Comparison of Index-Finger Guided, Two-Finger Guided, and 90° Rotation Techniques for Insertion of Flexible LMA in Pediatric Patients
Abstract
Background: Flexible LMA offers the advantage of providing a better surgical field without being compressed compared to other LMAs in surgeries around the oral cavity. The insertion of flexible LMA is comparatively difficult as the shaft is flexible. The aim of this study is to compare the index-finger guided technique, two-finger guided technique, and 90° rotation technique for the success and time of insertion of flexible LMA in pediatric patients.
Methods: After obtaining consent from parents,84 patients aged between 3 to 12 years of either gender were randomized into 3 groups. After administration of general anesthesia, flexible LMA of appropriate size as per manufacturer recommendations was inserted.
In the index finger guided method (Group A), the LMA was held like a pen and the mask was pushed backward pressing against the palate. In the two-finger guided method (Group B), the anesthetist stood by the side facing the patient. LMA was fixed in between the index and middle fingers, held facing the lower jaw, and pushed along the palatopharyngeal curve. In the 90° rotation method (Group C), the LMA was rotated 90° anticlockwise in the oral cavity and was advanced through the right side of the tongue till resistance was felt and then turned back. The time from insertion of LMA and the number of attempts taken for successful insertion were noted. The data were analyzed using ANOVA.
Results: The mean time of insertion was the least in Group B and highest in Group C. The first attempt success rate was highest in Group B and least in Group C. However, the mean time of insertion and the first attempt success rates were not significantly different between Group A and Group B.
Conclusion: The LMA insertion by the two-finger guided method is the easiest and most efficient method and a good alternative to the standard method (index finger guided) for insertion of flexible LMA.
[2] van Zundert TC, Cattano D. The LMA-Flexible: time to celebrate a unique extraglottic airway device. Minerva Anestesiol. 2017; 83(9):895-898.
[3] Wan Y, Liu Y, Yang W, Cui X. A prospective randomized study for the placement of flexible laryngeal airway mask with two-step jaw-thrust technique by both hands for adults. Am J Transl Res. 2022; 14(2):1060-1067.
[4] Takuro S, Hiroki S, Sugioka Sh, Komi N, Hirokane, M. Comparison of Metal Stylet, Small Tracheal Tube and Combined Introducer-Aided Insertions of the Flexible Reinforced Laryngeal Mask Airway with the Conventional Method: a Manikin Study. Journal of Anesthesia & Clinical Research. 2011; 2(7).
[5] Cook TM, Ford P, Craft TM, McCormick B, Ryder SA. An evaluation of the flexiguide introducer with the flexible laryngeal mask airway. Anaesth Intensive Care. 2003; 31(2):193-5.
[6] Kulkarni AH, Simon BP, Jose JK. A new flexible laryngeal mask airway introducer. Indian J Anaesth. 2012; 56(1):94-5.
[7] Kim DH, Chae YJ, Min SK, Ha EJ, Yoo JY. Lightwand-Guided Insertion of Flexible Reinforced Laryngeal Mask Airway: Comparison with Standard Digital Manipulation Insertion. Med Sci Monit. 2021; 27:e928538.
[8] Sun QM, Wang HL. A new insertion technique of the laryngeal mask airway flexible used in patients for whom the index-finger guided method failed. Minerva Anestesiol. 2021; 87:833-4.
[9] Xi C, Shi D, Cui X, Wang G. Safety, efficacy and airway complications of the flexible laryngeal mask airway in functional endoscopic sinus surgery: A retrospective study of 6661 patients. PLoS One. 2021; 16(2):e0245521.
[10] Ozmete O, Sener M, Caliskan E, Kipri M, Aribogan A. The use of flexible laryngeal mask airway for Adenoidectomies: An experience of 814Paediatric patients. Pak J Med Sci. 2017; 33(4):823-828.
[11] Bharadwaj H, Dhakate VR, Agrawal NK. Comparison of Laryngeal Mask Airway Insertion Techniques In Children: Standard Technique With Fully Deflated Cuff Vs Lateral Approach With 90⁰ Rotation With Partially Inflated Cuff. International Journal of Current Research. 9(12): 63423-63426.
| Files | ||
| Issue | Article in Press |
|
| Section | Research Article(s) | |
| Keywords | ||
| Flexible LMA Pediatrics Insertion | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
