Prospective Randomised Comparitive study of Positioning of Laryngeal Mask Airway in Relation to Laryngeal Inlet between Standard and Rotational Insertion Techniques using Fiberoptic Bronchoscope in Children

BACKGROUND: The laryngeal mask airway (LMA) was introduced into anesthetic practice for use on normal adult and pediatric patients, and it has proven to be of benefit in many difficult airway scenarios. However, different insertion methods are recommended. The LMA can be inserted by the standard or rotational method. AIM AND OBJECTIVE: This study done to compare laryngeal mask airway (LMA) position in children using two LMA insertion techniques namely the standard and rotational by using fiber-optic bronchoscope. Also time taken for LMA insertion, number of attempts, hemodynamic parameters and complications were compared between two groups. METHODS: A prospective randomised comparitive study was conducted among 60 children between 3 to 8 years age group belonging to ASA PS I and II posted for elective surgery under general anaesthesia using LMA. After obtaining informed consent from the parents, children were premedicated with oral midazolam (0.5 mg/kg), Inj. glycopyrrollate 10μg/kg iv and inj. fentanyl l2 μg/kg iv. Patient was induced with inj.propofol 3.5mg/kg iv and LMA insertion done by either standard or rotational technique after randomisation. Spontaneous ventilation maintained with N2O and O2 mixture with 2% sevoflurane. Grading of LMA position in relation to glottis was done using FOB. Various above parameters noted. OBSERVATION AND RESULTS: The incidence of FOB grade I was 96.67% with rotational technique and 60% in standard technique with p value of 0.0006 was statistical significant with true difference among the study groups. The mean time for LMA insertion was 8.43 seconds in Rotational technique and 11 seconds in standard technique and was statistically significant with p value