classic laryngeal mask airway insertion with four different methods in elective surgeries under general anesthesia: a comparison of efficacy, ease, speed of insertion and post-operative complications

aim and background:   safe airway maintenance in patients under general anesthesia is the most important duty of anaesthesiologists. classic laryngeal mask airway (clma) is a supra-glottic device to achieve this aim. there are different insertion techniques for this device, but the best of them is unknown. methods and materials:   two hundred patients were included in this mono-blinded clinical trial. patients were divided into four groups. the clma was inserted by the index finger in the standard group, by 45 degree rotation into lateral position in the lateral technique group, by 180 degree rotation in the rotational technique, and finally in the modified standard group we used a standard like method without using the index finger. we evaluated the number of insertion trials, ease of insertion and the time needed for successful trial. airway sealing pressure and post operative complications were also assessed. findings:   with the lateral technique, clma was more easily inserted, and the time needed for insertion was also significantly decreased. in the meanwhile, we encountered less blood stained lma with the lateral technique (p<0/05). the first-trial success rate was more in the lateraltechnique group but the difference was not shown to be significant. conclusions:   lateral insertion of clma increases ease and first-attempt success rate and at the same time, it reduces insertion time and bleeding .as a result, this technique can be recommended whenever lma insertion is necessary in patients undergoing general anesthesia.