Ease of Proseal Laryngeal Mask Airway Insertion Using Miller Blade; a Comparison with Conventional Digital Technique

The Proseal laryngeal mask airway (PLMA) (The Laryngeal Mask Company Ltd., Victoria, Seychelles) is an advanced form of the LMA with a softer and larger cuff to improve sealing and a drain tube to permit venting of the stomach. However, when a larger cuff is used, it is more difficult to save space for inserting the PLMA in the patient's mouth, and the larger cuff is more likely to fold over (1, 2). Use of gum elastic bougie, gastric tube, and stylet have been described to avoid this fold over and to increase success s rate and ease of insertion of PLMA (3-10 ). Use of Mackintosh laryngoscope has been described to assist variety of laryngeal mask airways including classic laryngeal mask airway, flexible laryngeal mask airway and PLMA (11-15). However we have observed that large cuff size of PLMA hampers the smooth insertion of PLMA alongside the Macintosh blade especially in patients with small mouth opening and decreased submandibular space. We attempted to evaluate the use of miller blade, an important part of armamentarium for difficult airway management (15)to ease insertion of PLMA by anesthesia residents at various levels of junior residency (six months to 3 years) and compared its success rate to digital insertion technique. Materials and Methods This study was approved by the Institutional ethical committee. Written informed parental consent was obtained during the preoperative visit. A total of 130 anesthetized paralyzed adult patients were enrolled in the study. Patients were allocated randomly to one of two groups, i.e., group D (PLMA insertion using the digital insertion technique) or group M (PLMA insertion using the Miller blade). All patients were managed by anesthesia residents who were unskilled in using each technique under the supervision of faculty members . We accessed success rates of insertion at the first attempt, number of attempts, oropharyngeal leak pressure and insertion time for an effective airway, and airway morbidity if any. A total of 130 patients (American Society of Anesthesiologists physical status I-II, aged 18 to 75) scheduled for surgery under general anesthesia were Introduction Abstract The Current study compared the success rate and rate of complications between digital insertion and Miller blade-guided insertion of the laryngeal mask airway ProSealTM (PLMA) when performed by anesthesia residents in adult patients. A total of 126 anesthetized paralyzed adult patients were included in the study. Patients were allocated randomly to one of two groups, i.e., Digital group (PLMA insertion using the digital insertion technique) or Miller group (PLMA insertion using the Miller blade-laryngoscope ). We assessed success rates of insertion at the first attempt, insertion time for an effective airway and postoperative morbidity. The success rate of insertion at the first attempt was higher with the Millerguided technique than with the digital insertion technique (97% vs 72%, respectively; P <0.05). Insertion time at the first attempt for an effective airway were shorter in the Miller group than in the Digital group (33.5 seconds vs. 21.0 seconds P <0.05). Ease of insertion was significantly better when using miller blade to insert PLMA (p<0.05). Blood staining was more frequent in the Digital group than in the Miller group (P <0.05). When inserting the PLMA in adults, anesthesia residents were more successful using the Miller blade-guided insertion technique than using the digital insertion technique