The Korean Journal of Emergency Medical Services (한국응급구조학회지)

The Korea Society of Emergency Medical Services (한국응급구조학회)
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Which is the proper insertion method of laryngeal mask airway according to the rescuer's position? : Comparison between index finger insertion and thumb insertion

구조자의 위치에 따른 적절한 후두마스크기도기 삽입방법은 무엇일까? : 검지손가락법과 엄지손가락법의 비교

  • Chun, Kyoung-Ha (Department of Emergency Medical Service, Kongju National University) ;
  • Moon, Jun-Dong (Department of Emergency Medical Service, Kongju National University)
  • 천경하 (공주대학교 응급구조학과) ;
  • 문준동 (공주대학교 응급구조학과)
  • Received : 2017.10.25
  • Accepted : 2017.12.19
  • Published : 2017.12.31
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Abstract

Purpose: The purpose of the study was to investigate the effects of laryngeal mask airway (LMA) insertion from different positions, using different methods, on the quality of the insertion, for identifying a more convenient and effective insertion method. Methods: In a model ambulance, 30 paramedic students performed the LMA insertion procedure, in four different settings, combinations of the rescuer's position (at the head end of the patient, at the side of the patient), and insertion technique (index finger insertion, thumb insertion), in a randomized order. Quality of insertion index and convenience of use were measured. Results: The quality of insertion index (tidal volume, gastric insufflation, airway pressure, airway sealing pressure, midline positions, insertion success grade, and insertion time) were not significantly different among four different settings. However LMA insertion from the anterior (head) end, using the index finger method compared to the thumb method was found to be significantly more convenient. Conclusion: We recommend using the more convenient and familiar LMA insertion method, between index finger insertion and thumb insertion, regardless of rescuer's position.

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References

  1. Barata I. The laryngeal mask airway: prehospital and emergency department use. Emerg Med Clin North Am 2008;26(4):1069-83. https://doi.org/10.1016/j.emc.2008.07.006
  2. Brain AI. Historical aspects and future directions. Int Anesthesiol Clin 1998;36(2):1-18. https://doi.org/10.1097/00004311-199803620-00003
  3. Jeong JS, Hong KJ, Shin SD, Suh GJ, Song KJ. Evaluation of the appropriateness of prehospital emergency care by 119 rescue services in Seoul Metropolitan area. J Korean Soc Emerg Med 2008;19(3):233-44.
  4. Hwang JY, Cho KJ. Comparison of tracheal intubation using the Macintosh laryngoscope versus the intubating laryngeal mask airway. Korean J Emerg Med Ser 2012;16(3):19-28. https://doi.org/10.14408/KJEMS.2012.16.3.019
  5. Teleflex. LMA instruction for use. Available at http://www.lmaco-ifu.com, 2017
  6. Goyal M, Dutt A, Khan Joad AS. Laryngeal mask airway insertion by classic and thumb insertion technique: a comparison. F1000Res 2013;2:123. https://doi.org/10.12688/f1000research.2-123.v1.
  7. Davies PR, Tighe SQ, Greenslade GL, Evans GH. Laryngeal mask airway and tracheal tube insertion by unskilled personnel. Lancet 1990;336(8721):977-9. https://doi.org/10.1016/0140-6736(90)92429-L
  8. Räsänen J. The laryngeal mask airway-first class on difficult airways. Finnanest Nro 2000;33(3):302-5.
  9. Matta BF, Marsh DS, Nevin M. Laryngeal mask airway: a more successful method of insertion. J Clin Anesth 1995;7(2):132-5. https://doi.org/10.1016/0952-8180(94)00027-2
  10. Ghai B, Makkar JK, Bhardwaj N, Wig J. Laryngeal mask airway insertion in children: comparison between rotational, lateral and standard technique. Paediatr Anaesth 2008;18(4):308-12. https://doi.org/10.1111/j.1460-9592.2008.02434.x
  11. Benumof JL. Laryngeal mask airway and the ASA difficult airway algorithm. Anesthesiology 1996;84(3):686-99. https://doi.org/10.1097/00000542-199603000-00024
  12. Kim HJ, Lee SK. A comparative easiness of blind orotracheal intubation using laryngeal mask airway with two different head positions. Korean J Anesthesiol 2000;39(4):469-75. https://doi.org/10.4097/kjae.2000.39.4.469
  13. Son SC, Ko YK, Lee SJ. Comparison of ETT and LMA on respiratory mechanics during the induction of general anesthesia in children. Korean J Anesthesiol 2004;47(6):772-8. https://doi.org/10.4097/kjae.2004.47.6.772
  14. Choi HK, Jung HK. Simulation study for Bag-valve-mask application guideline on pathologic pulmonary condition. Korean J Emerg Med Ser 2013;17(3):21-8. https://doi.org/10.14408/KJEMS.2013.17.3.021
  15. Shin SY, Lee JG, Roh SG. Comparative analysis of tidal volume and airway pressure with a bag-valve mask using RespiTrainer. Fire Sci. Eng 2014;28(6):76-81. https://doi.org/10.7731/KIFSE.2014.28.6.076
  16. Cork RC, Depa RM, Standen JR. Prospective comparison of use of the laryngeal mask and endotracheal tube for ambulatory surgery. Anesth Analg 1994;79(4):719-27.
  17. Keller C, Brimacombe JR, Keller K, Morris R. Comparison of four methods for assessing airway sealing pressure with the laryngeal mask airway in adult patients. Br J Anaesth 1999;82(2):286-7. https://doi.org/10.1093/bja/82.2.286
  18. Keller C, Puhringer F, Brimacombe JR. Influence of cuff volume on oropharyngeal leak pressure and fibreoptic position with the laryngeal mask airway. Br J Anaesth 1998;81(2):186-7. https://doi.org/10.1093/bja/81.2.186
  19. Ocker H, Wenzel V, Schmucker P, Steinfath M, Dörges V. A comparison of the laryngeal tube with the laryngeal mask airway during routine surgical procedures. Anesth Analg 2002;95(4):1094-7. https://doi.org/10.1213/00000539-200210000-00057
  20. Korean emergency airway management society. Manual of emergency airway management (Ron MW, Michael FM). 4th ed. Gyeonggi: Koonja, 2013. 108-9.
  21. Brimacombe JR, Berry A. The incidence of aspiration associated with the laryngeal mask airway: a meta-analysis of published literature. J Clin Anesth 1995;7(4):297-305. https://doi.org/10.1016/0952-8180(95)00026-E
  22. Asai T, Barclay K, McBeth C, Vaughan RS. Cricoid pressure applied after placement of the laryngeal mask prevents gastric insufflation but inhibits ventilation. Br J Anaesth 1996;76(6):772-6. https://doi.org/10.1093/bja/76.6.772