title: Gum elastic bougie-guided insertion of the ProSeal laryngeal mask airway is superior to the digital and introducer tool techniques.
abstract: BACKGROUND
  The authors compare three techniques for insertion of the ProSeal laryngeal mask airway.
  
  
  METHODS
  Two hundred forty healthy patients aged 18-80 yr were randomly allocated for ProSeal laryngeal mask airway insertion using the digital, introducer tool (IT), or gum elastic bougie (GEB)-guided techniques. The digital and IT techniques were performed according to the manufacturer's instructions. The GEB-guided technique involved priming the drain tube with the GEB, placing the GEB in the esophagus under direct vision, and inserting the ProSeal laryngeal mask airway using the digital technique with the GEB as a guide. Failed insertion was defined by any of the following criteria: (1) failed pharyngeal placement; (2) malposition (air leaks, negative tap test results, or failed gastric tube insertion if pharyngeal placement was successful); and (3) ineffective ventilation (maximum expired tidal volume < 8 ml/kg or end-tidal carbon dioxide > 45 mmHg if correctly positioned). Any visible or occult blood was noted. Sore throat, dysphonia, and dysphagia were assessed 18-24 h postoperatively.
  
  
  RESULTS
  Insertion was more frequently successful with the GEB-guided technique at the first attempt (GEB, 100%; digital, 88%; IT, 84%; both P < 0.001), but success after three attempts was similar (GEB, 100%; digital, 99%; IT, 98%). The time taken to successful placement was similar among groups at the first attempt but was shorter for the GEB-technique after three attempts (GEB, 25 +/- 14 s; digital, 33 +/- 19 s; IT, 37 +/- 25 s; both: P < 0.003). There were no differences in the frequency of visible blood, but occult blood occurred less frequently with the GEB-guided technique (GEB, 12%; digital, 29%; IT, 31%; both: P < 0.02) but was similar among techniques if insertion was successful at the first attempt. There were no differences in postoperative airway morbidity. CONCLUSION The GEB-guided insertion technique is more frequently successful than the digital or IT techniques. The authors suggest that the GEB-guided technique may be a useful backup technique for when the digital and IT techniques fail.
authors.affiliation: Department of Anaesthesia and Intensive Care, Cairns Base Hospital, and James Cook University, Cairns, Australia. jbrimaco@bigpond.net.au
authors.forename: Joseph
authors.initials: J
authors.lastname: Brimacombe
authors.forename: Christian
authors.initials: C
authors.lastname: Keller
authors.forename: Dana Vosoba
authors.initials: DV
authors.lastname: Judd
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000769:Anesthesia, Inhalation / Q000295:instrumentation*; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000209:etiology / Q000503:physiopathology; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D017214:Laryngeal Masks / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000293:injuries; D009780:Occult Blood; D013990:Tidal Volume / Q000502:physiology; D017211:Treatment Failure