title: Guided insertion of the ProSeal laryngeal mask airway is superior to conventional tracheal intubation by first-month anesthesia residents after brief manikin-only training.
abstract: In the following pilot study, we compared conventional laryngoscope-guided tracheal intubation (tracheal intubation) and laryngoscope-guided, gum elastic bougie-guided ProSeal laryngeal mask airway insertion (guided ProSeal) for airway management by first-month anesthesia residents after brief manikin-only training. Five first-month residents with no practical experience of airway management were observed performing these techniques in 200 ASA I-II anesthetized, paralyzed adults. Each resident managed 40 patients, 20 in each group, in random order. The number of insertion attempts, effective airway time, ventilatory capability during pressure-controlled ventilation set at 15 cm H2O, airway trauma, and skill acquisition were studied. Data were collected by unblinded observers. Insertion was more frequently successful (100% versus 65%) and effective airway time was shorter (41 +/- 24 s versus 89 +/- 62 s) in the guided ProSeal group (both P < 0.0001). Expired tidal volume was larger (730 +/- 170 mL versus 560 +/- 140 mL) and end-tidal CO(2) lower (33 +/- 4 mm Hg versus 37 +/- 5 mm Hg) in the guided ProSeal group during pressure controlled ventilation (both P < 0.0001). Blood staining was more frequent on the laryngoscope (24% versus 2%; P < 0.0001) in the tracheal intubation group. There was evidence for skill acquisition in both groups. We conclude that laryngoscope-guided, gum elastic bougie-guided insertion of the ProSeal laryngeal mask airway is superior to conventional laryngoscope-guided tracheal intubation for airway management in terms of insertion success, expired tidal volume, and airway trauma by first-month anesthesia residents after brief manikin-only training. The guided ProSeal technique has potential for cardiopulmonary resuscitation by novices when conventional intubation fails.
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, Medical University Innsbruck, Austria.
authors.forename: Matthias
authors.initials: M
authors.lastname: Hohlrieder
authors.forename: Joseph
authors.initials: J
authors.lastname: Brimacombe
authors.forename: Achim
authors.initials: A
authors.lastname: von Goedecke
authors.forename: Christian
authors.initials: C
authors.lastname: Keller
mesh_terms: D000293:Adolescent; D000368:Aged; D000776:Anesthesiology / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods*; D017214:Laryngeal Masks / Q000009:adverse effects; D007828:Laryngoscopy; D008875:Middle Aged; D010865:Pilot Projects