A comparison of standard and rotational techniques for ease of insertion of ProSeal laryngeal mask airway in adult patients: A 1-year hospital-based randomized clinical trial

Abstract

Title: A prospective randomised clinical trial for comparison of two techniques of insertion of proseal laryngeal mask airway in adults - index finger insertion technique versus 90 degree rotational technique. Introduction: ProSeal laryngeal mask airway is not easy to be inserted due to its larger cuff especially in Indian population.The 90 degrees rotation technique for inserting the PLMA is reported to be better than the standard index finger insertion technique to improve the insertion success rate. The objective of this study was to evaluate and compare the ease of insertion through the rotational and standard insertion technique in terms of number of attempts, duration of insertion and occurrence of complications. Methods: 120 adult patients were allocated to either a standard technique or a rotation technique group with 60 patients in each group. In the rotation technique group the entire cuff of the PLMA was placed in the patient's mouth in a midline approach without finger insertion, rotated 90 degrees counter clockwise around the patient's tongue, advanced and then rotated back until resistance was felt. The outcomes measured were success rate at first insertion, insertion time, haemodynamic changes and complications. Results: For the rotation technique group the success rate at first insertion was greater (98% vs 78%, respectively; P = 0.001), and less time for insertion was required (11.88 +/- 3.62 sec vs 25.98 +/- 10.92 sec, respectively; P Conclusion: The 90 degrees rotation technique for inserting the PLMA has a higher success rate at first insertion than the standard index finger insertion technique with lesser insertion time and fewer side effects.