title: Techniques for the insertion of the ProSeal laryngeal mask airway: comparison of the Foley airway stylet tool with the introducer tool in a prospective, randomized study.
abstract: BACKGROUND
  Many tools have been developed to facilitate the insertion of the ProSeal laryngeal mask airway (LMA) insertion, which can be impeded by folding of its soft cuff. The aim of this study was to compare the efficiency of ProSeal LMA insertion guided by a soft, direct optical Foley Airway Stylet Tool (FAST) with the standard introducer tool (IT).
  
  
  METHODS
  One hundred sixty patients undergoing general anesthesia using the ProSeal LMA as an airway management device were randomly allocated to either FAST-guided or IT-assisted groups. Following ProSeal LMA insertion, the glottic and esophageal openings were identified using a fiberoptic bronchoscope introduced through the airway and the drain tube. The primary outcomes were time taken to insert the ProSeal LMA and the success rate at the first attempt. Secondary end points included ease of insertion, hemodynamic response to insertion, and postoperative adverse events recorded in the recovery room and on the first postoperative morning.
  
  
  RESULTS
  One hundred forty patients were included in the final analysis: 66 in the FAST-guided group and 74 in the IT-assisted group. The success rate of FAST device-guided ProSeal LMA insertion (95.7%) was broadly comparable with IT-assisted insertion (98.7%). However, the time taken to insert the ProSeal LMA was significantly longer when the FAST technique was used (p <0.001). The incidence of correct alignment of the airway tube and the drain tube did not differ significantly between the groups. There were no significant differences in ease of insertion or hemodynamic responses to insertion, except that the incidence of postoperative sore throat was significantly higher in the FAST group on the first postoperative day (22.2% compared with 6.8% in the IT group; p = 0.035).
  
  
  CONCLUSIONS
  Both FAST-guided and IT-assisted techniques achieved correct ProSeal LMA positioning, but the IT technique was significantly quicker and less likely to cause a sore throat.
  
  
  BACKGROUND
  ClinicalTrials.gov Identifier: NCT02048657.
authors.affiliation: Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: Mao-Kai
authors.initials: MK
authors.lastname: Chen
authors.affiliation: Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: Hung-Te
authors.initials: HT
authors.lastname: Hsu
authors.affiliation: Department of Anesthesiology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.
authors.forename: I-Cheng
authors.initials: IC
authors.lastname: Lu
authors.affiliation: Department of Anesthesiology, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Chih-Kai
authors.initials: CK
authors.lastname: Shih
authors.affiliation: Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: Ya-Chun
authors.initials: YC
authors.lastname: Shen
authors.affiliation: Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: Kuang-Yi
authors.initials: KY
authors.lastname: Tseng
authors.affiliation: Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan ; Department of Anesthesiology, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Kuang-I
authors.initials: KI
authors.lastname: Cheng
mesh_terms: D000328:Adult; D000368:Aged; D058109:Airway Management / Q000295:instrumentation / Q000379:methods*; D000768:Anesthesia, General / Q000379:methods*; D020680:Bronchoscopes; D001999:Bronchoscopy / Q000379:methods; D004867:Equipment Design; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D017214:Laryngeal Masks; D008297:Male; D008875:Middle Aged; D010612:Pharyngitis / Q000453:epidemiology; D011446:Prospective Studies; D013997:Time Factors; D055815:Young Adult
keywords: Fiberoptic bronchoscope; Foley Airway Stylet Tool (FAST); Introducer tool (IT); ProSeal laryngeal mask airway (LMA)