Comparison of Ultrasound Examination and Fiberoptic Laryngoscopy for Confirmation of Laryngeal Mask Airway Placement.

ABSTRACT

OBJECTIVES: 1) To compare ultrasound (US) examination and fiberoptic laryngoscopy (FOL) for confirmation of laryngeal mask airway (LMA) placement. 2) To evaluate the necessity for reinsertion of LMA based on FOL. METHODS: This prospective observational study included 100 adult patients of American Society of Anesthesiologists (ASA) Grade I and II, undergoing elective surgery under General Anesthesia requiring Proseal LMA™ placement as an airway device. LMA placement was first confirmed by clinical tests. Clinically acceptable patients were further assessed by US and categorized as acceptable (US-A) or unacceptable (US-U) and again by FOL as (FOL-A and FOL-U). Categorical variables presented in number, percentage (%), and continuous variables presented as mean ± SD and median. Inter-rater kappa agreement was used to find out the strength of agreement of acceptability between FOL and US. RESULTS: The LMA placement was clinically acceptable in 82% of patients on first attempt. FOL had 63% (FOL-A) acceptable LMA placement as compared with US examination which had 56% (US-A). In 85% of patients, US and FOL findings were in good agreement with each other for LMA placement (κ = 0.690 and P < .05). In all patients of FOL of unacceptable (FOL-U) category (37%), LMA was replaced with endotracheal tube. CONCLUSION: US provides a safe, non-invasive, and real-time dynamic assessment with 85% diagnostic accuracy for confirmation of LMA placement as compared with FOL.