title: Comparison of the ease of laryngeal mask airway ProSeal insertion and the fiberoptic scoring according to the head position and the presence of a difficult airway.
abstract: BACKGROUND
  The sniffing position is recommended for conventional laryngeal mask airway (LMA) insertion. However, there has been a high success rate of LMA insertion with the head in the neutral position. The effect of a difficult airway on the ease of LMA insertion is not clear. In this study, we compared the ease of LMA ProSeal™ (PLMA) insertion and the fiberoptic scoring according to the head position and the presence of a difficult airway.
  
  
  METHODS
  After obtaining informed consent from the subjects, we enrolled 144 adult patients (age range: 18-65) with an ASA physical status 1 or 2. After evaluation of the airway, all the patients were grouped into the EA (easy airway) group (n = 68) and the DA (difficult airway) group (n = 76). According to the head position, each group was divided into the EA-SE (extension) group (n = 35), the EA-SN (sniffing) group (n = 33), the DA-SE group (n = 39) and the DA-SN group (n = 37). The success rate and insertion time at the first attempt were evaluated. The position of the PLMA was fiberoptically scored from the mask aperture of the airway tube in the original head position. After the head position was changed to the sniffing and neutral positions in the SE and SN group, respectively, the position of PLMA was re-evaluated fiberoptically.
  
  
  RESULTS
  The success rate and insertion time at the first attempt and the fiberoptic score showed no significant difference among the groups. After head position was changed, there were no significant changes in the fiberopitc scores.
  
  
  CONCLUSIONS
  A difficult airway and the head position had no influence on the ease of PLMA insertion and the fiberopic score. Therefore, the head position can be selected according to the individual patient's situation.
authors: Department of Anesthesiology and Pain Medicine, School of Medicine, Ewha Womans University, Seoul, Korea.
authors: Joo Hyun
authors: JH
authors: Jun
authors: Hee Jung
authors: HJ
authors: Baik
authors: Jong Hak
authors: JH
authors: Kim
authors: Youn Jin
authors: YJ
authors: Kim
authors: Ri-Na
authors: RN
authors: Chang
references: Anaesthesia. 1985 Apr;40(4):353-5
references: 3890603
references: Anesthesiology. 2000 Jul;93(1):104-9
references: 10861152
references: Anesth Analg. 2003 Feb;96(2):600-5, table of contents
references: 12538219
references: Anaesthesia. 1993 Aug;48(8):670-1
references: 8214454
references: Anesth Analg. 1993 Feb;76(2):457
references: 8424538
references: Anesth Analg. 1995 Nov;81(5):1001-4
references: 7486037
references: Br J Anaesth. 1985 Mar;57(3):306-10
references: 3978013
references: Br J Anaesth. 1989 Jan;62(1):6-12
references: 2917111
references: Can J Anaesth. 2007 Feb;54(2):129-33
references: 17272252
references: Br J Anaesth. 1983 Aug;55(8):801-5
references: 6349667
references: Br J Anaesth. 1988 Aug;61(2):211-6
references: 3415893
references: Anesth Analg. 2003 Feb;96(2):595-9, table of contents
references: 12538218
references: Anesthesiology. 2001 Jan;94(1):83-6
references: 11135726
references: Anesthesiology. 2001 Oct;95(4):836-41
references: 11605921
references: Korean J Anesthesiol. 2009 Jun;56(6):634-638
references: 30625802
references: Anaesthesia. 1993 Apr;48(4):347
references: 8494147