# Comparison of ProSeal Laryngeal Mask Airway (PLMA) Placement Using Introducer Tool and Stylet in Neutral Head Position in Adult Patients Under General Anaesthesia

## TL;DR

This study compares two methods for inserting a ProSeal laryngeal mask airway in patients with restricted head movement, finding that one method is faster without compromising safety.

## Contribution

The study provides evidence that using a stylet instead of an introducer tool can reduce insertion time for PLMA in neutral head positioning.

## Key findings

- Both insertion techniques achieved excellent placement quality in neutral head positioning.
- The stylet technique resulted in significantly shorter insertion times compared to the introducer tool.
- No significant differences were observed in success rates or hemodynamic responses between the two groups.

## Abstract

Background: Airway management in patients with cervical spine injuries presents significant challenges during general anaesthesia. The ProSeal laryngeal mask airway (PLMA) has emerged as a viable alternative for difficult airway management. However, optimal insertion techniques in neutral head positioning remain unclear. This study compared PLMA insertion using an endotracheal stylet versus the standard introducer tool for patients requiring neutral head positioning, with placement quality assessed using fibre-optic bronchoscopy.

Methods: A prospective, randomized controlled trial was conducted with 60 patients undergoing elective surgery requiring PLMA insertion in a neutral head position. Patients were randomly allocated to the introducer tool group (Group IT, n=30) or the stylet group (Group ST, n=30). The primary outcome was PLMA placement quality using Brimacombe's fibre-optic scoring system. Secondary outcomes included first-attempt success rate, number of insertion attempts, insertion time and haemodynamic responses. Statistical analysis was performed using chi-square and unpaired t-tests, with p<0.05 considered significant.

Results: Optimal placement (grades 3 and 4) was achieved in all patients in both groups, with no significant difference in Brimacombe scoring between Group IT and Group ST (p=0.76). Group ST demonstrated a significantly shorter insertion time (79.37±18.74 seconds) compared to Group IT (96.40±22.92 seconds, p=0.002). No significant differences were observed in first-attempt success rate, haemodynamic parameters or insertion attempts between groups.

Conclusion: Both techniques achieved excellent PLMA placement quality in neutral head positioning. The stylet technique demonstrated significantly faster insertion times while maintaining comparable success rates and haemodynamic stability. These findings suggest that the stylet technique may offer practical advantages for PLMA insertion in patients requiring cervical spine immobilization, potentially improving efficiency in challenging airway scenarios.