Insertion of the LMA-Unique with and without digital intraoral manipulation by inexperienced personnel after manikin-only training.

Journal of Emergency Medicine

PubMedID: 14751472

Brimacombe J, Keller C. Insertion of the LMA-Unique with and without digital intraoral manipulation by inexperienced personnel after manikin-only training. J Emerg Med. 2004;26(1):1-5.
In a randomized, crossover study, we compared insertion of the LMA-Unique with and without digital intraoral manipulation by inexperienced personnel after manikin-only training. Ten registered nurses with no hands-on clinical experience of airway management and 100 anesthetized, paralyzed adults (ASA Status 1-2, aged 18-80 years) participated in the trial. Training comprised: 1) a 30-min didactic lecture; 2) a 3-min description of each of the insertion techniques; 3) a 3-min demonstration of each technique using a manikin; 4) 10 min of supervised training on the manikin with each technique. The time to achieve an effective airway (2 consecutive expired tidal volumes >/= 8 ml/kg; maximum 90 s or 3 attempts allowed) and the number of insertion attempts were determined by analysis of digital video recordings. Any blood staining on the first randomized device was noted at removal. The first attempt success rate (with digital intraoral manipulation, 84%; without digital intraoral manipulation, 87%) and overall success rate (with digital intraoral manipulation, 94%; without digital intraoral manipulation, 93%) were similar. Effective airway time was shorter without digital intraoral manipulation (43 +/- 17 vs. 33 +/- 15 s). Blood staining was detected in 12% (6/50) with and 16% (8/50) without digital intraoral manipulation (not significant). There were no differences in performance among nurses. We conclude that insertion of the LMA-Unique is equally successful with or without digital intraoral manipulation by inexperienced personnel in paralyzed adults after manikin-only training. Successful insertion of the LMA-Unique does not require insertion of the finger into the patient's mouth.