Original Article
Comparative analysis of LMA Blockbuster^® clinical performance: Blind versus Miller laryngoscope-guided insertion in paediatric general anaesthesia – A double-blinded, randomised controlled trial
Bihani, Pooja; Shivanand; Jaju, Rishabh; Paliwal, Naveen; Janweja, Sarita; Vyas, Ankit

Indian Journal of Anaesthesia 68(10):p 875-881, October 2024. | DOI: 10.4103/ija.ija_186_2

Summary:
Aims and Objectives

ü  To compare the oropharyngeal leak pressure (OPLP) between blind insertion and Miller laryngoscope-guided insertion of the LMA Blockbuster® in children aged 1-4 years undergoing elective surgery.

ü  To evaluate secondary outcomes, including the number of insertion attempts, haemodynamic disturbances, insertion time, and airway complications associated with both insertion techniques.

ü  The authors hypothesized that under-vision insertion of the LMA Blockbuster® using a Miller laryngoscope would result in higher OPLP compared to the traditional blind insertion technique.

Methods:

Ø  Double-blinded, randomised controlled trial conducted between January 2023 and June 2023.

Ø  100 pediatric patients aged 1-4 years, with ASA physical status I and II, weighing between 7 and 20 kg, scheduled for elective below-umbilicus surgical procedures were included.

Ø  Patients were randomly allocated to one of two groups:
Group A: Blind insertion of LMA Blockbuster®.
Group B: Miller laryngoscope-guided insertion of LMA Blockbuster®.

Ø  Standard anaesthesia procedures were followed, and vital signs (HR, MAP, SpO2) were continuously monitored.

Ø  OPLP was measured by closing the expiratory valve of the circle system and recording the airway pressure at which an audible air leak was detected.
Postoperative complications such as injury to the tongue, dental trauma, laryngospasm, and blood on the device were noted.

Ø  Statistical analyses were performed using appropriate tests, with a significance level set at P < 0.05

Results:

Ø  Significantly higher mean OPLP was observed in Group B (Miller laryngoscope-guided insertion) compared to Group A (blind insertion): 27.9 (SD: 1.58) cmH2O vs. 25.94 (SD: 0.63) cmH2O (P < 0.001)

Ø  Mean insertion time was longer in Group B, but the difference was not considered clinically relevant.

Ø  First-attempt insertion success, haemodynamic stability, and postoperative complications were comparable between the two groups (P > 0.05).

 Conclusion: 

The study concluded that Miller laryngoscope-guided insertion of the LMA Blockbuster® in pediatric patients results in improved alignment with epiglottic structures and a significantly higher OPLP than blind insertion.1
This technique can potentially enhance airway management's safety and effectiveness in pediatric anaesthesia.