A Comparative Study Between Standard And 45-Degree Rotation Insertion Techniques Of Proseal(Tm) Laryngeal Mask Airway In Anaesthetized Patients

Abstract

INTRODUCTION
ProSeal™ Laryngeal Mask Airway (PLMA) is widely used to secure the airway in adult patients undergoing short elective surgical procedures. Although the manufacturer’s standard, index-finger insertion technique is commonly practiced, alternative methods such as the rotational approach have been proposed to improve first-attempt success and minimize airway trauma. This study compares the standard technique with a 45-degree rotational technique regarding ease of insertion, hemodynamic response, and airway morbidity in adults.
METHODS
A total of 120 patients (ASA I–II, aged 18–60 years) scheduled for short elective surgeries under general anesthesia were prospectively enrolled and randomly allocated into two groups (60 each). Group S underwent PLMA insertion via the standard index-finger approach, while Group R utilized a 45-degree rotational method. Primary outcomes included first-attempt success rate and time to successful insertion. Secondary measures encompassed oropharyngeal leak pressure, incidence of gastric insufflation, blood staining on removal, sore throat at 2 and 24 hours, and hemodynamic changes (heart rate, mean arterial pressure) recorded at key time points.
RESULTS
Patients in Group R achieved a higher first-attempt success rate (approximately 98%) compared with Group S (around 78%) and required significantly less time for successful device placement. Fewer subjects in the rotational group demonstrated blood-stained devices or postoperative sore throat. Hemodynamic parameters (heart rate and mean arterial pressure) also showed milder increases in Group R, indicating reduced oropharyngeal stimulation. Although both methods provided adequate airway seals with minimal gastric insufflation, the 45-degree rotation technique was consistently associated with a gentler insertion process and fewer complications.
CONCLUSION
The 45-degree rotational insertion method for ProSeal™ LMA demonstrates clear benefits over the standard, index-finger approach in adults. It offers faster placement, higher first-attempt success, and reduced airway trauma. Consequently, the rotational technique may be recommended as a more efficient and patient-friendly option for secure PLMA insertion in routine anesthetic practice.