrolled. Exclusion criteria were body mass index >35 kg/m ², laryngeal or oesophageal varices, risk of aspiration or difficult face mask ventilation either referred or suspected (Langeron's criteria ≥2) and modified Mallampati classification score >2. Participants were randomly allocated to one of the two groups in which PLMA was inserted using DT (DT-group) or SC (SC-group).

Statistical Analysis:

Chi-square test with Yates’ correction, Mann-Whitney U-test or Student's t-test were carried-out as appropriate.

Results:

The final insertion success rate was greater in SC-groupcompared with DT-group 90.1% ( n = 109) versus 74.4% ( n = 99) respectively ( P = 0.002). Mean airway leak pressure was higher in SC-group compared to DT-group (23.7 ± 3.9 vs. 21.4 ± 3.2 respectively; ( P = 0.001). There were no differences in insertion time, post-operative airway morbidity and complications.

Conclusion:

The findings of this study suggest that SC-technique improves the success rate of PLMA insertion by untrained physicians.

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Most cited references 15

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Prediction of difficult mask ventilation.

C Huraux, P Coriat, Dario Bianchi … (2000)

Maintenance of airway patency and oxygenation are the main objectives of face-mask ventilation. Because the incidence of difficult mask ventilation (DMV) and the factors associated with it are not well known, we undertook this prospective study. Difficult mask ventilation was defined as the inability of an unassisted anesthesiologist to maintain the measured oxygen saturation as measured by pulse oximetry > 92% or to prevent or reverse signs of inadequate ventilation during positive-pressure mask ventilation under general anesthesia. A univariate analysis was performed to identify potential factors predicting DMV, followed by a multivariate analysis, and odds ratio and 95% confidence interval were calculated. A total of 1,502 patients were prospectively included. DMV was reported in 75 patients (5%; 95% confidence interval, 3.9-6.1%), with one case of impossible ventilation. DMV was anticipated by the anesthesiologist in only 13 patients (17% of the DMV cases). Body mass index, age, macroglossia, beard, lack of teeth, history of snoring, increased Mallampati grade, and lower thyromental distance were identified in the univariate analysis as potential DMV risk factors. Using a multivariate analysis, five criteria were recognized as independent factors for a DMV (age older than 55 yr, body mass index > 26 kg/m2, beard, lack of teeth, history of snoring), the presence of two indicating high likelihood of DMV (sensitivity, 0.72; specificity, 0.73). In a general adult population, DMV was reported in 5% of the patients. A simple DMV risk score was established. Being able to more accurately predict DMV may improve the safety of airway management.

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A systematic review (meta-analysis) of the accuracy of the Mallampati tests to predict the difficult airway.

Guang Fan, Anna Pierson, Tony Gin … (2006)

The original and modified Mallampati tests are commonly used to predict the difficult airway, but there is controversy regarding their accuracy. We searched MEDLINE and other databases for prospective studies of patients undergoing general anesthesia in which the results of a preoperative Mallampati test were compared with the subsequent rate of difficult airway (difficult laryngoscopy, difficult intubation, or difficult ventilation as reference tests). Forty-two studies enrolling 34,513 patients were included. The definitions of the reference tests varied widely. For predicting difficult laryngoscopy, both versions of the Mallampati test had good accuracy (area under the summary receiver operating characteristic (sROC) curve = 0.89 +/- 0.05 and 0.78 +/- 0.05, respectively). For predicting difficult intubation, the modified Mallampati test had good accuracy (area under the sROC curve = 0.83 +/- 0.03) whereas the original Mallampati test was poor (area under the sROC curve = 0.58 +/- 0.12). The Mallampati tests were poor at identifying difficult mask ventilation. Publication bias was not detected. Used alone, the Mallampati tests have limited accuracy for predicting the difficult airway and thus are not useful screening tests.

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The ProSeal laryngeal mask airway: A randomized, crossover study with the standard laryngeal mask airway in paralyzed, anesthetized patients.

Matthew Keller, J Brimacombe (2000)

The ProSeal laryngeal mask airway (PLMA) is a new laryngeal mask device with a modified cuff to improve seal and a drainage tube to provide a channel for regurgitated fluid and gastric tube placement. In the present randomized, crossover study, the authors tested the hypothesis that ease of insertion, airway sealing pressure, and fiberoptic position differ between the PLMA and the standard laryngeal mask airway (LMA). For the PLMA, we also assess ease of gastric tube placement and the efficacy of an introducer tool. Sixty paralyzed, anesthetized adult patients were studied. Both devices (only size 4) were inserted into each patient in random order. Airway sealing pressure and fiberoptic position were determined during cuff inflation from 0 to 40 ml in 10-ml increments. Gastric tube insertion was attempted with the PLMA if there was no gas leak from the drainage tube. In 60 additional patients, ease of insertion for the PLMA was compared with and without an introducer. First-time success rates were higher (60 of 60 vs. 52 of 60; P = 0.003) and the effective airway time shorter (9 +/- 3 s vs20 +/- 18 s; P < 0.0001) for the LMA. There were no failed uses of either device within three attempts. Airway sealing pressure was 8-11 cm H2O higher for the PLMA at all cuff volumes (P < 0.00001) and was higher in females for both devices. Fiberoptic position was better with the LMA at all cuff volumes (P < 0.00001), but vocal cord visibility was similar (LMA, 59 of 60; PLMA, 56 of 60). For the PLMA, gastric tube placement was successful in 58 of 58 patients and took 9 +/- 5 s. First-time success rates were higher (59 of 60 vs53/60; P = 0.03) and the effective airway time shorter (15 +/- 13 s vs 23 +/- 18 s; P = 0.008) with the introducer. The PLMA is capable of achieving a more effective seal than the LMA and facilitates gastric tube placement, but it is more difficult to insert unless an introducer tool is used. When correctly positioned, the PLMA isolates the glottis from the upper esophagus with possible implications for airway protection.

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Author and article information

Journal

Journal ID (nlm-ta): Indian J Anaesth

Journal ID (iso-abbrev): Indian J Anaesth

Journal ID (publisher-id): IJA

Title: Indian Journal of Anaesthesia

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 0019-5049

ISSN (Electronic): 0976-2817

Publication date (Print): Jan-Feb 2014

Volume: 58

Issue: 1

Pages: 25-29

Affiliations

[1]Department of Anesthesiology and Intensive Care, A. Gemelli Hospital, Largo A. Gemelli 8, 00168 Rome, Italy

Author notes

Address for correspondence: Dr. Paola Aceto, Department of Anesthesiology and Intensive Care, A. Gemelli Hospital, Largo A. Gemelli 8, 00168 Rome, Italy. E-mail: pa.aceto@ 123456gmail.com

Article

Publisher ID: IJA-58-25

DOI: 10.4103/0019-5049.126784

PMC ID: 3968646

SO-VID: b1ff7250-abac-493b-acfb-4d316e8f44f0

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Suction catheter guided insertion of ProSeal laryngeal mask airway: Experience by untrained physicians

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Abstract

Background:

Aims:

Methods:

Statistical Analysis:

Results:

Conclusion:

Related collections

Irish Journal of Paramedicine

Most cited references 15

Prediction of difficult mask ventilation.

A systematic review (meta-analysis) of the accuracy of the Mallampati tests to predict the difficult airway.

The ProSeal laryngeal mask airway: A randomized, crossover study with the standard laryngeal mask airway in paralyzed, anesthetized patients.

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