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PATIENT SAFETY

Gum Elastic Bougie-Guided Insertion of the ProSeal Laryngeal Mask Airway Is Superior to the Digital and Introducer Tool Techniques in Patients with Simulated Difficult Laryngoscopy Using a Rigid Neck Collar

Stephan Eschertzhuber, MD^*, Joseph Brimacombe, MD, Matthias Hohlrieder, MD^*, Karl-Heinz Stadlbauer, MD^*, and Christian Keller, MD, MSc^*

From the *Department of Anaesthesia and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria; Department of Anaesthesia and Intensive Care, Cairns Base Hospital, The Esplanade, Cairns, Australia; and Department of Anaesthesia, SchulthessKlinik, Lengghalde 2, Zürich, Switzerland.

Address correspondence and reprint requests to Joseph Brimacombe, MD, Department of Anaesthesia and Intensive Care, Cairns Base Hospital, The Esplanade, Cairns 4870, Australia. Address e-mail to jbrimaco{at}bigpond.net.au.

Abstract

BACKGROUND: We compared three techniques for insertion of the laryngeal mask airway ProSeal^TM (PLMA) in patients with simulated difficult laryngoscopy using a rigid neck collar.

METHODS: Ninety-nine anesthetized healthy female patients aged 19–68 yr were randomly allocated for PLMA insertion using the digital, introducer tool (IT) or guided techniques. Difficult laryngoscopy was simulated using a rigid neck collar. The laryngoscopic view was graded before PLMA insertion. The digital and IT techniques were performed according to the manufacturer’s instructions. The guided technique involved priming the drain tube with an Eschmann tracheal tube introducer, placing the introducer in the esophagus under direct vision and railroading the PLMA into position. Failed insertion was defined by any of the following criteria: 1) failed pharyngeal placement, 2) malposition, and 3) ineffective ventilation.

RESULTS: The median laryngoscopic view was 3 and the mean interincisor distance was 3.3 cm. Insertion was more frequently successful with the guided technique at the first attempt (guided 100%, digital 64%, IT 61%; P < 0.0001), but success after three attempts was similar (guided 100%, digital 94%, IT 91%). The time taken for successful placement was similar among groups at the first attempt, but was shorter for the guided technique after three attempts (guided 31 ± 8 s, digital 49 ± 28 s, IT 54 ± 37 s; P < 0.02).

CONCLUSION: The guided insertion technique is more frequently successful than the digital or IT techniques in patients with simulated difficult laryngoscopy using a rigid neck collar.

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