The use of flexible laryngeal mask airway for Adenoidectomies: An experience of 814Paediatric patients

A Prospective Randomized Study for the Placement of Flexible Laryngeal Airway Mask with Two-Step of Jaw-Thrust Technique by Both Hands for Adults

To investigate the effect of two-step of jaw-thrust technique on the placement of flexible laryngeal mask with both hands. 157 patients scheduled for functional endoscopic sinus surgery were divided into two groups using a random number table method: control group (group C, n = 78) and test group (group T, n = 79). After induction of general anesthesia, the traditional method was applied to insert the flexible laryngeal airway mask in group C, and the two-step of jaw-thrust technique with both hands by the nurse was applied to help place the laryngeal mask in group T. The success rate, alignment status, oropharyngeal leak pressure (OLP) of the laryngeal mask, soft tissue injury of the oropharyngeal cavity and postoperative sore throat, and the incidence of adverse airway event were recorded in both groups. Results: The success rate of the first placement of flexible laryngeal masks in group C and group T were 73.8% and 97.5%, and the final success rates were 97.5% and 98.7%, respectively. Compared with group C, the success rate of first placement in group T was higher, and the difference was statistically significant (P < 0.01). There was no significant difference in the final success rate between the two groups (P = 0.56). The alignment score showed that the placement of group T was better than that of group C, and the difference was statistically significant (P < 0.01). The OLP of group C was 22.1 ± 2.6 cmH2O, and the OLP of group T was 25.4 ± 3.8 cmH2O. The OLP of group T was significantly higher than that of group C (P < 0.01). The incidence of mucosal injury and postoperative sore throat in group T were 2.5% and 5.0%, which were significantly lower than that of 23.0% and 16.7% in group C (both P < 0.01). There was no adverse airway event in each group. Conclusion: The two-step of jaw-thrust technique with both hands can improve the success rate of the first placement of the flexible laryngeal mask and the positioning of the laryngeal mask, increase the sealing pressure of the laryngeal mask, and reduce the incidence of oropharyngeal soft tissue injury and postoperative pharyngeal pain.

Wooden Disposable Tongue Depressor: Can Facilitate Appropriate Reinforced Laryngeal Mask Insertion? A Randomized Controlled Trial

Background: The reinforced laryngeal mask airway (RLMA) is difficult to insert due to the flexibility of its inner armored shaft. Many authors agreed that the available techniques have some disadvantages. They use materials that are reusable and require resterilization but may not guarantee infection control particularly during pandemics. The standard method can cause contamination and prone the operator to unanticipated trauma to their finger during placement. So this study aimed to evaluate the usefulness of disposable tongue depressors to aid insertion of the reinforced laryngeal mask airway. Methods: A randomized controlled trial included one hundred ninety-four adult patients of either gender American Society of Anesthesiologists (ASA) I and II attended for elective day case surgery under general anesthesia. Patients were randomly categorized into two groups; each group consisted of ninety-seven. In the first group, insertion of the reinforced laryngeal mask airway was done using the standard technique of digital manipulation whereas the second one is the study group where disposable wooden tongue depressor guided insertion was used. The data were analyzed using SPSS version 23. Data were presented as frequencies or means and standard deviations. Chi-Square, Fisher Exact, and t-test were used. P value < 0.05 was considered significant. Results: No significant difference in basic patients' demographic, anthropometric, and clinical characteristics were noticed between the two groups. The insertion time as well as the total time for RLMA placement, was significantly shorter in the new method group. Trauma was significantly less than 2.1% in the new method group compared to the standard group 10.3%, p=0.003). Conclusion: The disposable wood tongue depressor insertion technique helps facilitate the correct placement of the reinforced laryngeal mask airway.

A prospective randomized study for the placement of flexible laryngeal airway mask with two-step jaw-thrust technique by both hands for adults

OBJECTIVE

A prospective, randomized, and controlled study was conducted to investigate the effect of two-step jaw-thrust technique on the placement of flexible laryngeal mask (FLMA) with both hands.

METHODS

Between November 2019 and January 2020, 160 patients scheduled for functional endoscopic sinus surgery with general anesthesia were enrolled in this study and were divided into two groups (n=80 each) using a random number table method: control group (group C) and test group (group T). After the induction of general anesthesia, the traditional method was applied to insert the flexible laryngeal airway mask in patients of group C, and the two-step jaw-thrust technique with both hands by the nurse was applied to help place the laryngeal mask in patients of group T. The success rate, alignment status by fibroscope (FOB) score, oropharyngeal leak pressure (OLP) of the laryngeal mask, oropharyngeal cavity soft tissue injury and postoperative sore throat, and the incidence of adverse airway event were compared between the two groups. (The registry of clinical trial: Chinese Clinical Trial Register, ChiCTR2100053017, https://www.chictr.org.cn).

RESULTS

78 patients in group C and 79 patients in group T were in includedfinal analysis. The success rates of the first placement of flexible laryngeal masks in patients of group C and group T were 73.81% and 97.52%, respectively. The final success rates were 97.52% and 98.81%, respectively. The success rate of first placement in group T was significantly higher than that of group C. There was no significant difference in the final success rate between the two groups (P=0.561). The alignment score showed that the placement of group T was significantly better than that of group C. The OLP of group T (25.43±3.82 cm) was significantly higher than that of group C (22.13±2.62 cm). The incidences of mucosal injury and postoperative sore throat in group T were 2.52% and 5.01%, which were significantly lower than those of 23.02% and 16.72% in group C. There was no adverse airway event in each group.

CONCLUSION

The two-step jaw-thrust technique with both hands can improve the success rate of the first placement of the flexible laryngeal mask and the positioning of the laryngeal mask, increase the sealing pressure of the laryngeal mask, and reduce the incidence of oropharyngeal soft tissue injury and postoperative pharyngeal pain.