Suction catheter guided insertion of the ProSeal™ laryngeal mask airway is superior to the digital technique

Purpose: We tested the hypothesis that digital insertion of the ProSeal (TM) laryngeal mask airway (ProSeal (TM) LMA) is more successful when using a suction catheter (SC) as a guide. Methods: Two hundred and forty-three patients (ASA physical status I-III; aged 18-84 yr) were randomly allocated for the digital or SC-guided technique. The digital technique was performed according to the manufacturer's instructions. The SC technique involved priming the drain tube with the SC so that it protruded by 15 cm, blindly inserting the SC into the pharynx to a depth of 15 cm, followed by the digital technique. Failed insertion was defined by any of the following criteria: 1) failed passage into the pharynx; 2) malposition; and 3) ineffective ventilation. Any airway trauma, and visible or occult blood was noted. Sore throat, dysphonia and dysphagia were assessed 16 to 24 hr postoperatively. Results: Fewer insertion attempts were required with the SC-guided technique (P = 0.02), but first attempt and overall success were similar. The time taken to provide an effective airway was shorter for the SC-guided technique (36 24 sec vs 44 28 sec, P = 0.02). A lateral approach was required less frequently with the SC-guided technique (0% vs 4%, P = 0.0004). There were no adverse events. Mouth trauma was more frequent with the digital technique (P = 0.04), but overall trauma was similar. There were no differences in the frequency of visible or occult blood. There were no differences in postoperative airway morbidity. Conclusions: The SC-guided technique is more frequently successful than the digital technique and is associated with less mouth trauma during insertion of the ProSeal (TM) LMA. We suggest that the SC technique may be a useful alternative when the digital technique fails.