Comparison of the ease of insertion and complications of the classical method of laryngeal mask airway insertion with an alternative method

Laryngeal mask airway (LMA), a supraglottic device for airway management and ventilation, is used both in emergencies, out of the operating room, and in the operating room during general anesthesia. This study aims to compare the success rate and complications of the classic insertion method (with a semi-inflated cuff) and another technique using the index and middle fingers of the second hand to prevent retroversion of the mask tip (alternative method). In total, 288 patients scheduled for short-time ophthalmologic elective surgeries under general anesthesia were randomly allocated to two groups for LMA placement; group C, classical method (with semi-inflated cuff), and group A, alternative method. Difficulty in placement, insertion duration, and the number of attempts were studied. Assessment of pharyngolaryngeal complications (blinded assessor) was made at the time of LMA removal. The success rate of LMA insertion in the classic group with first, second, and third attempts were 86.3%, 93.5%, and 94.2%, respectively, whereas in the alternative group these values in the first and second attempts were 98.6% and 100%, respectively, and there was no need for the third attempt. Insertion time was not significantly different. There was no meaningful difference between the rate of the bloody streak on the mask ( = 0.37) and the incidence of sore throat ( = 0.048) in the two groups of the study. This newly introduced technique can be considered as an alternative method when a difficult insertion situation is suspected or the classic technique of insertion has failed.