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Performance of the PA_Xpress^TM vs the ProSeal^TM laryngeal mask airway during general anesthesia

[Efficacité du PA_Xpress^TM et du masque laryngé ProSeal^TM durant l’anesthésie générale]

From the Department of Anesthesiology, University of Montreal, Montreal, Quebec, Canada.

Address correspondence to: Dr. Alexandre Lallo, Department of Anesthesiology, CHUM, Hôpital Notre-Dame, 1560, Sherbrooke East, Montreal, Quebec H2L 4M1, Canada. Phone: 514-890-8000, ext. 26876; Fax: 514-412-7653; E-mail: a.lallo{at}umontreal.ca

Purpose: The PA_Xpress^TM (PA_X^TM) is a relatively new pharyngeal airway device that is easily inserted and effective in routine airway management. A prospective, randomized study was undertaken to compare the PA_X^TM with the ProSeal^TM laryngeal mask airway (PLMA^TM) during anesthesia with positive pressure ventilation.

Methods: One hundred adult patients scheduled for elective surgery under general anesthesia were randomized to airway management with either the PA_X^TM (n = 50) or the PLMA^TM (n = 50). All patients swallowed a methylene blue capsule before anesthesia. After insertion, leak and inspiratory pressures were measured. Fibrescopy was used to view the glottis. Devices were inspected for blood or methylene blue staining upon removal at the end of surgery. An interview was conducted postoperatively to evaluate the occurrence of sore throat, dysphagia and dysphonia.

Results: Insertion time was longer for the PAx^TM than for the PLMA^TM (52 ± 44s vs 34 ± 23 sec; P = 0.003). Leak pressure was lower while peak inspiratory pressures, and EtCO₂ values were higher (P = 0.016; 0.027 and 0.04 respectively) with the PAx^TM. Both devices provided comparable fibreoptic viewing of the glottis. There were no differences with respect to the incidence or pattern of blue stains upon removal. Blood was seen more often on the PAx^TM (58% vs 19%) and dysphagia was also more frequent and severe with the PA_X^TM.

Conclusion: In comparison with the PLMA^TM, PA_X^TM insertion time is longer and the ventilatory characteristics of this new device may be marginally inferior. The PA_X^TM is also more traumatic and is associated with more postoperative discomfort compared to the PLMA^TM.