Introduction

 

 

The reusable ProSeal Laryngeal Mask Airway (PLMA; manufactured by the Laryngeal Mask Company Limited, Henley-on-Thames, United Kingdom) is based on the standard laryngeal mask airway (LMA) with a modified cuff and an esophageal drain tube (DT) (1). The first adult versions of the PLMA became commercially available in the year 2000; the manufacturer  recommended insertion of the PLMA using digital manipulation (as with the standard LMA) or with a special introducer tool; unfortunately, the insertion success of the PLMA at the first attempt for these techniques compared with digital insertion of the LMA was lower due to impaction at the back of the oropharynx and failure of the distal cuff to reach the hypopharynx, with folding over of the distal cuff or the distal cuff being directed into the laryngeal aperture rather than the hypopharynx (3, 6).

 

Howath and co-workers (8) described an insertion technique that overcomes these difficulties by priming the DT of the PLMA with a gum elastic bougie (GEB), first placed into the esophagus under direct conventional laryngoscopic view, to guide the distal cuff of the PLMA by digital manipulation into the correct position; in a subsequently published clinical report (9), they had no failed uses in 100 consecutive PLMA insertions. The overhelming success rate (at the first attempt) with this insertion technique was confirmed by Brimacombe and co-workers (2); however, they recommended the GEB-guided PLMA insertion technique mainly as backup when the digital or the introducer technique fail.

 

The main disadvantage of the GEB may be the apparent stiffness of this device. Although there are currently no published data on injuries to the esophageal mucosa with the use of GEBs for this procedure (2), we decided to use a simple gastric tube (GT) with a stiffening device inside the tube for guidance of the PLMA with far less potential of leading to esophageal injuries. The suction catheter-guided insertion technique (7) may be an alternative, but has its limitations; suction catheters, but also some GTs, are usually not sufficiently stiff enough to guide the PLMA around the back of the oropharynx.

 

We adopted the PLMA insertion technique recently communicated by Micaglio and co-workers (14); they used the GlideScope Video Laryngoscope (GVL; manufactured by Verathon Medical, Bothell, Washington, United States) and a GT, placed into the esophagus under video laryngoscopic view, to guide the distal cuff of the PLMA into the hypopharynx. In this clinical study, we evaluated the new GVL-assisted and GT-guided technique for PLMA insertion and the performance of the PLMA as airway device (additionally assessed by flexible laryngoscopic view grading through the airway tube).

 

 

Materials and Methods