title: A comparative study of three methods of ProSeal laryngeal mask airway insertion in children with simulated difficult laryngoscopy using a rigid neck collar.
abstract: BACKGROUND
  Combined introducer tool and stylet technique of ProSeal laryngeal mask airway (PLMA) insertion was compared with the conventional digital manipulation and introducer tool technique in children with a rigid neck collar.
  
  
  METHODS
  This was a randomized, single blinded, prospective study. Ninety ASA Grade I-II children weighing 10-20 kg were randomly allocated for PLMA insertion using the digital, introducer tool (IT) or combined IT and stylet techniques. Each group contained 30 patients. Difficult laryngoscopy was simulated using a rigid neck collar. The laryngoscopic view was graded prior to PLMA insertion. The digital and IT techniques were performed according to the manufacturer's instructions. The combined technique involved attaching the IT to the PLMA and inserting a flexible stylet through the drain tube.
  
  
  RESULTS
  The median Cormack and Lehane grade was 2 in all three groups. Insertion was more frequently successful with the combined technique at the first attempt (combined 100%, digital 65.38%, IT 66.67%; p < 0.05), but success after three attempts was similar (combined 100%, digital 86.67%, IT 90%; p > 0.05). The time taken for successful placement was similar among groups at the first attempt, but was shorter for the combined technique for overall attempts (combined 18.33 ± 1.27 seconds, digital 27.85 ± 9.05 seconds, IT 26.89 ± 7.17 seconds; p < 0.05). There was no difference in postoperative airway morbidity.
  
  
  CONCLUSIONS
  PLMA insertion with combined IT and stylet technique was more frequently successful than the digital or IT technique in pediatric patients without cervical spine motion.
authors: Department of Anaesthesiology, Government Medical College, Haldwani, India. Electronic address: bikramjit_81@rediff.com.
authors: Bikramjit
authors: B
authors: Das
authors: Department of Anaesthesiology, Government Medical College, Haldwani, India.
authors: Subhro
authors: S
authors: Mitra
authors: Department of Anaesthesiology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India.
authors: Arijit
authors: A
authors: Samanta
authors: Department of Anaesthesiology, Institute of Post Graduate Medical Education and Research, Kolkata, India.
authors: Rajiv Kumar
authors: RK
authors: Samal
mesh_terms: D002675:Child, Preschool; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D017214:Laryngeal Masks; D007828:Laryngoscopy; D008297:Male; D011446:Prospective Studies; D016037:Single-Blind Method
keywords: laryngeal masks: ProSeal; laryngoscopy: difficult