Ease and Safety of Securing Airway by Railroading ProSeal Laryngeal Mask Airway over Bougie versus Traditional Digital Insertion Technique

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.