Mohd Nazri, Ali
(2008)
Comparison for ease of insertion for
laryngeal mask airway between
trendelenburg and supine position for
elective orthopaedic, surgical and
gynecology surgery.
Masters thesis, Universiti Sains Malaysia.
Abstract
The purpose of this study is to assess the ease of insertion of the Laryngeal Mask Airway
(LMA) between supine and trendelenburg position in the elective Gynecology, Orthopedic
and General surgery patient. We measured easiness of insertion, incidence of adverse
respiratory complication and hemodynamic response to LMA insertion. A randomized
single blinded prospective study was conducted involving a total of 92 premedicated, ASA
1 or 11 patients, aged 18 to 65 years and were divided into 2 groups either insertion in
supine or trendelenburg position. After a standardized induction of anesthesia with
Fentanyl 1.5 meg/kg and propofol 2 mg/kg, a size 3 or 4 Laryngeal mask airway was
inserted and the patient breathe spontaneously through the surgery with no muscle relaxant
given. Anesthesia was maintained with nitrous oxide, oxygen and servoflurance. The LMA
was removed at the end of surgery with the patient fully awake. The speed and ease of
insertion and the number of attempts needed to successfully secure airway were recorded.
The incidence of adverse respiratory complications like sore throat, presence of blood on
LMA, laryngospasm, coughing, vomiting and desaturation was recorded. Hemodynamic
changes such as systolic blood pressure, diastolic blood pressure, mean arterial pressure
and heart rate at the different time interval were recorded. We found that there was no
statistically significant difference in time required for successful insertion and number of
attempts for both group. We were able to insert LMA at frrst attempt in 73.9% within
20.20 seconds in trendelenburg position. There were no differences in incidence of adverse
airway complication both in supine and trendelenburg position. Both groups had no
statistical differences in hemodynamic parameters during spontaneous ventilation under anesthesia except systolic blood pressure and mean arterial pressure just after LMA
insertio~ which had statistically significant. We conclude that, insertion of the LMA in
trendelenburg position is appropriate provided with a good experience and proper patients
selection and strongly indicated in the scenario of fail intubation and ventilation as an
alternative to the conventional method of LMA insertion.
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