Kasturba Medical College, Manipal, Manipal University Background LMA CTrach is a relatively new intubating conduit which allows for ventilation during the process of intubation and visualization of the tracheal tube passing through the glottic inlet. The shaft of the LMA of LMA CTrach is thicker compared to that of intubating LMA. This is because the optical fibres of the system are embedded within the shaft. The increased circumference of the shaft of the LMA may cause difficulty in introducing the LMA into the mouth despite normal mouth opening.

From our experience with LMA C Trach we found that two maneuvers 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 degrees and then complete the insertion. A retrospective analysis of 200 insertions of LMA CTrach was done to evaluate the utility of these maneuvers. ResultsOut of 200 insertions15 were found to be difficult. Maneuver �a� was applied in 13 cases to facilitate the insertion and maneuver �b� was applied in 2 cases where insertion was not possible despite maneuver �a�. Insertion was successful in these cases after the application of the described maneuvers.

The two maneuvers described above can be useful when LMA CTrach insertion into the oral cavity is obstructed by the incisor teeth.