Comparison of Index-Finger Guided, Two-Finger Guided, and 90° Rotation Techniques for Insertion of Flexible LMA in Pediatric Patients

Shreedevi Yenni; Namburi Rama Naveena; Rajesh Mane; Guruprasad Shetty

doi:10.18502/aacc.v10i4.16263

Shreedevi Yenni Department of Anesthesiology, JN Medical College, KLE Academy of Higher Education and Research, Belagavi, India.
Namburi Rama Naveena Department of Anesthesiology, JN Medical College, KLE Academy of Higher Education and Research, Belagavi, India.
Rajesh Mane Department of Anesthesiology, JN Medical College, KLE Academy of Higher Education and Research, Belagavi, India.
Guruprasad Shetty Department of Anesthesiology, JN Medical College, KLE Academy of Higher Education and Research, Belagavi, India.

DOI: https://doi.org/10.18502/aacc.v10i4.16263

Keywords: Flexible LMA; Pediatrics; Insertion

Abstract

Background: Flexible LMA offers the advantage of providing a better surgical field without being compressed compared to other LMAs in surgeries around the oral cavity. The insertion of flexible LMA is comparatively difficult as the shaft is flexible. The aim of this study is to compare the index-finger guided technique, two-finger guided technique, and 90° rotation technique for the success and time of insertion of flexible LMA in pediatric patients.

Methods: After obtaining consent from parents,84 patients aged between 3 to 12 years of either gender were randomized into 3 groups. After administration of general anesthesia, flexible LMA of appropriate size as per manufacturer recommendations was inserted.

In the index finger guided method (Group A), the LMA was held like a pen and the mask was pushed backward pressing against the palate. In the two-finger guided method (Group B), the anesthetist stood by the side facing the patient. LMA was fixed in between the index and middle fingers, held facing the lower jaw, and pushed along the palatopharyngeal curve. In the 90° rotation method (Group C), the LMA was rotated 90° anticlockwise in the oral cavity and was advanced through the right side of the tongue till resistance was felt and then turned back. The time from insertion of LMA and the number of attempts taken for successful insertion were noted. The data were analyzed using ANOVA.

Results: The mean time of insertion was the least in Group B and highest in Group C. The first attempt success rate was highest in Group B and least in Group C. However, the mean time of insertion and the first attempt success rates were not significantly different between Group A and Group B.

Conclusion: The LMA insertion by the two-finger guided method is the easiest and most efficient method and a good alternative to the standard method (index finger guided) for insertion of flexible LMA.