Study compares Blind and Miller Laryngoscope-guided Insertion of LMA Blockbuster in Paediatric Patients

The research paper compared blind insertion versus Miller laryngoscope-guided insertion of the LMA Blockbuster® in children aged 1-4 years undergoing general anesthesia. The primary objective of the study was to compare the oropharyngeal leak pressure (OPLP) between blind insertion and Miller laryngoscope-guided insertion. Secondary outcomes included insertion time, haemodynamic changes, and postoperative complications. The study revealed that Miller laryngoscope-guided insertion provided significantly higher mean OPLP compared to blind insertion. Although the insertion time was longer with the Miller laryngoscope-guided method, it was not clinically relevant. The study concluded that Miller laryngoscope-guided under-vision insertion of LMA Blockbuster® improves alignment with epiglottic structures compared to blind insertion. The research study involved 100 pediatric patients aged 1-4 years. The patients were randomly assigned to either blind insertion or Miller laryngoscope-guided insertion of the LMA Blockbuster®. The results revealed that the mean OPLP was significantly higher in the Miller laryngoscope-guided insertion group compared to the blind insertion group. Additionally, the insertion time was longer with the Miller laryngoscope-guided insertion method. However, this difference was not clinically relevant. There were no significant differences in the number of insertion attempts, haemodynamic stability, and postoperative complications between the two insertion methods.

Background and Aims of the Research

The study also discussed the background and aims of the research, highlighting the importance of effective airway management in pediatric anesthesia. It discussed the advantages of supraglottic airway devices over endotracheal intubation and emphasized the significance of proper alignment and positioning of the LMA Blockbuster® for efficient ventilation.

Limitations of the Study

The paper also addressed the limitations of the study, including the inability to grade the malposition of the LMA Blockbuster® and the lack of measuring the leak volume, which could provide insights into the effectiveness of the airway seal. The study acknowledged the need for further investigation to explore the applicability of guided insertion techniques in pediatric anesthesia practice.

Overall Study Conclusion

In conclusion, the study demonstrated that Miller laryngoscope-guided under-vision insertion of the LMA Blockbuster® in pediatric patients improves alignment with epiglottic structures and provides a significantly higher OPLP compared to blind insertion. While the insertion time was longer with the Miller laryngoscope-guided method, the study did not find any clinically relevant differences in terms of insertion attempts, haemodynamic stability, and postoperative complications between the two insertion methods.

Key Points

- The research paper compared blind insertion and Miller laryngoscope-guided insertion of the LMA Blockbuster® in children aged 1-4 years undergoing general anesthesia. The primary objective was to compare the oropharyngeal leak pressure (OPLP) between the two insertion methods.

- Results revealed that Miller laryngoscope-guided insertion provided significantly higher mean OPLP compared to blind insertion. Although the insertion time was longer with the Miller laryngoscope-guided method, it was not clinically relevant. - The study involved 100 pediatric patients who were randomly assigned to either blind insertion or Miller laryngoscope-guided insertion. The mean OPLP was significantly higher in the Miller laryngoscope-guided insertion group, and the insertion time was longer with this method. But there were no significant differences in the number of insertion attempts, haemodynamic stability, and postoperative complications between the two insertion methods.

- The background and aims of the research emphasized the importance of effective airway management in pediatric anesthesia, the advantages of supraglottic airway devices over endotracheal intubation, and the significance of proper alignment and positioning of the LMA Blockbuster® for efficient ventilation.

- The limitations of the study included the inability to grade the malposition of the LMA Blockbuster® and the lack of measuring the leak volume. The study also acknowledged the need for further investigation to explore the applicability of guided insertion techniques in pediatric anesthesia practice.

- In conclusion, the study demonstrated that Miller laryngoscope-guided under-vision insertion of the LMA Blockbuster® in pediatric patients improves alignment with epiglottic structures and provides a significantly higher OPLP compared to blind insertion. No clinically relevant differences were found in terms of insertion attempts, haemodynamic stability, and postoperative complications between the two insertion methods.

Reference -

Bihani P, Shivanand, Jaju R, Paliwal N,  Janweja S, Vyas A. Comparative analysis of LMA Blockbuster®  clinical performance: Blind versus Miller laryngoscope‑guided insertion in paediatric general anaesthesia – A double‑blinded,  randomised controlled trial. Indian J Anaesth 2024;68:875‑81