The Size 1 1/2 ProSeal™ Laryngeal Mask Airway in Infants: A Randomized, Crossover Investigation With the Classic™ Laryngeal Mask Airway
Kai Goldmann, Christine Roettger, and Hinnerk Wulf
(Anesth Analg, 102:405-410, 2006)
Department of Anesthesia and Intensive Care Therapy, Philipps-Universität Marburg, Germany.
A number of problems with the Classic laryngeal mask airway (CLMA) in infants are thought to be related to its inadequate cuff design. One of the main limitations of the CLMA is that the resultant low-pressure seal can be inadequate for positive-pressure ventilation (PPA). The ProSeal laryngeal mask airway (PLMA) is a new laryngeal mask airway with a modified cuff, which has been demonstrated to form a more effective seal than the CLMA in children. Size 1 1/2, the first infant-size PLMA, recently became available. Thirty anesthetized, nonparalyzed infants aged (mean) 15 months (range, 2-30 months) and weighing 9 kg (range, 5-12 kg) were studied. The CLMA and PLMA were inserted into each patient in random order, and airway leak pressure and maximum tidal volume were measured. Ease of insertion, quality of initial airway, and fiberoptic position were also ascertained. Gastric tube placement was assessed for the PLMA. The mean airway leak pressure in neutral head position (26.7 vs. 18.9 cm H20), maximum flexion (35.6 vs. 28.2 cm H20), and the mean maximum tidal volume (312 vs. 260 mL) were markedly higher for the PLMA. Air entered the stomach in 8 patients with the CLMA but did not with the PLMA. Gastric tube placement was possible in all but 1 patient, and in 3 patients, the use of the PLMA resulted in some degree of clinically relevant compression of the larynx. The size 1 1/2 PLMA appears to be a more suitable device for airway maintenance in infants than does the same-size CLMA. The ability to insert a gastric tube at the same time and a markedly higher airway leak pressure than with the CLMA may hold important implications for the use of the PLMA for PPV in infants.