Observational Study to Compare the Efficacy of Macintosh Laryngoscope Guided Insertion of Laryngeal Mask Airway with Conventional Blind Insertion Technique

Background: Maintaining a patent airway is a fundamental responsibility of anesthesiologists during general anesthesia. The laryngeal mask airway (LMA) is widely used as a supraglottic airway device because of its ease of insertion and favorable safety profile. Conventionally, LMA insertion is performed using a blind technique; however, this method may lead to suboptimal placement due to the absence of direct visualization of airway structures. Laryngoscope-guided insertion has been proposed as a technique that may improve anatomical alignment and airway sealing.

Aim: To compare the efficacy of Macintosh laryngoscope-guided insertion of the laryngeal mask airway with the conventional blind insertion technique.

Methods: This prospective observational study was conducted in the Department of Anesthesiology at Travancore Medical College Hospital, Kollam. A total of 204 adult patients undergoing elective surgeries under general anesthesia were included and allocated into two groups: Group A (blind insertion, n = 102) and Group B (Macintosh laryngoscope-guided insertion, n = 102). Insertion characteristics, fiberoptic bronchoscopy (FOB) grading, oropharyngeal leak pressure (OPLP), hemodynamic parameters, and postoperative complications were evaluated.

Results: Baseline demographic characteristics were comparable between the groups. The first-attempt success rate was higher in the laryngoscope-guided group (85.3%) compared with the blind insertion group (75.5%), although the difference was not statistically significant (p = 0.078). Ease of insertion was significantly better in the laryngoscope-guided group (p < 0.001). Fiberoptic bronchoscopy demonstrated significantly improved anatomical positioning with guided insertion (p = 0.002). The mean OPLP was significantly higher in the laryngoscope-guided group (24.78 ± 1.56 cmH₂O) compared with the blind group (19.96 ± 1.16 cmH₂O, p < 0.001). However, insertion time was longer with laryngoscope guidance (p < 0.001). Hemodynamic parameters and postoperative complications were comparable between groups.

Conclusion: Macintosh laryngoscope-guided LMA insertion improves anatomical positioning and airway sealing compared with the conventional blind technique while maintaining similar hemodynamic stability and complication rates. Although insertion time is slightly longer, the guided technique may provide a more reliable airway seal and improved device placement.