Comparison of Rotational and Standard Techniques of Laryngeal Mask Airway Insertion in Children

The laryngeal mask airway (LMA) was introduced into anesthetic practice for use on normal adult and pediatric patients, and it has proven to be of benefit in many difficult airway scenarios. However, different insertion methods have been recommended. The LMA can be inserted by the standard or rotational method with a semi-inflated cuff. The aim of this study was to compare the complications and ease of insertion of these two methods. After approval by the local ethics committee and written parental consent, one hundred ninety-six ASA (American Society of Anesthesiology) class 1 or 2 children aged below 11 years, electively scheduled for minor surgeries (inguinal hernia repair, etc.), were enrolled in this study. All subjects received premedication with midazolam (0.03 mg/kg/IV) and fentanyl (1?g/kg/IV) approximately 10 min before induction of anesthesia. Induction was performed with lidocaine (1 mg/kg/IV) and propofol (3 mg/kg/IV). The appropriate size of LMA for each patient was inserted. Patients were randomized into two equal groups for standard or rotational insertion of the LMA. The success rate of insertion at the first attempt, and complications after LMA insertion (cough, swallowing, laryngospasm and extremity movement) were recorded. Blood pressure and heart rate were recorded before and just after LMA insertion. Demographic data were similar between the two groups. During LMA insertion one patient had extremity movement and two had coughs in the standard group. There were no statistically significant differences between the two groups regarding ease of LMA insertion (P > 0.05). It seems that the success rate and the complication rate of LMA insertion are similar in standard and rotational insertion techniques.