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Besdata Video Laryngeal Mask (BD-VLM)- a New Vision-Incorporated 3rd Generation Video Laryngeal Mask Airway : Dear editor

Tan LZ, Seet E, Kumar CM

J Clin Monit Comput, 2022 Dec;36(6):1907-1908.
PMID: 35616796 DOI: 10.1007/s10877-022-00850-0

Since the recent editorial 2, we were approached to evaluate another video laryngeal mask airway - the Besdata Video Laryngeal Mask (BD-VLM) TM, which has a different design concept, specifications and characteristics (Figure 1) compared to the other two.

Matched MeSH terms: Laryngeal Masks*
Fulltext Optimal size selection of laryngeal mask airway in Malaysian female adult population

Rao AS, Yew AEG, Inbasegaran K

Med J Malaysia, 2003 Dec;58(5):717-22.
PMID: 15190658 MyJurnal

The summary of various studies done looking at size selection of the laryngeal mask airway (LMA) in adults is that, selection based on sex is appropriate, and that both sizes 4 or 5 are adequate for adult females. However, in our local population these sizes may be too large especially the size 5 for adult females.

Matched MeSH terms: Laryngeal Masks/standards*
Fulltext Comparison of the Air-Q intubating laryngeal mask airway and the Ambu AuraGain laryngeal mask airway as a conduit for fibreoptic assisted endotracheal intubation for simulated cervical spine injury

Che Omar S, Hardy Mohamad Zaini R, Fui Wong T, Nazaruddin W Hassan WM

Anaesthesiol Intensive Ther, 2021;53(3):241-245.
PMID: 34006053 DOI: 10.5114/ait.2021.105759

INTRODUCTION: Airway management in patients with a cervical spine injury is a difficult and challenging task. The aim of this study was to compare the effectiveness of the Air-Q intubating laryngeal airway and the Ambu AuraGain laryngeal mask airway as a conduit for fibreoptic (FO) assisted endotracheal intubation in adult patients with a simulated cervical spine injury.
MATERIAL AND METHODS: A total of 66 adult patients underwent elective surgery under general anaes-thesia, and they were randomized to two groups: the Air-Q (AQ) group (n = 33) and the Ambu AuraGain (AA) group (n = 33). A simulated cervical spine injury was created using a cervical collar, which was applied after the induction of general anaesthesia. Ease of insertion, time taken for successful insertion, time taken for successful FO guided endotracheal intubation, oropharyngeal leak pressure (OLP), Brimacombe score for FO laryngeal view, post-intubation complications and haemodynamic changes were recorded for both groups.
RESULTS: The OLP was significantly higher in the AA group than in the AQ group (34.9 ± 6.4 vs. 28.6 ± 7.8 cm H 2 O; P = 0.001). Otherwise, there were no significant differences in the ease of insertion, time taken for successful insertion, time taken for successful FO guided endotracheal intubation, Brimacombe score for FO laryngeal view, haemodynamic parameters or complication rate between the two groups.
CONCLUSIONS: Air-Q was comparably effective as Ambu AuraGain as a conduit for FO endotracheal intubation in patients with a simulated cervical spine injury; however, Ambu AuraGain has a better seal with significant OLP.

Matched MeSH terms: Laryngeal Masks*
Postoperative sore throat in children: comparison between proseal LMA and classic LMA

Mokhtar AM, Choy CY

Middle East J Anaesthesiol, 2013 Feb;22(1):65-70.
PMID: 23833853

Postoperative sore throat after minor pediatric surgery although uncommon and the symptoms are mild, the incidence may be affected by several factors. This study was designed to compare the frequency and severity of post operative sore throat in children undergoing elective surgery following the use of proseal LMA (PLMA) compared to classic LMA (cLMA).

Matched MeSH terms: Laryngeal Masks/adverse effects*
Randomised comparison of the LMA Supreme with the I-Gel in spontaneously breathing anaesthetised adult patients

Chew EE, Hashim NH, Wang CY

Anaesth Intensive Care, 2010 Nov;38(6):1018-22.
PMID: 21226431

We compared the performance of the LMA Supreme (SLMA) with the I-Gel during anaesthesia in spontaneously breathing adult patients. Ninety patients with American Society of Anesthesiologists physical status I or II were studied in a prospective randomised controlled study. Our primary outcome measure was oropharyngeal leak pressure. We also compared the overall insertion success rate, ease of insertion, adequacy of ventilation and incidence of complications. The mean (SD), oropharyngeal leak pressure for the SLMA was 25.6 (5.1) cmH2O, which was greater than for the I-Gel 20.7 (5.9) cmH2O (P = 0.0001). The first attempt and overall insertion success rates were similar between the two groups (SLMA 97.8 and 97.8%; I-Gel 93.3 and 100%, P = 0.132). The SLMA was rated easier to insert than the I-Gel (P = 0.011), but the time taken for insertion (P = 0.433) was similar. The incidence of complications was low in both groups. The grade of fibreoptic view was better with the I-Gel than the SLMA (P = 0.001). We conclude that in adults with normal airways, the SLMA is easier to insert and provides a higher oropharyngeal leak pressure, but fibreoptic views are better with the i-gel.

Matched MeSH terms: Laryngeal Masks*
Fulltext Comparison between LMA-Classic and AMBU AuraOnce laryngeal mask airway in patients undergoing elective general anaesthesia with positive pressure ventilation

Suzanna AB, Liu CY, Rozaidi SW, Ooi JS

Med J Malaysia, 2011 Oct;66(4):304-7.
PMID: 22299547

The LMA-Classic laryngeal mask airway (Classic LMA) is an autoclavable and reusable laryngeal mask airway with strong evidence supporting its efficacy and safety. Due to the concern of infection risk particularly of prion disease, various single-use laryngeal mask devices were developed. The Ambu AuraOnce LMA (Ambu LMA) is a single use disposable laryngeal mask airway with special design that conforms better to the anatomy of the airway.

Matched MeSH terms: Laryngeal Masks*
Fulltext A comparison between Laryngeal Tube Suction II Airway and Proseal Laryngeal Mask Airway in laparascopic surgery

Esa K, Azarinah I, Muhammad M, Helmi MA, Jaafar MZ

Med J Malaysia, 2011 Aug;66(3):182-6.
PMID: 22111436

This was a prospective randomized study comparing the ease of insertion, haemodynamic changes, quality of airway seal, oxygenation and ventilation parameters and complications between Laryngeal Tube Suction II (LTS II) with Proseal Laryngeal Mask Airway (PLMA), both are supraglottic airway incorporated with gastric passage. Fifty-four ASA I and II patients were randomly allocated to receive either LTS II or PLMA. Both devices provided a secure airway even under conditions of elevated intra-abdominal pressure up to 17 mmHg. In this study, there were no differences concerning ease of insertion, haemodynamic changes, quality of airway seal, oxygenation and ventilation parameters and complications between LTS II and PLMA.

Matched MeSH terms: Laryngeal Masks*
Fulltext Nitrous oxide pollution in the operating room. A comparison of two modes of ventilation

Noorddin Y, Raha AR, Jaafar MZ, Rozaidi SH, Muraly S, Marlizan MY

Med J Malaysia, 2007 Jun;62(2):127-9.
PMID: 18705444 MyJurnal

The use of laryngeal mask airway (LMA) as an alternative to the endotracheal tube (ETT) is becoming more popular in the practice of anesthesia. It is undeniable that this device has numerous advantages over endotracheal tube, however it does not provide an airtight seal between the airway and atmospheric gases. This may lead to pollution of the operating room environment with nitrous oxide. One hundreds adult patients undergoing general anaesthesia were divided into two groups. The airway in Group I was maintained with LMA with spontaneous ventilation and ETT with intermittent positive pressure ventilation (IPPV) was used for Group II. The result demonstrated that the ETT group recorded concentrations of nitrous oxide that were well above the NIOSH recommended eight hour time weighted average of 25ppm throughout the duration of surgery when compared to patients using LMA.

Matched MeSH terms: Laryngeal Masks*
The Proseal laryngeal mask airway in children: a comparison between two insertion techniques

Teoh CY, Lim FS

Paediatr Anaesth, 2008 Feb;18(2):119-24.
PMID: 18184242 DOI: 10.1111/j.1460-9592.2007.02385.x

The Proseal laryngeal mask airway (PLMA) is a relatively new supraglottic airway device with a drain tube to minimize the risk of gastric insufflation and aspiration. We compared introducer tool (IT) and gum elastic bougie (GEB)-guided techniques for insertion of the Proseal LMA in children.

Matched MeSH terms: Laryngeal Masks/adverse effects*
Randomised crossover comparison of the Ambu AuraOnce Laryngeal Mask with the LMA Classic laryngeal mask airway in paralysed anaesthetised patients

Shariffuddin II, Wang CY

Anaesthesia, 2008 Jan;63(1):82-5.
PMID: 18086075

We compared the performance of the Ambu AuraOnce Laryngeal Mask with that of the LMA Classic laryngeal mask airway during controlled anaesthesia. Forty patients requiring intermittent positive pressure ventilation were studied using a randomised crossover design. The mean (SD) oropharyngeal leak pressure for the Ambu device (19 (7.5) cmH2O) was significantly greater than for the LMA Classic (15 (5.2) cmH2O; p = 0.004), and the number of attempts for successful insertions was significantly less (39 (50%) vs 45 (56%), respectively; p = 0.02). There was one failure to obtain a patent airway with the Ambu Laryngeal Mask and none with the LMA Classic. Insertion of the Ambu Laryngeal Mask required more manipulations to achieve a patent airway than did the LMA Classic (6 (15%) vs 1 (2.5%), respectively; p = 0.045), but the time taken for insertion was similar between the two groups. The incidence of trauma, grade of fibreoptic view, peak airway pressure and quality of ventilation during maintenance of anaesthesia were similar in both groups.

Matched MeSH terms: Laryngeal Masks*
Fulltext Comparison of the ease of insertion of the laryngeal tube VBM and laryngeal mask airway during manual in-line neck stabilization

Noor Zairul M, Khairul Faizi A, Norzalina E

Med J Malaysia, 2006 Jun;61(2):157-61.
PMID: 16898305

The purpose of this study is to assess whether the newly developed laryngeal tube (LT) VBM is easy, simple to use and able to provide adequate ventilation and oxygenation to a patient with an unstable neck who required airway management. We compared the LT to the laryngeal mask airway (LMA) as alternative airway management tool in adult patient with unstable neck who underwent intubation with manual in-line neck stabilization. A randomized single-blinded prospective study was conducted involving a total of 40 ASA I and II premedicated patients who were divided into two groups with 20 patients for each group; either LT or LMA group for airway management during elective surgery. After preoxygenation, anaesthesia was induced and neuromuscular blockade was produced with intravenous drugs. The LT or LMA was inserted after neuromuscular blockade was confirmed using a peripheral nerve stimulator (TOF 1). A size 3, 4 or 5 LT OR a size 3 or 4 LMA was inserted while the patient's head and neck were being stabilized by an assistant who held the sides of the neck and the mastoid processes (manual in-line stabilization). If it was not possible to ventilate the lungs, or if endotrachial carbon dioxide (ETCO2) and/or chest movement did not indicate a patent airway, the LT or LMA was removed. After three failed attempts, the study was terminated and the airway was secured in the most suitable manner determined by the anaesthetist. There was a statistically significant difference for both groups in the time required for successful insertion (time required for LT was 24.8 +/- 7.7 seconds and LMA was 36.1+/-17.3 seconds) (p= 0.01). There was no statistical differences (p>0.05) in number of attempts needed to achieve a patent airway although we were able to achieve a clear airway in all patients in LT group at the first attempt compared with 85% in LMA group. successful insertion rate was 100% for both groups. We conclude that the LT is easier to insert and is a suitable alternative to the LMA for airway management when the patient's head and neck are stabilized by manual in-line method.

Matched MeSH terms: Laryngeal Masks*
The use of modified VBM laryngeal tube compared to Laryngeal Mask Airway during spontaneous ventilation

Chiu CL, Murugasu J, Chan L

Anaesth Intensive Care, 2003 Apr;31(2):187-92.
PMID: 12712784

We have compared the use of the laryngeal mask airway with the new modified laryngeal tube in a prospective randomized controlled study. Sixty ASA 1 or 2 patients, aged 18 to 65 years, scheduled for elective surgery and breathing spontaneously under general anaesthesia, were studied. After preoxygenation, anaesthesia was induced with fentanyl and propofol. The patients were randomized to receive either a laryngeal mask airway or a laryngeal tube. Anaesthesia was maintained with nitrous oxide, oxygen and isoflurane. We recorded the speed and the ease of insertion, the number of attempts needed to successfully secure the airway and intraoperative complications, such as partial airway obstruction needing airway manipulation. The airway devices were removed with the patients fully awake at the end of surgery. Systolic arterial blood pressure, heart rate and end-tidal CO2 were recorded at various time intervals. Postoperative complications were recorded. We found that the incidence of partial airway obstruction needing intraoperative airway manipulation was higher with the laryngeal tube than with the laryngeal mask airway. We conclude that during spontaneous ventilation the modified laryngeal tube is not as reliable in providing a satisfactory airway and we consider it is not a suitable alternative to the laryngeal mask airway.

Matched MeSH terms: Laryngeal Masks*
Fulltext Unilateral hypoglossal nerve palsy after the use of laryngeal mask airway (LMA) Protector

Tham LY, Beh ZY, Shariffuddin II, Wang CY

Korean J Anesthesiol, 2019 12;72(6):606-609.
PMID: 31304693 DOI: 10.4097/kja.d.18.00354

BACKGROUND: The laryngeal mask airway (LMAⓇ) ProtectorTM (Teleflex Medical Co., Ireland) is the latest innovation in the second generation of LMA devices. One distinguishing feature of this device is its integrated, color-coded cuff pressure indicator (Cuff PilotTM technology) which enables continuous cuff pressure monitoring and allows adjustments when necessary; this ensures patient safety due to better monitoring.
CASE: We report a case of postoperative unilateral hypoglossal nerve palsy after uncomplicated use of the LMA Protector. To the best of our knowledge, this could be the second reported case.
CONCLUSIONS: This case demonstrates that anesthetists need to routinely measure cuff pressure and that the Cuff PilotTM technology is not a panacea for potential cranial nerve injury after airway manipulation.

Matched MeSH terms: Laryngeal Masks/adverse effects*
Fulltext Comparison of the Baska mask and the i-gel supraglottic airway devices in patients undergoing elective surgery

Kumar Sinasamy T, Nazaruddin Wan Hassan WM, Hardy Mohamad Zaini R, Seevaunnamtum P, Ab Mukmin L

Anaesthesiol Intensive Ther, 2020;52(5):383-388.
PMID: 33327696 DOI: 10.5114/ait.2020.101407

INTRODUCTION: The Baska mask and i-gel are two new types of second-generation supraglottic airway devices. The aim of this study was to compare these two devices in terms of quality of insertion, quality of ventilation and post-insertion complications.
MATERIAL AND METHODS: A total of 80 adult patients who were scheduled for elective surgery under general anaesthesia were randomised to two groups: Group BM: Baska mask (n = 40) and Group IG: i-gel (n = 40). The assessment focused on ease of insertion, number of attempts, insertion time, number of corrective manoeuvres, oropharyngeal leak pressure, tidal volume, peak airway pressure (PAP) and post-insertion complications.
RESULTS: Group IG showed a significantly shorter median insertion time (13.3 [interquartile range, IQR 7.8] vs. 17.0 [IQR 9.6] s; P < 0.001), a higher percentage in the 'very easy' ease of insertion category (62.5% vs. 10.0%; P < 0.001), a higher percentage in the no corrective manoeuvre category (92.5% vs. 72.5%; P = 0.003) and a higher percentage in the no post-operative throat pain category (67.5% vs. 32.5%; P = 0.011) than Group BM. However, Group BM showed a significantly higher generated PAP than Group IG (12.7 [1.8] and 11.5 [2.2] cm H2O, respectively; P = 0.010). There were no significant differences in other parameters.
CONCLUSIONS: The i-gel was better than the Baska mask in terms of ease of insertion, speed of insertion, fewer corrective manoeuvres and less post-operative throat pain. However, the Baska mask had a better cuff seal, as shown by a higher generated PAP.

Matched MeSH terms: Laryngeal Masks*
Fulltext The 50% and 95% effective doses of desflurane for removal of the classic laryngeal mask airway in spontaneously breathing anaesthetised adults

Hui MT, Subash S, Wang CY

Anaesthesia, 2011 Apr;66(4):274-7.
PMID: 21401540 DOI: 10.1111/j.1365-2044.2011.06620.x

The 50% and 95% effective doses of desflurane for removal of the classic laryngeal mask airway after suction of the upper airway, in anaesthetised spontaneously breathing adult patients, are not known. To determine these, we studied 38 healthy patients, aged between 18 and 44 years. The target desflurane concentration in each individual patient was determined by the Dixon up-and-down method. When the predetermined target end-tidal desflurane concentration reached steady state, we kept a constant end-expiratory partial pressure between the alveolus and the brain for 10 min before attempting to remove the classic laryngeal mask airway after suctioning the upper airway. The initial desflurane target concentration was set at 6% and up-down desflurane increments were 0.1%. This continued until there were at least six crossover pairs. From the probit analysis, the 50% effective dose of desflurane was 5.29% (95% CI 5.132-5.379%) and the 95% effective dose was 5.55% (95% CI 5.429-6.394%).

Matched MeSH terms: Laryngeal Masks*
Fentanyl dose for the insertion of Classic Laryngeal Mask Airways in non-paralysed patients induced with propofol 2.5 mg/kg

Tan AS, Wang CY

Anaesth Intensive Care, 2010 Jan;38(1):65-9.
PMID: 20191779

The aim of this randomised, controlled trial was to determine the optimum dose of fentanyl in combination with propofol 2.5 mg x kg(-1) when inserting the Classic Laryngeal Mask Airway. Seventy-five ASA I or II patients were randomly assigned to five groups of fentanyl dosage: 0 microg x kg(-1) (placebo), 0.5 microg x kg(-1), 1.0 microg x kg(-1), 1.5 microg x kg(-1) and 2.0 microg x kg(-1). Anaesthesia was induced by first injecting the study drug over 10 seconds. Three minutes after the study drug was injected, propofol (2.5 mg x kg(-1)) was injected over 10 seconds. The Classic Laryngeal Mask Airway was inserted four minutes and 30 seconds after injection of the study drug. Insertion conditions were evaluated using a four-category score. Thirty-nine males and 36 females aged 19 to 59 years were studied. The incidence of prolonged apnoea increased as fentanyl dose increased. We found that there was a high rate of successful first attempt at insertion with 1 microg x kg(-1) and 1.5 microg x kg(-1), 93% and 87% respectively, compared to 87% in the 2.0 microg x kg(-1) group. The 1.0 microg x kg(-1) group also achieved an 80% optimal insertion conditions score of 4, compared to 73% in the 1.5 microg x kg(-1) group and 80% in the 2 microg x kg(-1) group. Therefore we recommend 1.0 microg x kg(-1) as the optimal dose of fentanyl when used in addition to propofol 2.5 mg/kg for the insertion of the Classic Laryngeal Mask Airway.

Matched MeSH terms: Laryngeal Masks*
Randomized double-blind comparison of ketamine-propofol, fentanyl-propofol and propofol-saline on haemodynamics and laryngeal mask airway insertion conditions

Goh PK, Chiu CL, Wang CY, Chan YK, Loo PL

Anaesth Intensive Care, 2005 Apr;33(2):223-8.
PMID: 15960405

The aim of this prospective, double-blind, randomized, placebo-controlled clinical trial was to investigate whether the administration of ketamine before induction with propofol improves its associated haemodynamic profile and laryngeal mask airway (LMA) insertion conditions. Ninety adult patients were randomly allocated to receive either ketamine 0.5 mg x kg(-1) (n = 30), fentanyl 1 microg x kg(-1) (n = 30) or normal saline (n = 30), before induction of anaesthesia with propofol 2.5 mg x kg(-1). Insertion of the LMA was performed 60s after injection of propofol. Arterial blood pressure and heart rate were measured before induction (baseline), immediately after induction, immediately before LMA insertion, immediately after LMA insertion and every minute for three minutes after LMA insertion. Following LMA insertion, the following six subjective endpoints were graded by a blinded anaesthestist using ordinal scales graded 1 to 3: mouth opening, gagging, swallowing, movement, laryngospasm and ease of insertion. Systolic blood pressure was significantly higher following ketamine than either fentanyl (P = 0.010) or saline (P = 0.0001). The median (interquartile range) summed score describing the overall insertion conditions were similar in the ketamine [median 7.0, interquartile range (6.0-8.0)] and fentanyl groups [median 7.0, interquartile range (6.0-8.0)]. Both appeared significantly better than the saline group [median 8.0, interquartile range (6.75-9.25); P = 0.024]. The incidence of prolonged apnoea (> 120s) was higher in the fentanyl group [23.1% (7/30)] compared with the ketamine [6.3% (2/30)] and saline groups [3.3% (1/30)]. We conclude that the addition of ketamine 0.5 mg x kg(-1) improves haemodynamics when compared to fentanyl 1 microg x kg(-1), with less prolonged apnoea, and is associated with better LMA insertion conditions than placebo (saline).

Matched MeSH terms: Laryngeal Masks*
Fulltext Clinical performance of the LMA Protector™ airway in moderately obese patients

Shariffuddin II, Chaw SH, Ng LW, Lim CH, Zainal Abidin MF, Wan Zakaria WA, et al.

BMC Anesthesiol, 2020 07 31;20(1):184.
PMID: 32736516 DOI: 10.1186/s12871-020-01100-z

BACKGROUND: The 4th National Audit Project of The Royal College of Anaesthetists and The Difficult Airway Society (NAP4) reported a higher incidence of supraglottic airway device (SAD) related pulmonary aspiration in obese patients especially with the first-generation SADs. The latest single-use SAD, the Protector™ provides a functional separation of the respiratory and digestive tracts and its laryngeal cuff with two ports allowing additional suction in tandem with the insertion of a gastric tube. The laryngeal cuff of LMA Protector™ allows a large catchment reservoir in the event of gastric content aspiration.
METHODS: We evaluated the performance characteristics of the LMA Protector™ in 30 unparalysed, moderately obese patients. First attempt insertion rate, time for insertion, oropharyngeal leak pressure (OLP), and incidence of complications were recorded.
RESULTS: We found high first and second attempt insertion rates of 28(93%) and 1(33%) respectively, with one failed attempt where no capnography trace could be detected, presumably from a downfolded device tip. The LMA Protector™ was inserted rapidly in 21.0(4.0) seconds and demonstrated high OLP of 31.8(5.4) cmH2O. Fibreoptic assessment showed a clear view of vocal cords in 93%. The incidence of blood staining on removal of device was 48%, postoperative sore throat 27%, dysphagia 10% and dysphonia 20% (all self-limiting, resolving a few hours postoperatively).
CONCLUSIONS: We conclude that the LMA Protector™ was associated with easy, expedient first attempt insertion success, demonstrating high oropharyngeal pressures and good anatomical position in the moderately obese population, with relatively low postoperative airway morbidity.
TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12617001152314 . Registered 7 August 2017.

Matched MeSH terms: Laryngeal Masks*
Difficult mask ventilation: simple step to make the impossible, possible!

Chong SE, Mohammad Zaini RH, Wan Mohd Rubi I, Lim JA

J Clin Anesth, 2016 Nov;34:612-4.
PMID: 27687458 DOI: 10.1016/j.jclinane.2016.06.035

Mask ventilation is one of the most important skills in airway management. Difficulty in mask ventilation can become life threatening if it is associated with difficulty in intubation during general anesthesia. We report a potential impossible ventilation condition which was safely and easily overcome with appropriate innovative modification of an Opsite adhesive film.

Matched MeSH terms: Laryngeal Masks*
Fulltext Comparison of the VBM laryngeal tube and laryngeal mask airway for ventilation during manual in-line neck stabilisation

Noor Zairul M, Khairul Faizi A

Singapore Med J, 2006 Oct;47(10):892-6.
PMID: 16990966

INTRODUCTION: The purpose of this study is to assess whether the newly-developed VBM (Medizintechnik GmbH, Sulz, Germany) laryngeal tube (LT) is able to provide adequate ventilation and oxygenation to patients with an unstable neck and require airway management. The haemodynamic responses to insertion between the two devices were also studied. We compared the LT to the laryngeal mask airway (LMA) as an alternative airway management tool in adult patients with unstable neck and who underwent intubation with manual in-line neck stabilisation.
METHODS: A randomised single-blinded prospective study was conducted involving a total of 40 American Society of Anesthesiology I and II pre-medicated patients who were divided into two groups, LT or LMA, for airway management during elective surgery. There were 20 patients for each group. After pre-oxygenation, anaesthesia was induced using intravenous (i.v.) fentanyl and i.v. propofol. The neuromuscular blockade was produced with either i.v. vecuronium or i.v. atracurium. The LT or LMA was inserted after neuromuscular blockade was confirmed using a peripheral nerve stimulator (train-of-four 1). A size 3, 4 or 5 LT or a size 3 or 4 LMA was inserted while the patient's head and neck were being stabilised by an assistant who held the sides of the neck and the mastoid processes (manual in-line stabilisation). If it was not possible to ventilate the lungs, or if end-tidal carbon dioxide and/or chest movement did not indicate a patent airway, the LT or LMA was removed. After three failed attempts, the study was terminated and the airway was secured in the most suitable manner determined by the anaesthetist. After successful placement of LT or LMA, anaesthesia was maintained with 66 percent nitrous oxide in oxygen and 2 minimum alveolar concentration sevoflurane. All patients received standard anaesthesia monitoring. The ease of insertion, the number of attempts needed to successfully secure the airway, episodes of desaturation (less than 95 percent) and end-tidal carbon dioxide at various time intervals were studied. The haemodynamic parameters such as systolic blood pressure, diastolic blood pressure, mean arterial pressure and heart rate at different time intervals were also studied.
RESULTS: The study showed a statistically significant difference in time required for successful insertion between the groups; time required for LT was 24.8 +/- 7.7 seconds and LMA was 36.1 +/- 17.3 seconds (p-value equals 0.01). Both groups had no statistical differences (p-value is greater than 0.05) in number of attempts needed to achieve a patent airway, and the successful insertion rate was 100 percent for both groups. There were also no statistical differences in the haemodynamic response to insertion and the end-tidal carbon dioxide in this study.
CONCLUSION: We conclude that, under anaesthesia, the LT was a valuable and better alternative to LMA for ventilation and airway management when the patient's head and neck are stabilised by the manual in-line method.

Matched MeSH terms: Laryngeal Masks*

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