Airway Management in Anesthetized Spontaneosly Breathing Patients: Proseal Versus Classic Laryngeal Mask Airways
DOI:
https://doi.org/10.51984/thywd440Keywords:
Airways, Laryngeal mask, PLMA, InsertionAbstract
Background: Since the development of the classic laryngeal mask airway (cLMA) in 1988, airway management becomes more advanced in recent years. This advancement is demonstrated by the introduction of a wide variety of new alternative airway devices including the ProSeal laryngeal mask airways (PLMA).
Aim of the study: To compare the PLMA with the cLMA in anesthetized nonparalyzed adult patients with respect to insertion characteristics, airway sealing pressure (ASP) and incidence of related complications. For the PLMA, we also compared the efficacy of the introducer tool (IT).
Methods: Sixty adult patients scheduled for elective minor surgery were categorized into three equal groups; we inserted cLMA in group I, PLMA using the IT in group II, and PLMA with finger insertion technique in group III.
Results: The first attempt insertion success rate in group I and II was higher (100%) than in group III (95%). Insertion time (mean ± SD) differed significantly between the groups, and was 8.7 ± (0.92), 13.35 ± (1.66), and 16.95 ± (1.39) seconds in group-I, II and III, respectively. The ASP (cmH2O) was significantly higher in group II (29.15 ± 1.39) and III (28.9 ± 1.17) than in group I (18.35 ± 0.88). The complications encountered were gastric inflation in group I (10%), gagging in all groups (10% in each of group I and II, and 15% in group-III), and in group III, soft tissue injury (5%) and airway obstruction (5%).
Conclusion: In anesthetized, spontaneously breathing patients the cLMA is easier and quicker to insert but the PLMA provides a more effective ASP. PLMA insertion using the IT is easier than the finger insertion technique, and causes fewer complications.
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References
Hung O and Law JA. Advances in airway management. Can J Anesth 2006; 53(6): 628-31.
Randell T and Antela H. Developments in laryngoscopy and tracheal intubation: videogames and practical tools. Acta Anaesthesiol Scand 2008; 52: 3-5.
Cook TM, Lee G and Nolan J. The ProSeal Laryngeal Mask Airway: A review of the literature. Can J Anaesth 2005; 52: 739-60.
Brain A, Verghese C and Strube PJ. The LMA ProSeal: a laryngeal mask with an oesophageal vent. Br J Anaesth 2000; 84: 650–4.
Brimacombe J. Placement phase. In: Laryngeal Mask Anesthesia. Principles and Practice. London: WB Saunders; 2005; 265–80.
Maltby JR, Beriault MT and Watson NC. LMA Classic and LMA-ProSeal are effective alternatives to endotracheal intubation for gynecologic laparoscopy. Can J Anesth 2003; 50: 71-7.
Asia T, Nagata A and Shngu K. Awake tracheal intubation through the laryngeal mask in neonates with upper airway obstruction. Ped Anesth 2008; 18: 77-80.
Hohlrieder M, Brimacombe J, Von-Goedecke A and Keller C. Postoperative nausea, vomiting, airway morbidity, and analgesic requirements are lower for the ProSeal laryngeal mask airway than the tracheal tube in females undergoing breast and gynaecological surgery. Br J Anaesth 2007; 99(4): 576-80.
Brimacombe J. ProSeal LMA for ventilation and airway protection. In: Laryngeal Mask Anesthesia. Principles and Practice. London: WB Saunders, 2005, 505–38.
Brimacombe J, Keller C, Boehler M and Puhringer F. Positive pressure ventilation with ProSeal versus Classic laryngeal mask airway: a randomized, crossover study of healthy female patients. Anesth Analg 2001; 93: 1351–3.
Brimacombe J and Joseph MB, Fullekrug B, et al. A multicenter study comparing the ProSeal and classic laryngeal mask airway in anesthetized, nonparalyzed patients. Anesthesiology 2002: 96 (2); 289-95.
Cook TM, Nolan JP, Verghese C, et al. Randomized crossover comparison of the ProSeal with the classic laryngeal mask airway in unparalysed anaesthetized patients. Br J of Anaesth 2002; 88: 527-33.
Brimacombe J and Keller C. The ProSeal laryngeal mask airway: A randomized, crossover study with the standard laryngeal mask airway in paralyzed, anesthetized patients. Anesthesiology 2000; 93: 104-9.
Brimacombe J and Keller C. Stability of the LMA-ProSeal® and the standard laryngeal mask airway in different head and neck positions: a randomized crossover study. Eur J Anaesthesiol 2003; 20: 65–9.
Coulson A, Brimacombe J, Keller C, et al. A comparison of the ProSeal and Classic laryngeal mask airways for airway management by inexperienced personnel after manikin-only training. Anaesth Intensive Care 2003; 31: 286-9.
Cook TM and Gibbison B. Analysis of 1000 consecutive uses of the ProSeal laryngeal mask airway by one anaesthetist at a district general hospital. Br J Anaesth 2007; 99(3): 436-9.
Kihara S, Brimacombe JL, Yaguchi Y, et al. A comparison of sex and weight-based ProSealTM laryngeal mask size selection criteria. A randomized study of healthy anesthetized, paralyzed adult patients. Anesthesiology 2004; 101: 340–3.
Keller C and Brimacombe J. Mucosal pressure and oropharyngeal leak pressure with the ProSeal versus laryngeal mask airway in anaesthetized paralysed patients. Br J Anaesth 2000; 85: 262-6.
Evans NR, Gardner SV and James MF. ProSeal laryngeal mask protects against aspiration of fluid in the pharynx. Br J Anaesth 2002; 88: 584-7.
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