title: Laryngeal mask airways and use of a Boyle-Davis gag in ENT surgery: is there a learning curve? A prospective analysis.
abstract: OBJECTIVE
  The objective was to identify whether the experience of the operating surgeon was relevant to the frequency of the laryngeal mask airway (LMA) airway obstruction or change to an endotracheal tube during ear, nose, and throat surgery.
  
  
  METHODS
  Data were prospectively collected for 186 patients undergoing a procedure with the use of a Boyle-Davis gag and LMA over 12 months in a district-general hospital in the United Kingdom. patient demographics (age, mallampati grade), grade of surgeon, grade of anesthetist, LMA size inserted, and any intraoperative adjustments needed were recorded.
  
  
  RESULTS
  There was an overall intraoperative airway intervention rate of 21%. The experience of the surgeon affected the rate of intraoperative airway interventions encountered, reflected by the significantly lower rate of airway complications (ie, 10%) seen when associate specialists perform these types of procedures compared to other grades of surgeon (Fisher's exact test 2-tailed P value = .04). A significant complication rate of 50% was seen with core surgical trainees compared to other grades of surgeon (Fisher's exact test 2-tailed P value = .002).
  
  
  CONCLUSIONS
  The results of this study suggest there may be a learning curve for otolaryngology trainees when using a LMA. However, larger studies and further subanalyses are essential before further conclusions can be made.
authors.affiliation: Department of Otolaryngology, Royal Berkshire Hospital, Oxford Deanery, UK.
authors.forename: Roland
authors.initials: R
authors.lastname: Hettige
authors.forename: Miran
authors.initials: M
authors.lastname: Pankhania
authors.forename: Vias
authors.initials: V
authors.lastname: Demetriou
authors.forename: Mark
authors.initials: M
authors.lastname: Draper
mesh_terms: D004502:Education, Medical, Continuing; D007432:Intraoperative Period; D017214:Laryngeal Masks; D059032:Learning Curve; D013517:Otorhinolaryngologic Surgical Procedures / Q000193:education* / Q000295:instrumentation*; D011446:Prospective Studies; D006113:United Kingdom
keywords: Boyle–Davis gag; airway; experience; intervention; laryngeal mask airway