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.
Zusammenfassung
Hintergrund
Die Insertion einer Larynxmaske (LMI) stellt eine fundamentale Fähigkeit des Anästhesisten sowohl im Routinemanagement als auch im Rahmen einer schwierigen Atemwegssituation dar. Ziel der vorliegenden Untersuchung war es, das von Erstjahresweiterbildungsassistenten benötigte Zeitintervall bis zu Durchführung von 40 LMI und die hiermit assoziierte Erfolgsrate sowie die Zahl der notwendigen Versuche bis zur erfolgreichen LMI zu evaluieren.
Methoden
In der prospektiven monozentrischen Untersuchung wurden die Zahl der Arbeitstage, die Erfolgsraten und die zur erfolgreichen LMI (LMA ProSeal™) benötigten Versuche in konsekutiven Blocks von 5 LMI-Prozeduren ebenso wie die entstandenen Schwierigkeiten und Komplikationen erfasst.
Ergebnisse
Von 2007 bis 2010 wurden 10 anästhesiologische Erstjahresweiterbildungsassistenten konsekutiv evaluiert. Die Weiterbildungsassistenten benötigten durchschnittlich 18,3 ± 4,1 Arbeitstage (Mittelwert ± Standardabweichung) für 40 LMI. Die Erfolgsrate der LMI stieg nach den ersten 5 LMI stetig bis zu den 40 LMI/Weiterbildungsassistent an (Erfolgsrate der LMI im 1. Versuch: 72 vs. 86 %, p = 0,09; Erfolgsrate der LMI bei allen Versuchen: 74 vs. 96 %, p = 0,001). Die Anzahl der benötigten Versuche bis zur erfolgreichen LMI verringerte sich von 1,45 ± 0,82 nach den ersten 5 LMI auf 1,16 ± 0,37 nach 40 LMI (p = 0,03). Die häufigsten Schwierigkeiten, die mit einer nichterfolgreichen LMI durch die Weiterbildungsassistenten einhergingen und zur Übergabe der LMI an einen erfahrenen Kollegen führten, waren schmale Mundöffnung (9,8 %), kurzer/dicker Hals, große Zunge, Blut/Sekret im Mund-Rachen-Raum (je 7,3 %) und Retrognathie (4,9 %).
Schlussfolgerung
Die ansteigende Erfolgsrate der LMI und die sinkende Anzahl an benötigten Versuchen bis zur erfolgreichen LMI korrelierten mit der Lernkurve und der entwickelten Sicherheit der LMI über die Zeit.
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Acknowledgements
The authors would like to thank the motivated first-year anesthesiology resident physicians and staff at our university hospital for voluntary participation in this study. We would also like to extend our thanks to the attending physicians in the Department of Anesthesiology of the University Hospital of Heidelberg, Germany, for the committed supervision of their trainees. We would like to thank Dr. T. Becker (Department of Emergency Medicine, University of Michigan) for his review of the manuscript.
Conflict of interest
The corresponding author states the following: This work was supported by the Department of Anaesthesiology, University Hospital of Heidelberg, Germany. None of the authors have any conflict of interest.
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Mohr, S., Weigand, M., Hofer, S. et al. Developing the skill of laryngeal mask insertion. Anaesthesist 62, 447–452 (2013). https://doi.org/10.1007/s00101-013-2185-7
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DOI: https://doi.org/10.1007/s00101-013-2185-7