Comparison of ProSeal laryngeal mask airway placement techniques using digital, introducer tool and gum elastic bougie in anaesthetized paralyzed patients

Background:Conventionally laryngeal mask airway (LMA) is placed in the oral cavity using fingers without the need for laryngoscope. ProSeal laryngeal mask airway (PLMA) placement is relatively difficult owing to its bulky design and sometimes require alternative techniques. We compared three techniques (digital, introducer-tool, gum-elastic bougie) for its placement.Methods: One hundred fifty patients of ASA class I & II of either sex, undergoing surgery under general anaesthesia were randomly allocated to one of the three groups. Standard anaesthesia protocol comprising of glycopyrrolate, thiopentone, vecuronium and halothane in oxygen plus nitrous oxide was used. Insertion attempts, success rate and time taken were noted after confirmation of proper placement. Efficacy of airway seal, oropharyngeal leak pressure (OLP) , ease of gastric tube insertion, trauma to oropharyngeal structures, postoperative airway morbidity were noted. Haemodynamic monitoring was done throughout the procedure.Results: First attempt success rate as well as overall success rate was high in gum elastic bougie group. Although in this group insertion time was slightly longer. Airway seal was also better in this group as shown by high OLP. Airway trauma was comparable in all the three groups.Conclusions: Gum elastic bougie guided PLMA insertion is a good alternative if traditional methods of its placement fail.