Laryngeal mask placement in the prone position. An online-survey among German anaesthetists in private practice

Background: The insertion of a laryngeal mask (LMA) in prone patients was first described twenty years ago and has subsequently become widespread. Critical aspects of this technique are the risk of pulmonary aspiration and the need to have to turn the patient back into the supine position should insertion fail. Two reports from the specialty specific German Incident-Reporting System "CIRS-AINS" have alerted the German Society of Anaesthesiology and Intensive Care Medicine (DGAI) and the Association of German Anaesthetists (BDA) to the fact that this method is practiced regularly among anaesthetists in private practice. No data on the frequency of induction in the prone position and on the incidence of complications are available. Methods: Online surveys among members of BDA and DGAI working in private practice. Results: 471 surveys (27% of all members) were evaluated. 48.3% of respondents insert a laryngeal mask in the prone position. In 52.6% additional staff is available for patient positioning. Pre-oxygenation and mask ventilation are applied respectively in 81.7% and 41.2% of patients prior to LMA insertion. Difficulties with mask insertion arise in 1% of the cases. 7% of the respondents reported an aspiration with LMA in the prone position. Incidence and distribution of complications among respondents differ from the figures reported in the literature. Conclusions: Laryngeal mask placement in prone patients is a widely applied airway management technique among German anaesthetists in private practice. Despite evidence for its safety and utility for airway management of these patients, the data are still insufficient to definitively recommend the technique as safe and superior to tracheal intubation in this patient population.