A comparison of metal introducer and bougie-guided techniques of insertion PLMA (TM) with respect to cuff position and air leak

Background: Drain tube is an integral part of proseal laryngeal mask airway (PLMA). It can lodge a sleek device such as bougie which can act as a guiding tool to advance and position the cuff. As an alternative to metal introducer tool (MIT), we compared the two techniques for ease of insertion score, various cuff positions and air leak encountered during insertion of PLMA under nonparalysed situation. Materials and Methods: Sixty anesthetized patients were divided into two groups using computer-based randomization. PLMA was inserted into either MIT or adult introducer bougie. The primary outcome was ease of insertion (Score 1-4), cuff positions defined by suprasternal notch test, gel displacement test, gastric tube passage test and air leak. Airway pressure, seal pressure, and complications encountered were the secondary outcome. Independent t-test, Fisher's exact test, and Chi-square test were used to analyze the data. P < 0.05 was considered statistically significant. Results: Ease of insertion score 4.0 was observed in 18 (60%) and 29 (96.6%) patients in MIT and AIB group, respectively. Comparing the two groups for the cuff positions, hypopharynx position was significantly higher in the AIB group (P = 0.001), whereas proximal and cuff fold positions were higher in the MIT group (P = 0.02). However, there was no difference for glottis position among the groups. The significantly higher air leak was observed in the MIT group (P = 0.01). Complications related to airway were more frequent in the MIT group. Conclusions: Bougie-guided advancement appears to be a preferred technique for inserting PLMA device in its appropriate position. With the discretionary power to provide an opportunity for effective ventilation, complications are markedly reduced with this technique.