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GENERAL ARTICLES

Guided Insertion of the ProSeal Laryngeal Mask Airway Is Superior to Conventional Tracheal Intubation by First-Month Anesthesia Residents After Brief Manikin-Only Training

Matthias Hohlrieder, MD^*, Joseph Brimacombe, MB ChB, FRCA, MD, Achim von Goedecke, MD^*, and Christian Keller, MD, MSc^*

From the *Department of Anaesthesia and Intensive Care Medicine, Medical University Innsbruck, Austria; and Department of Anaesthesia and Intensive Care, James Cook University, Cairns Base Hospital, Cairns, Australia.

Address correspondence to Prof. J. Brimacombe, Department of Anaesthesia and Intensive Care, Cairns Base Hospital, The Esplanade, Cairns 4870, Australia. Address e-mail tojbrimaco{at}bigpond.net.au.

In the following pilot study, we compared conventional laryngoscope-guided tracheal intubation (tracheal intubation) and laryngoscope-guided, gum elastic bougie-guided ProSeal laryngeal mask airway insertion (guided ProSeal) for airway management by first-month anesthesia residents after brief manikin-only training. Five first-month residents with no practical experience of airway management were observed performing these techniques in 200 ASA I–II anesthetized, paralyzed adults. Each resident managed 40 patients, 20 in each group, in random order. The number of insertion attempts, effective airway time, ventilatory capability during pressure-controlled ventilation set at 15 cm H₂O, airway trauma, and skill acquisition were studied. Data were collected by unblinded observers. Insertion was more frequently successful (100% versus 65%) and effective airway time was shorter (41 ± 24 s versus 89 ± 62 s) in the guided ProSeal group (both P < 0.0001). Expired tidal volume was larger (730 ± 170 mL versus 560 ± 140 mL) and end-tidal CO₂ lower (33 ± 4 mm Hg versus 37 ± 5 mm Hg) in the guided ProSeal group during pressure controlled ventilation (both P < 0.0001). Blood staining was more frequent on the laryngoscope (24% versus 2%; P < 0.0001) in the tracheal intubation group. There was evidence for skill acquisition in both groups. We conclude that laryngoscope-guided, gum elastic bougie-guided insertion of the ProSeal laryngeal mask airway is superior to conventional laryngoscope-guided tracheal intubation for airway management in terms of insertion success, expired tidal volume, and airway trauma by first-month anesthesia residents after brief manikin-only training. The guided ProSeal technique has potential for cardiopulmonary resuscitation by novices when conventional intubation fails.

This article has been cited by other articles:

				A. Timmermann, S. G. Russo, C. Eich, M. Roessler, U. Braun, W. H. Rosenblatt, and M. Quintel The Out-of-Hospital Esophageal and Endobronchial Intubations Performed by Emergency Physicians Anesth. Analg., March 1, 2007; 104(3): 619 - 623. [Abstract] [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999