Original ContributionA comparison of classic laryngeal mask airway insertion between lightwand- and standard index finger–guided techniques
Introduction
Since the classic laryngeal mask airway (cLMA) was first introduced into clinical practice in 1988, a variety of new extraglottic airway devices with some specific advantages have been developed [1], [2]. However, the first generation of cLMA is still widely used in clinical practice, especially in patients undergoing minor surgeries by providing a safe and effective alternative to tracheal intubation [3], [4]. The standard recommended cLMA placement technique is performed blindly and requires full insertion of the index finger into the mouth [5], [6]. The correct cLMA position is determined by feeling of resistance while the cLMA is pushed down in the pharynx [5], [6]. As a result, the first attempt success rate of cLMA insertion varies between 67% and 95% due to the lack of an objective indicator of correct cLMA position, unmatched cLMA sizes, and operator experience [7], [8], [9], [10], [11]. In addition, more and more operators are reluctant to insert their index fingers into the patient's mouth [5], [12].
The standard rigid lightwand has been successfully used to guide difficult endotracheal intubation depending on the location of light [13], [14]. Furthermore, flexible lighted stylets have been used to help adjust the laryngeal mask airway (LMA) position for facilitating intubation through the intubating LMA [15], [16]. For these reasons, we conducted this study to evaluate the feasibility of the lightwand-guided real time insertion of the cLMA, which offers significant benefits such as having no need to insert fingers into the patient's mouth.
Section snippets
Materials and methods
After obtaining approval from institutional ethics committee and written informed consent from all the subjects participating in the study, 300 patients scheduled for elective gynecological or orthopedic surgeries under general anesthesia in supine position with anticipated duration less than 45 minutes were enrolled. The inclusion criteria for the study were as follows: (a) patients of either sex, aged 20 to 65 years, body mass index (BMI) 20 to 25 kg/m2, and (b) American Society of
Results
The 2 groups were similar in sex, age, weight, BMI, Mallampati score, thyromental distance, and ASA physical status (Table 1).
In all except 2 patients in standard insertion group, the cLMA was successfully inserted within 3 attempts. The success rates of lightwand-guided insertion technique at first attempt of insertion were 92% (138/150), significantly higher than standard insertion technique (76%, 114/150); the perfect view rates assessed by fiberoptic bronchoscopy for lightwand-guided
Discussion
Lightwand is a rapid, effective, and safe tool for facilitating intubation in patients with difficult airway and in patients required for minimal neck movements through transillumination in the neck [14], [19]. Whether lightwand-guided technique can also be used for guiding real-time insertion of the cLMA remains unclear. In present study, we found that the lightwand-guided cLMA insertion technique helped anesthesiologist get higher success rates at the first attempt of cLMA insertion, better
References (24)
- et al.
Laryngeal mask airway: a more successful method of insertion
J Clin Anesth
(1995) - et al.
Comparison of 2 cuff inflation methods of laryngeal mask airway classic for safe use without cuff manometer in adults
Am J Emerg Med
(2014) - et al.
Fiberoptic assessment of laryngeal mask airway placement: blind insertion versus direct visual epiglottoscopy
J Oral Maxillofac Surg
(2004) The case against the laryngeal mask airway for anesthesia in oral and maxillofacial surgery
J Oral Maxillofac Surg
(2004)The laryngeal mask—a new concept in airway management
Br J Anaesth
(1983)- et al.
Evolution of the extraglottic airway: a review of its history, applications, and practical tips for success
Anesth Analg
(2012) - et al.
Extraglottic airway devices: a review
Int J Crit Illn Inj Sci
(2014) - et al.
Failure of the laryngeal mask airway unique and classic in the pediatric surgical patient: a study of clinical predictors and outcomes
Anesthesiology
(2013) - et al.
Are new supraglottic airway devices, tracheal tubes and airway viewing devices cost-effective?
Paediatr Anaesth
(2015) - et al.
Insertion of LMA classic with and without digital intraoral manipulation in anesthetized unparalyzed patients
J Anaesthesiol Clin Pharmacol
(2012)
Proper technique for insertion of the laryngeal mask
Anesthesiology
The laryngeal mask airway: a comparison between two insertion techniques
Anesth Analg
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