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Insertion of the ProSeal™ laryngeal mask airway is more successful with the Flexi-Slip™ stylet than with the introducer

L’insertion du masque laryngé ProSeal™ est plus souvent réussie avec le mandrin Flexi-Slip™ qu’avec l’introducteur

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Canadian Journal of Anesthesia/Journal canadien d'anesthésie Aims and scope Submit manuscript

Abstract

Purpose

The ProSeal™ laryngeal mask airway (PLMA™) may be difficult to insert because of its large soft cuff, even when using a dedicated introducer tool. The purpose of this study was to investigate whether introduction of a stylet (Flexi-Slip™) in the drainage tube improved insertion characteristics compared with the standard introducer.

Methods

In this randomized controlled trial, 160 adults were allocated randomly to either the Introducer group (n = 80) or to the Flexi-Slip stylet group (n = 80). In the Introducer group, the PLMA was inserted with an introducer as described in the manufacturer’s instructions. In the Flexi-Slip stylet group, a Flexi-Slip stylet was inserted into the drainage tube of the PLMA and bent to form a near 90° angle at the junction of the cuff and the airway tube. The primary outcome measurement was the success rate at first attempt. Insertion time, visible blood staining, and complications were also noted.

Results

Success at first attempt was more frequent with the Flexi-Slip stylet than with the introducer (100% vs 86%, respectively; P = 0.001). Overall time (mean ± standard deviation) taken for successful placement was shorter with the Flexi-Slip stylet than with the introducer (19.9 ± 5.6 sec vs 28.4 ± 15.2 sec, respectively; P < 0.001). The incidences of blood staining and postoperative sore throat were lower in the Flexi-Slip stylet group than in the Introducer group (4% vs 15%, respectively; P = 0.015 and 8% vs 23%, respectively; P = 0.008).

Conclusion

Insertion of the PLMA with a Flexi-Slip stylet has a higher success rate at first attempt, requires less time, and results in fewer airway complications than the introducer technique.

Résumé

Objectif

Le masque laryngé ProSeal™ (PLMA™) peut être difficile à insérer en raison de la taille de son ballonnet mou et ce, même en utilisant l’introducteur spécialement prévu à cet effet. L’objectif de cette étude était d’examiner si l’introduction d’un mandrin (Flexi-Slip™) dans le tube de drainage améliorait les caractéristiques d’insertion par rapport à l’introducteur standard.

Méthode

Dans cette étude randomisée contrôlée, 160 adultes ont été aléatoirement répartis en deux groupes, soit le groupe introducteur (n = 80) et le groupe mandrin Flexi-Slip (n = 80). Dans le groupe introducteur, le PLMA a été inséré à l’aide d’un introducteur conformément aux instructions du fabricant. Dans le groupe mandrin Flexi-Slip, un mandrin Flexi-Slip a été inséré dans le tube de drainage du PLMA et courbé afin de former un angle proche de 90° à la jonction du ballonnet et de la sonde. Le critère d’évaluation principal était le taux de réussite à la première tentative. Le temps d’insertion, les taches de sang visibles et les complications ont également été enregistrés.

Résultats

La première tentative a réussi plus souvent avec le mandrin Flexi-Slip qu’avec l’introducteur (100 % vs 86 %, respectivement; P = 0,001). Le temps global (moyenne ± écart type) nécessaire au positionnement réussi était plus court avec le mandrin Flexi-Slip qu’avec l’introducteur (19,9 ± 5,6 sec vs 28,4 ± 15,2 sec, respectivement; P < 0,001). Les incidences de taches de sang et de maux de gorge postopératoires étaient plus faibles dans le groupe mandrin Flexi-Slip que dans le groupe introducteur (4 % vs 15 %, respectivement; P = 0,015 et 8 % vs 23 %, respectivement; P = 0,008).

Conclusion

L’insertion du PLMA avec un mandrin Flexi-Slip a un taux de réussite à la première tentative plus élevé, nécessite moins de temps, et entraîne moins de complications au niveau des voies aériennes qu’une technique avec introducteur.

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Acknowledgement

The authors sincerely thank Mr. T. Randall Gillespie for his assistance in proofreading the manuscript.

Funding sources supporting the submitted work

Department of Anesthesiology, E-DA Hospital, Kaohsiung, Taiwan.

Conflict of interest

None declared.

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Authors and Affiliations

  1. Department of Anesthesiology, E-DA Hospital, I-Shou University, 1, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung City 824, Taiwan, ROC

    Hung-Shu Chen MD, Chih-Fang Chang Chien MD, Jan Spielberger MD & Kuo-Chuan Hung MD

  2. Department of Orthopedic Surgery, E-DA Hospital, I-Shou University, Kaohsiung, Taiwan, ROC

    Shih-Chieh Yang MD, PhD

  3. Institute of Biomedical Engineering, National Cheng-Kung University, Tainan, Taiwan, ROC

    Hung-Shu Chen MD, Shih-Chieh Yang MD, PhD & Kao-Chi Chung PhD

Authors
  1. Hung-Shu Chen MD
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  2. Shih-Chieh Yang MD, PhD
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  3. Chih-Fang Chang Chien MD
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  4. Jan Spielberger MD
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  5. Kuo-Chuan Hung MD
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  6. Kao-Chi Chung PhD
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Correspondence to Hung-Shu Chen MD.

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Chen, HS., Yang, SC., Chien, CF.C. et al. Insertion of the ProSeal™ laryngeal mask airway is more successful with the Flexi-Slip™ stylet than with the introducer. Can J Anesth/J Can Anesth 58, 617–623 (2011). https://doi.org/10.1007/s12630-011-9506-6

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  • DOI: https://doi.org/10.1007/s12630-011-9506-6

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