Simulated Comparison of Standard Versus Rotational Laryngeal Mask Airway Insertion in Novice Anaesthesiologists. (LMA)

Simulated Comparison of Standard Versus Rotational Laryngeal Mask Airway Insertion in Novice Anaesthesiologists.

Simulation Based Comparison Of Standard Versus Rotational Laryngeal Mask Airway Insertion Technique In Novice Anesthesiologists. A Randomised Control Crossover Trial

The primary objective of study was to compare insertion ease by standard and rotational LMA insertion technique on basis of LMA insertion attempts and insertion time duration. The secondary objective of study was to analyse impact of prior information for airway device, insertion techniques, general or specific work experience in airway management with ease of both insertion techniques. And, tertiary objective of study was to analyse the trainee's preference insertion technique on basis of learning method and practical adaptability. Hypothesis: The rotational LMA insertion technique is easy to understand and practice than the standard LMA insertion technique at the beginning of airway management training among the novice anesthesiologists. Hypothesis: The rotational LMA insertion technique is easy to understand and practice than the standard LMA insertion technique at the beginning of airway management training among the novice anesthesiologists.

LMA insertion attempts are the number of LMA insertion attempts with each study's insertion technique. The 10 insertion attempts will be performed with each insertion technique by trainees. LMA insertion time duration is the time taken to complete LMA insertion; from the holding of device till the confirmation of chest movement (artificial lungs inflation in manikin). The correlation of previous information for airway device, insertion techniques, general or specific work experience in airway management with the ease of both study's insertion techniques will be asked by participant's through the questionnaire at the start of study. The trainees will be asked at the end of study for preferred insertion method at novice level on the basis of learning method and practical conduct (user friendly)

Each novice resident will place ten times LMA insertion with each insertion technique in randomised cross over manner by dividing the residents in two groups (5 residents in each group), by draw method. The one group will place LMA with standard insertion technique and other group will place by rotational LMA insertion technique, then after, the groups will switch over with concerned insertion techniques

Standard LMA insertion technique; LMA held like a pen and index finger placed at the junction of LMA tube and cuff. Index finger used to press LMA against hard palate and posterior pharyngeal wall until definite resistance felt at the base of hypopharynx. LMA then held with non- dominant hand and index finger removed.

Rotational LMA insertion; LMA inserted like guedel airway insertion: LMA proximally grasped close to anaesthesia circuit attachment. Insertion was conducted with LMA cuff facing towards nose, hard palate and then advanced into the base of hypopharynx until resistance was felt. At this point, LMA rotated at 180 degree anti-clockwise and LMA tube black line positioned and confirmed on the nasal side.

Standard LMA insertion technique; LMA held like a pen and index finger placed at the junction of LMA tube and cuff. Index finger used to press LMA against hard palate and posterior pharyngeal wall until definite resistance felt at the base of hypopharynx. LMA then held with non- dominant hand and index finger removed. Rotational LMA insertion; LMA inserted like guedel airway insertion: LMA proximally grasped close to anaesthesia circuit attachment. Insertion was conducted with LMA cuff facing towards nose, hard palate and then advanced into the base of hypopharynx until resistance was felt. At this point, LMA rotated at 180 degree anti-clockwise and LMA tube black line positioned and confirmed on the nasal side.

Ease of LMA insertion in mannequin mouth was measured by performing the 10 times insertion of LMA with both study techniques in mannequin mouth by trainees.

The total time duration of final LMA insertion confirmation in mannequin mouth was recorded. The time duration counting was started from LMA holding in operator's hand to the confirmed successful insertion in mannequin mouth.

The trainee's baseline knowledge was assessed for the type of supraglottic airway devices and LMA insertion techniques.

The questionnaire based trainee's asked for the prior information of the LMA and other supraglottic airway devices.

The trainee's baseline knowledge was assessed for the general or specific work experience in airway management using the LMA.

The questionnaire based trainee's asked for the previous experience for rotational LMA insertion technique.

The trainee's asked for the choice of LMA insertion technique at the start of learning airway management using the LMA device at his level.

The questionnaire based trainee's asked for the choice of type of LMA insertion technique such as standard or rotational LMA insertion at start of learning the airway management at his level of training year.

The questionnaire based trainee's asked for his experience of easy learning of type of LMA insertion technique such as standard or rotational LMA insertion at his level of training year.

The trainee's asked for the preference of LMA insertion technique in his practice at his level of training.

The questionnaire based trainee's asked for his preference to practice most of the time for the type of LMA insertion technique like standard or rotational LMA insertion at his level of training year.

Inclusion Criteria: First year anaesthesia trainee Using adult mannequin Exclusion Criteria: Paediatric mannequin Participant's refusal

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