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Ease and safety of securing airway by railroading proseal laryngeal mask airway over bougie versus traditional digital insertion technique

 Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India

Correspondence Address:
Sunil Rajan,
Department of Anaesthesiology, Amrita Institute of Medical Sciences, Kochi, Kerala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/aer.aer_99_21

Background: ProSeal insertion is usually more time-consuming with lower first-attempt success. Aim of the Study: We aimed to compare the incidence of successful placement of ProSeal laryngeal mask airway (PLMA) in the first attempt by railroading it over soft gum-elastic bougie introduced into esophagus versus traditional digital insertion technique. Time taken and ease of securing airway, associated hemodynamic responses, and trauma were also assessed. Settings and Design: This was a prospective randomized study conducted in a tertiary care institute. Subjects and Methods: Forty patients were recruited into two groups. Following induction in Group P, PLMA was introduced using digital technique, whereas in Group B, a soft gum-elastic bougie was introduced into esophagus and then PLMA was railroaded over the bougie. Correct placement was confirmed with end-tidal carbon dioxide waveform. Statistical Tests Used: Fisher's exact test and independent samples t-test were used for statistical analysis. Results: Successful first-attempt insertion was significantly higher in Group B compared to Group P (100% vs. 70%). Percentage of easy insertion was also significantly higher in Group B (95% vs. 65%). Time taken to insert ProSeal was significantly shorter in Group B (30.8 ± 7.8 vs. 59.5 ± 44.6 s). No patient in Group B had blood-stained secretion versus 70% in Group P. Mean arterial pressures at and after ProSeal insertion were significantly higher in Group P. However, heart rate remained comparable in both the groups. Conclusion: Bougie-guided ProSeal insertions had significantly higher first-attempt insertion success rates and were significantly faster and less traumatic with blunted blood pressure response compared to traditional digital insertion technique.

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