Comparative evaluation of 90° and 180° rotational techniques to the standard technique of proseal laryngeal mask airway – A randomized control study

Background: Supraglottic airway (SGA) has become standard routine practice for airway management during surgeries. Proseal LMA™ (PLMA) a type of SGA, insertion by digital or introducer technique has first-attempt success rate of 65%–85%. Rotational techniques 90° and 180° with various supraglottic devices have reported a higher first-attempt success rate in literature. Hence, the study was conducted to evaluate and compare the first-attempt success rate of three different insertion methods of PLMA placement. Methodology: A double-blind randomized controlled trial was carried out involving 180 patients, classified as the American Society of Anesthesiologist physical status I or II, aged between 18 and 65 years, regardless of gender dividing into three groups of 60 each for insertion of PLMA using standard, 90° rotational or 180° rotational techniques. The aim was to study the first-attempt success rate of PLMA insertion. Other outcomes such as overall rate of successful insertion, insertion time, external airway manipulations, oropharyngeal leak pressure, fiber optic grading, and other pharyngolaryngeal morbidity. Results: Highest first-attempt success rate (95%) and best fiberoptic view (70%) were noted in the 180° rotation group, but it was statistically insignificant ( P = 0.195 and 0.07). Nonetheless, the need for external manipulation was in more number of patients with the standard technique (20%). Demographic profile was comparable between the groups. Conclusion: First-attempt successful insertion using the standard technique was equivalent to other rotational techniques.