BACKGROUND: The summary of various studies done looking at size selection of the laryngeal mask airway (LMA) in adults is that, selection based on sex is appropriate, and that both sizes 4 or 5 are adequate for adult females. However, in our local population these sizes may be too large especially the size 5 for adult females. OBJECTIVE: To determine the optimal size of LMA in Malaysian female adults. METHOD: 135 ASA 1 or 2 adult female patients coming for elective surgery, requiring general anaesthesia suitable for LMA insertion were randomised into 3 groups to receive either a size 3, 4 or 5 LMA. Optimal size of the LMA was assessed based on 4 parameters, the number of attempts at placement, the oropharyngeal leak pressure (OLP), fibre optic score and the percentage of the vocal cords seen. RESULTS: The 3 groups were demographically similar. There was no difference in the 3 groups in terms of number of attempts of placement, OLP and fibre-optic score. The percentage of vocal cords seen with the size 3 LMA was significantly less than for the size 4 and size 5 (p = 0.009). For the size 5 LMA group in 10/45 patients, the size 5 LMA was too big making it incorrectly positioned after successful insertion and in another 3/45 patients it was difficult to pass the size 5 LMA past the open mouth during insertion. There were no such problems with the size 3 or 4 LMA groups. CONCLUSION: The optimal size of LMA for the female Malaysian adult is size 4.
Laryngeal Masks/*standards ; Malaysia

PURPOSE: Supraglottic airway devices have been widely utilized as an alternative to tracheal intubation in various clinical situations. The rotation technique has been proposed to improve the insertion success rate of supraglottic airways. However, the clinical efficacy of this technique remains uncertain as previous results have been inconsistent, depending on the variable evaluated. MATERIALS AND METHODS: We systematically searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials in April 2015 for randomized controlled trials that compared the rotation and standard techniques for inserting supraglottic airways. RESULTS: Thirteen randomized controlled trials (1505 patients, 753 with the rotation technique) were included. The success rate at the first attempt was significantly higher with the rotation technique than with the standard technique [relative risk (RR): 1.13; 95% confidence interval (CI): 1.05 to 1.23; p=0.002]. The rotation technique provided significantly higher overall success rates (RR: 1.06; 95% CI: 1.04 to 1.09; p<0.001). Device insertion was completed faster with the rotation technique (mean difference: -4.6 seconds; 95% CI: -7.37 to -1.74; p=0.002). The incidence of blood staining on the removed device (RR: 0.36; 95% CI: 0.27 to 0.47; p<0.001) was significantly lower with the rotation technique. CONCLUSION: The rotation technique provided higher first-attempt and overall success rates, faster insertion, and a lower incidence of blood on the removed device, reflecting less mucosal trauma. Thus, it may be considered as an alternative to the standard technique when predicting or encountering difficulty in inserting supraglottic airways.
Device Removal ; Humans ; Intubation, Intratracheal/instrumentation/*methods/standards ; *Laryngeal Masks ; Randomized Controlled Trials as Topic ; Reference Standards ; Risk ; *Rotation