Laryngeal mask airway insertion in paediatric anaesthesia: comparison between the reverse and standard techniques

Sixty-seven children between one and 15 years of age were randomized to have Laryngeal Mask Airway (LMA) insertion using either the standard technique (Group A) as described by Brain or the "reverse technique" (involving a 180 degree turn after insertion with the cuff facing the palate) (Group B). A blinded observer using a fibreoptic bronchoscope assessed the final position of the LMA. The LMA had to be placed within 15 seconds for the procedure to be considered "successful". The success rate using the standard technique was 90.3% (28/31) and 100% (36/36) using the reverse technique (P value 0.06). The 95% confidence interval for the difference in success rates between Group B and A (B-A) was -0.73% to 20.1%. It is our opinion that the reverse technique of insertion of the LMA is an acceptable alternative to the standard technique.