Comparison of three different techniques for the insertion of proseal laryngeal mask airway in adults- A prospective randomised clinical study

Need for the study:

The Proseal Laryngeal mask airway (PLMA) is a supraglottic airway device

commonly used in clinical practice for airway management during general anaesthesia.

It has been popular due to its ease of insertion, high success rate of insertion, and less

risk of invasive manipulation.

1

However, despite its widespread use, the standard technique for insertion of

Proseal LMA (PLMA) remains a topic of debate. The traditional insertion technique

involves the use of the index finger to place the PLMA into position, which can be

challenging in patients with limited mouth opening, large tongue, or short neck.

2

In

response to these challenges, various alternative techniques have been introduced,

including the 90° rotation technique and the use of metallic introducer.

3

The index finger technique involves using the index finger for introducing the

PLMA upto hypopharynx, allowing for better control and a smoother insertion.

4

The 90 degree rotation technique involves rotating the Proseal laryngeal mask

airway 90 degrees anticlockwise during insertion into oropharynx, which has been

shown to reduce the risk of epiglottic entrapment and improve the seal of the Proseal

LMA.

5

The metallic introducer technique is performed using a rigid metallic introducer

which guides the PLMA into position, which may be advantageous in patients with

difficult airway.

6

However, the insertion technique for the Proseal LMA is crucial for its successful

use, and there is currently no consensus on the most optimal technique. This has led to

the development of different techniques for Proseal LMA insertion, each with its own

advantages and disadvantages. Therefore, our study is proposed to compare the efficacy

of these three techniques and determine the most suitable approach for Proseal LMA insertion