title: Gum elastic bougie-guided insertion of the ProSeal laryngeal mask airway is superior to the digital and introducer tool techniques in patients with simulated difficult laryngoscopy using a rigid neck collar.
abstract: BACKGROUND
  We compared three techniques for insertion of the laryngeal mask airway ProSeal (PLMA) in patients with simulated difficult laryngoscopy using a rigid neck collar.
  
  
  METHODS
  Ninety-nine anesthetized healthy female patients aged 19-68 yr were randomly allocated for PLMA insertion using the digital, introducer tool (IT) or guided techniques. Difficult laryngoscopy was simulated using a rigid neck collar. The laryngoscopic view was graded before PLMA insertion. The digital and IT techniques were performed according to the manufacturer's instructions. The guided technique involved priming the drain tube with an Eschmann tracheal tube introducer, placing the introducer in the esophagus under direct vision and railroading the PLMA into position. Failed insertion was defined by any of the following criteria: 1) failed pharyngeal placement, 2) malposition, and 3) ineffective ventilation.
  
  
  RESULTS
  The median laryngoscopic view was 3 and the mean interincisor distance was 3.3 cm. Insertion was more frequently successful with the guided technique at the first attempt (guided 100%, digital 64%, IT 61%; P<0.0001), but success after three attempts was similar (guided 100%, digital 94%, IT 91%). The time taken for successful placement was similar among groups at the first attempt, but was shorter for the guided technique after three attempts (guided 31+/-8 s, digital 49+/-28 s, IT 54+/-37 s; P<0.02).
  
  
  CONCLUSIONS
  The guided insertion technique is more frequently successful than the digital or IT techniques in patients with simulated difficult laryngoscopy using a rigid neck collar.
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria.
authors.forename: Stephan
authors.initials: S
authors.lastname: Eschertzhuber
authors.forename: Joseph
authors.initials: J
authors.lastname: Brimacombe
authors.forename: Matthias
authors.initials: M
authors.lastname: Hohlrieder
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Stadlbauer
authors.forename: Christian
authors.initials: C
authors.lastname: Keller
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods; D017214:Laryngeal Masks; D007828:Laryngoscopy / Q000379:methods; D008875:Middle Aged