title: The 90° rotation technique improves the ease of insertion of the ProSeal™ laryngeal mask airway in children.
abstract: BACKGROUND
  A previous study using a 180° rotation to insert the ProSeal™ laryngeal mask airway (LMA ProSeal) in children did not show improvement over the standard technique. We used a 90° rotation technique to insert the LMA ProSeal in pediatric patients and compared ease of insertion and pharyngeal trauma with the standard technique.
  
  
  METHODS
  This prospective randomized controlled study included 126 patients aged three to nine years. Anesthesia was induced with thiopental and rocuronium, and the LMA ProSeal used in the study ranged in size from 2 to 3 depending on the patient's body weight. In the control group (n = 63), the LMA ProSeal was inserted using the index finger. In the rotation group (n = 63), the entire cuff of the LMA ProSeal was placed in the patient's mouth without finger insertion and rotated 90° counter clockwise around the tongue. The LMA ProSeal was then advanced and rotated back until resistance was felt. The primary outcome was the insertion success rate at first attempt.
  
  
  RESULTS
  The success rate of insertion at first attempt was higher with the rotation technique than with the standard technique (97% vs 70%, respectively; P < 0.001) and the insertion time was shorter (16 ± 6 sec vs 30 ± 24 sec, respectively; P < 0.001). Mean blood pressure after LMA ProSeal insertion increased significantly in the control group (62 ± 12 to 69 ± 17 mmHg; P = 0.01), but not in the rotation group. The incidence of blood staining was lower in the rotation group than in the control group (10% vs 25%, respectively; P = 0.03), but the incidence of sore throat was not significantly different (24% vs 22%, respectively; P = 0.9).
  
  
  CONCLUSIONS
  The 90° rotation technique improves ease of insertion of the LMA ProSeal in children, and it decreases the risk of pharyngeal trauma. (ClinicalTrials.gov number, NCT01076725).
authors.affiliation: Department of Anesthesiology and Pain Medicine, National Medical Center, Seoul, South Korea.
authors.forename: Mi-Ja
authors.initials: MJ
authors.lastname: Yun
authors.forename: Jung-Won
authors.initials: JW
authors.lastname: Hwang
authors.forename: Sang-Heon
authors.initials: SH
authors.lastname: Park
authors.forename: Sung-Hee
authors.initials: SH
authors.lastname: Han
authors.forename: Hee-Pyoung
authors.initials: HP
authors.lastname: Park
authors.forename: Jin-Hee
authors.initials: JH
authors.lastname: Kim
authors.forename: Young-Tae
authors.initials: YT
authors.lastname: Jeon
authors.forename: Sang-Chul
authors.initials: SC
authors.lastname: Lee
mesh_terms: D001794:Blood Pressure; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D017214:Laryngeal Masks; D008297:Male; D011446:Prospective Studies; D012399:Rotation