A Simple Two-finger Technique to Prevent Malrotation during Flexible Laryngeal Mask Airway Insertion: A Case Series

A flexible laryngeal mask airway (FLMA) is commonly used for paediatric ophthalmic surgery but is prone to axial malrotation during insertion due to its long, flexible tube. We describe a simple two-finger modification of the standard index-finger insertion technique to prevent malrotation and facilitate successful placement. In nine paediatric patients with failed initial attempts using the conventional method, the two-finger technique achieved 100% rescue success without requiring adjuncts. Oropharyngeal leak pressures and fibreoptic grades remained acceptable, and no postoperative adverse events were noted. This low-cost and easily adoptable technique may provide a reliable troubleshooting manoeuvre in settings where adjuncts are unavailable; however, the limited sample size warrants cautious interpretation and further evaluation.