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BJA Advance Access published online on November 25, 2005
British Journal of Anaesthesia, doi:10.1093/bja/aei290
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Accepted October 26, 2005

Clinical Investigation

Bougie-guided insertion of the ProSealTM laryngeal mask airway has higher first attempt success rate than the digital technique in children

M. Lopez-Gil 1, J. Brimacombe 2 * {dagger}, L. Barragan 1, and C. Keller 3 {dagger}

1 Department of Anaesthesia and Reanimation, Maranon University Hospital, Madrid, Spain
2 Department of Anaesthesia and Intensive Care, Cairns Base Hospital, Cairns, Australia
3 Department of Anaesthesia and Intensive Care Medicine, Medical University, Innsbruck, Austria

* To whom correspondence should be addressed.
J. Brimacombe, E-mail: jbrimaco{at}bigpond.net.au


  Abstract

Background. We tested the hypothesis that bougie-guided insertion of the ProSealTM laryngeal mask airway (ProSealTM LMA) has higher success rate than the digital technique in children.

Methods. One hundred and twenty children (ASA I-II, aged 1-16 yr) were randomly allocated for ProSealTM LMA insertion using the digital or bougie-guided technique. The digital technique was performed according to the manufacturer's instructions. The bougie-guided technique involved priming the drain tube with a bougie, placing the bougie in the oesophagus under direct vision and railroading the ProSealTM LMA into position. Unblinded data were collected about ease of insertion (number of attempts and time taken to provide an effective airway), efficacy of seal, ease of gastric tube placement, haemodynamic responses and blood staining. Blinded data were collected about postoperative airway morbidity.

Results. The first attempt success rate was higher for the bougie-guided technique (59/60 vs 52/60, P=0.015), but effective airway time was longer (37 vs 32 s, P<0.001). There were no differences in efficacy of seal, ease of gastric tube placement, haemodynamic responses, blood staining or postoperative airway morbidity.

Conclusion. We conclude that bougie-guided insertion of the ProSealTM LMA has a higher first attempt success rate than the digital technique in children.

Keywords: airway, technique; complications, children; equipment, ProSealTM laryngeal mask airway.
{dagger}Declaration of interest. Dr Brimacombe and Dr Keller have worked as consultants for the Laryngeal Mask Company, who manufacture ProSealTM LMA.
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