Developing the skill of laryngeal mask insertion: prospective single center study.

ABSTRACT

BACKGROUND: Laryngeal mask insertion (LMI) represents a fundamental skill for anesthesiologists in routine management as well as in difficult airway situations. This study aimed to evaluate the time needed by first year anesthesiology residents to perform 40 LMIs and assessed the associated success rates and the number of attempts needed for successful LMI. METHODS: This prospective single center study evaluated the number of work days, the success rate and the attempts needed for successful LMI (LMA ProSeal™) in consecutive blocks of five LMI procedures and the related difficulties and complications. RESULTS: From 2007 to 2010 a total of 10 anesthesiology resident physicians were evaluated consecutively. These residents needed a mean of 18.3 ± 4.1 (mean ± standard deviation) working days to successfully perform 40 LMIs. The LMI success rate after the first 5 LMIs increased steadily up to the results after 40 LMIs per resident (LMI success rate within 1 attempt 72 versus 86 %, p = 0.09, LMI success rate within all LMI attempts 74 versus 96 %, p = 0.001). The mean number of attempts required until successful LMI decreased from 1.45 ± 0.82 after the first 5 LMIs to 1.16 ± 0.37 after 40 LMIs (p = 0.03). The most common difficulties associated with unsuccessful LMI by residents that led to handing over to an experienced colleague were small oral aperture (9.8 %), short thick neck, large tongue, blood/mucus in the mouth or throat (each 7.3 %) and retrognathy (4.9 %). CONCLUSIONS: The increasing LMI success rate and the decreasing rate of LMI attempts for successful airway management correlated to a learning curve and development of LMI dexterity over time.