Two manoeuvres to facilitate the oral insertion of LMA CTrach™

Background and Aims: LMA CTrach^TM, a new intubating conduit, has a thicker shaft compared to that of the intubating laryngeal mask airway (ILMA) due to the embedded optical fibres of the system. This causes difficulty during insertion despite normal mouth opening. Utility of two manoeuvres to overcome this was evaluated. Methods: From our experience with LMA CTrach^TMwe found that two manoeuvres can be helpful to facilitate the insertion of LMA (a) dorsal and downward pressure over the shaft at the point where it hinges against the incisors while continuing the one handed rotational insertion of LMA (b) Lateral insertion of the LMA till the cuff is inside the oral cavity and then rotation of the LMA by 90° and then complete the insertion. A retrospective analysis of 200 insertions of LMA CTrach^TMwas done to evaluate the utility of these manoeuvres. Results: Out of 200 insertions, 15 were found to be difficult. Manoeuvre 'a' was applied in 13 cases to facilitate the insertion and manoeuvre 'b' was applied in 2 cases where insertion was not possible despite manoeuvre 'a'. Insertion was successful in these cases after the application of the described manoeuvres. Conclusion: The two manoeuvres described above can be useful when LMA CTrach^TMinsertion into the oral cavity is obstructed by the incisor teeth.