Evaluation of gum elastic bougie guided Proseal laryngeal mask airway insertion technique

Abstract

Introduction: Endotracheal Intubation (ETI) is highest quality level for airway organization. LMA ProSeal™ (PLMA) insertion utilizing Gum Elastic Bougie (GEB) guidance, which has got 100% first attempt success rate, also requires laryngoscopy, hence nullifying its advantage of being a supraglottic airway device. We aimed to compare the hemodynamic responses associated with laryngoscopy assisted GEB guided PLMA placement with that of conventional endotracheal intubation. Method: Hundred normotensive ASA1 or 2 patients of either sex (age 18 to 40yrs) undergoing general anesthesia for elective surgery included and evaluated for pressor response. Following a uniform premedication and standard anesthesia technique (thiopentone + vecuronium), either of airway was placed and pulse rate, (beats/min); Mean blood pressure, MAP (mmHg) (at Tb = base line, T0 = just before laryngoscopy and PLMA/ETT placement, T1 = 1min, T3 = 3min, T5 = 5 min, T7 = 7 min after placement). Results: Patients demographics between the PLMA and ETT groups were similar. Following laryngoscopy and PLMA\ETT placement, both were associated with statistically significant increase in HR and MAP with respect to its basal value. Although it was less marked in case of PLMA Group, when comparison was made within individual Group. Duration of laryngoscopy and time of placement were longer in PLMA Group as compared to ETT Group (35.71 and 12.69 sec. vs 21.30 and 10.76 sec. respectively). ETT insertion was related with higher incidence of cough (p 0.05). Conclusion: Hence GEB guided PLMA method must be used as a reinforcement method in cases where standard insertion methods fall ineffective and in ineffectual tracheal intubation where the bougie is incidentally embedded into throat and quick control of the airway route is essential. Key words: Gum elastic bougie; Laryngeal Mask Airway; Hemodynamics; Pressor response Abbreviations: LMA – laryngeal mask airway; ETI – Endotracheal Intubation; GEB – Gum Elastic Bougie; ETT –Endotracheal tube; PLMA – Laryngeal Mask Airway ProSeal Citation: Upadhyay MK, Kumar G, Chaurasia A, Narang D. Evaluation of gum elastic bougie guided Proseal laryngeal mask airway insertion technique. Anaesth. pain intensive care 2021;25(3):338–344. DOI: doi.org/10.35975/apic.v25i3.1531 Received: March 20, 2021; Reviewed: April 11, 2021; Accepted: May 11, 2021