A learning curve of LMA® ProSeal™ insertion: a prospective analysis of cumulative sum method.
PURPOSE
LMA® ProSeal™ (pLMA) has been used as an alternative to tracheal tubes. It is unclear how many cases are required to achieve proficiency in performing pLMA insertion among novice residents. Therefore, we analyzed the learning curve of pLMA insertion using a cumulative sum (CUSUM) chart and assessed the effects of learning.


METHODS
In this single-center, prospective, observational study, we included 15 novice residents. Staff anesthesiologists recorded success or failure; insertion time; and incidences of bleeding or reflex including cough, hiccups, and limb movement. A successful pLMA insertion was defined as effective ventilation within two attempts with an insertion time of ≤ 120 s. Regarding CUSUM, we set acceptable and unacceptable failure rates as 20% and 40%, respectively. Further, α and β errors were designated as 0.1. We stratified the number of cases encountered by each resident into four groups of 10 cases each (1-10, 11-20, 21-30, and ≥ 31 cases) and evaluated the effects of learning.


RESULTS
Each resident encountered 44 ± 5 (mean ± SD) cases of pLMA insertion, and 14/15 achieved proficiency in performing pLMA insertion after 20 ± 8 cases. Success rate (76%, 86%, 91%, and 93%; P < 0.001) and insertion time (45 s, 35 s, 31 s, and 26 s; P < 0.001) significantly improved with increased experience; however, incidences of bleeding (16%, 10%, 8%, and 10%; P = 0.124) and reflex (5%, 3%, 3%, and 3%; P = 0.54) remained unchanged.


CONCLUSION
Experience with 20 ± 8 cases is needed to achieve proficiency in performing pLMA insertion for novice residents in a tertiary teaching hospital.
['Nakanishi|Toshiyuki|T|http://orcid.org/0000-0003-0328-0629', 'Sakamoto|Seishi|S|', 'Yoshimura|Manabu|M|', 'Toriumi|Takashi|T|']
D000768:Anesthesia, General D000769:Anesthesia, Inhalation D006801:Humans D017214:Laryngeal Masks D059032:Learning Curve D011446:Prospective Studies
Learning curve Cumulative sum method Airway management Laryngeal masks Medical education