LMA-ProSeal insertion by novice doctors as affected by a 90° bend created by an intubating stylet: a randomized clinical trial

Abstract

Study ObjectiveThis study aimed to test the hypothesis that insertion of the supraglottic device LMA-ProSeal (ProSeal) by novice doctors in anesthetized patients can be improved by using an intubating stylet to create a 90° bend and that better sealing pressure is achieved. DesignRandomized clinical trial. SettingOperating room. PatientsSeventy adult patients scheduled for elective surgery under general anesthesia using ProSeal with American Society of Anesthesiologists physical status 1 to 3. InterventionsProSeal were inserted with the 90° bend created by the intubating stylet (90D group, 35 patients) or not (ie, conventional insertion; C group, 35 patients). MeasurementsThe number of attempts to successful insertion, sealing pressure, subjective difficulty of insertion by novice doctors, and postoperative pharyngeal pain or hoarseness were compared between groups. Main ResultsThe total number of insertion attempts for the 90D and control groups were 1 (24 and 8, respectively), 2 (8 and 13), 3 (3 and 9), and failure (0 and 5), respectively, showing significant differences between groups (P<.001). Sealing pressure was significantly higher in the 90D group than in the C group (90D group, 23.3±3.7cm H2O; C group, 19.5±2.6cm H2O; P<.001), and the subjective difficulty of insertion was significantly lower in the 90D group (90D group, 27.3±17.6mm; C group, 55.4±22.8mm; P<.001). The incidence of postoperative pharyngeal pain and hoarseness did not differ significantly between groups. ConclusionsOur results suggest that creating a 90° bend using an intubating stylet facilitates ProSeal insertion by novice doctors, as reflected by higher successful insertion rates, higher sealing pressure, and lower subjective difficulty of insertion in anesthetized patients.