Validation of the unassisted, gum-elastic bougie-guided, laryngeal mask airway-ProSeal™ placement technique in anaesthetized patients

AIMS: The laryngeal mask airway-ProSeal™ can be inserted digitally, by introducer tool, or by railroading it over a bougie placed first in the patient's oesophagus, which is highly successful, but as originally described, requires an assistant. An unassisted bougie-guided placement technique has also been described, but no data on its effectiveness have been reported. METHODS: We reviewed data collected during a randomized, controlled trial comparing the air-Q(®) Intubating Laryngeal Airway and LMA-Proseal™, in which all LMA-Proseal™ devices were inserted using the unassisted (one-operator), bougie-guided placement technique. RESULTS: Forty-eight devices were placed. All devices were placed successfully. Successful placement was achieved in 47 (98%) patients on first attempt and in one (2%) patient on the third attempt. Mean (SD) time required for insertion establishing ventilation was 28 (11) s. Mean (SD) airway seal pressure was 30 (6) cmH(2)O. Gross blood was found on four (8%) devices upon removal, but no oropharyngeal injuries were noted on oral exam in the recovery unit prior to discharge. The most common complaints in recovery and 24 h post-operatively were sore throat [discharge: mild = 18/48 (38%); 24 h: mild = 9/38 (19%), moderate = 1/38 (3%)] and pain on swallowing [discharge: mild = 7/48 (15%); 24 h: mild = 2/38 (6%)]. CONCLUSIONS: Our data confirm that in experienced hands, bougie-guided placement of the LMA-Proseal™ without the aid of an assistant can be accomplished quickly and successfully without affecting the expected clinical performance of the device.