Predictive factors for failed proseal™ laryngeal mask airway (PLMA) insertion

Yee Tian Bong, Raha Abdul Rahman, Masdar Azlina, Li Ling Tai

Research output: Contribution to journalArticle

Abstract

Background: The ProSeal™ laryngeal mask airway (PLMA) is a second generation laryngeal mask airway which is more difficult to insert than conventional laryngeal mask airway. This study aimed to identify the factors to predict failed PLMA insertion. Methods: This prospective, observational study included 181 patients, aged between 18 to 65 years, who had PLMA insertion during general anesthesia. Patients with body mass index ≥35 kg/m², had cervical spine pathology and risk of aspiration were excluded. It was conducted by multiple operators with minimum of 3 years’ experience of PLMA insertion. Factors studied were modified Mallampati classification, thyromental distance, interincisor gap, Wilson sum score, neck circumference, range of head and neck movement, retrognathia, buck teeth and jaw movement. The ease of insertion was graded as easy or difficult. Results: Our study demonstrated 4.97% failure rates. Patients with flexible jaw movement had significant risk for failed PLMA insertion (OR: 7.25, 95% CI: 1.46-36.04, p = 0.015). It was demonstrated as an independent predictive factor for PLMA insertion failure (OR: 15.11, 95% CI: 1.83-124.67, p = 0.012). It also demonstrated 77.78% sensitivity, 67.44% specificity with 11.11% positive predictive value and 98.31% negative predictive value. Study also showed that difficult insertion was associated with higher risk of failure (OR: 16.11, 95% CI: 3.72-69.74, p = 0.000) and was demonstrated as a significant independent factor to detect failed insertion (OR: 45.95, 95% CI: 5.98-352.88, p = 0.000). Conclusion: The flexible jaw movement was found to be as an independent predictive factor, with moderate sensitivity and specificity and difficult insertion was a strong indicator for PLMA insertion failure.

Original languageEnglish
Pages (from-to)248-256
Number of pages9
JournalMiddle East Journal of Anesthesiology
Volume25
Issue number3
Publication statusPublished - 1 Oct 2018

Fingerprint

Laryngeal Masks
Jaw
Neck
Retrognathia
Tooth Movement Techniques
Sensitivity and Specificity
Head Movements
General Anesthesia
Observational Studies
Spine
Body Mass Index
Prospective Studies
Pathology

Keywords

  • Difficult insertion
  • ProSeal Laryngeal mask airway

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Predictive factors for failed proseal™ laryngeal mask airway (PLMA) insertion. / Bong, Yee Tian; Abdul Rahman, Raha; Azlina, Masdar; Tai, Li Ling.

In: Middle East Journal of Anesthesiology, Vol. 25, No. 3, 01.10.2018, p. 248-256.

Research output: Contribution to journalArticle

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abstract = "Background: The ProSeal™ laryngeal mask airway (PLMA) is a second generation laryngeal mask airway which is more difficult to insert than conventional laryngeal mask airway. This study aimed to identify the factors to predict failed PLMA insertion. Methods: This prospective, observational study included 181 patients, aged between 18 to 65 years, who had PLMA insertion during general anesthesia. Patients with body mass index ≥35 kg/m², had cervical spine pathology and risk of aspiration were excluded. It was conducted by multiple operators with minimum of 3 years’ experience of PLMA insertion. Factors studied were modified Mallampati classification, thyromental distance, interincisor gap, Wilson sum score, neck circumference, range of head and neck movement, retrognathia, buck teeth and jaw movement. The ease of insertion was graded as easy or difficult. Results: Our study demonstrated 4.97{\%} failure rates. Patients with flexible jaw movement had significant risk for failed PLMA insertion (OR: 7.25, 95{\%} CI: 1.46-36.04, p = 0.015). It was demonstrated as an independent predictive factor for PLMA insertion failure (OR: 15.11, 95{\%} CI: 1.83-124.67, p = 0.012). It also demonstrated 77.78{\%} sensitivity, 67.44{\%} specificity with 11.11{\%} positive predictive value and 98.31{\%} negative predictive value. Study also showed that difficult insertion was associated with higher risk of failure (OR: 16.11, 95{\%} CI: 3.72-69.74, p = 0.000) and was demonstrated as a significant independent factor to detect failed insertion (OR: 45.95, 95{\%} CI: 5.98-352.88, p = 0.000). Conclusion: The flexible jaw movement was found to be as an independent predictive factor, with moderate sensitivity and specificity and difficult insertion was a strong indicator for PLMA insertion failure.",
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AB - Background: The ProSeal™ laryngeal mask airway (PLMA) is a second generation laryngeal mask airway which is more difficult to insert than conventional laryngeal mask airway. This study aimed to identify the factors to predict failed PLMA insertion. Methods: This prospective, observational study included 181 patients, aged between 18 to 65 years, who had PLMA insertion during general anesthesia. Patients with body mass index ≥35 kg/m², had cervical spine pathology and risk of aspiration were excluded. It was conducted by multiple operators with minimum of 3 years’ experience of PLMA insertion. Factors studied were modified Mallampati classification, thyromental distance, interincisor gap, Wilson sum score, neck circumference, range of head and neck movement, retrognathia, buck teeth and jaw movement. The ease of insertion was graded as easy or difficult. Results: Our study demonstrated 4.97% failure rates. Patients with flexible jaw movement had significant risk for failed PLMA insertion (OR: 7.25, 95% CI: 1.46-36.04, p = 0.015). It was demonstrated as an independent predictive factor for PLMA insertion failure (OR: 15.11, 95% CI: 1.83-124.67, p = 0.012). It also demonstrated 77.78% sensitivity, 67.44% specificity with 11.11% positive predictive value and 98.31% negative predictive value. Study also showed that difficult insertion was associated with higher risk of failure (OR: 16.11, 95% CI: 3.72-69.74, p = 0.000) and was demonstrated as a significant independent factor to detect failed insertion (OR: 45.95, 95% CI: 5.98-352.88, p = 0.000). Conclusion: The flexible jaw movement was found to be as an independent predictive factor, with moderate sensitivity and specificity and difficult insertion was a strong indicator for PLMA insertion failure.

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