Comparison of two insertion techniques of the ProSeal laryngeal mask airway: standard versus 90° rotation in pediatric patients

Introduction

This study compared two insertion techniques of the ProSeal laryngeal mask airway in pediatric patients.

Methods

A total of 92 pediatric patients (American Society of Anesthesiologists physical status I or II; age 3 to 12 years) undergoing ophthalmologic surgery were randomly allocated to the standard or rotational technique groups. In the standard technique group (n = 46), ProSeal laryngeal mask airway insertion was performed by a single experienced user using digital manipulation. In the rotational technique group (n = 46), the ProSeal laryngeal mask airway was rotated counter-clockwise through 90° in the mouth and advanced until the resistance of the hypopharynx was felt, and then straightened out in the hypopharynx (n = 80). The ease of insertion was assessed by the success rate at the first attempt. Heart rate and mean blood pressure were recorded 1 minute before and 1 minute after insertion. Postoperative complications were noted.

Results

The success rate of insertion at the first attempt was higher for the rotational technique (95.7% vs 76.1%, P < 0.001). The overall success rate - that is, successful insertion within three attempts - was 100% for the both techniques. Systolic, diastolic and mean blood pressure and heart rate increased significantly with the standard technique (P <0.001). Systolic blood pressure and heart rate increased significantly with the rotational technique (P < 0.01). The incidence of blood staining (8.7% vs 23.9%, P = 0.048) was lower with the rotational technique.

Conclusions

The rotational technique is more successful than the standard technique and is associated with less pharyngeal mucosal trauma, as evidenced by a lower incidence of mucosal bleeding.