• Jung-won Hwang, Hee-Pyoung Park, Young-Jin Lim, Sang-Hwan Do, Sang-Chul Lee, and Young-Tae Jeon.
• Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea.
• Anesthesiology. 2009 Apr 1;110(4):905-7.

BackgroundThis study compared two insertion techniques of ProSeal laryngeal mask airway.MethodsA total of 160 female patients (American Society of Anesthesiologists physical status I or II; age 18-80 yrs) undergoing gynecologic surgery were randomly allocated to the standard or rotational technique groups. In the standard technique group (n = 80), ProSeal laryngeal mask airway insertion was performed by a single experienced user using digital manipulation. In the rotational technique group (n = 80), the ProSeal laryngeal mask airway was rotated counter clockwise through 90 degrees in the mouth and advanced until the resistance of the hypopharynx was felt, and then straightened out in the hypopharynx (n = 80). The ease of insertion was assessed by the success rate at the first attempt. Heart rate and mean blood pressure were recorded 1 min before and 1 min after insertion. Postoperative complications were noted.ResultsThe success rate of insertion at the first attempt was higher for the rotational technique (100% vs. 85%, P < 0.001). The overall success rate, i.e., successful insertion within three attempts, was 94% for the standard technique versus 100% for the rotational technique. There was no significant change in heart rate, but mean blood pressure increased significantly with the standard technique (P = 0.001). The incidence of blood staining (9% vs. 36%, P < 0.001) and sore throat (8% vs. 25%, P = 0.005) was lower with the rotational technique.ConclusionThe rotational technique is more successful than the standard technique and is associated with less pharyngeal mucosal trauma, as evidenced by a lower incidence of sore throat and mucosal bleeding.

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