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Correspondence |
Montréal, Québec
The ProSeal laryngeal mask airway (PLMA; Laryngeal Mask Company, Henley-on-Thames, UK) is a new device developed with a modified cuff intended to improve the seal, and a drainage tube designed to prevent aspiration by providing a bypass channel for regurgitated gastric content.1,2 Although not mandatory, the drainage tube also offers the opportunity to pass a gastric tube through it. The insertion of the gastric tube is generally easy and reliable if the PLMA is positioned properly.2 We recently encountered a case in which an aspiration catheter could not be inserted, and corrected the problem with a simple manoeuver. After inducing anesthesia and paralysis in a 74-yr-old female scheduled for elective laparoscopic cholecystectomy, a size 4 PLMA was inserted easily and provided a satisfactory airway with a seal over 30 cm H20 in the anesthesia circuit. Surprisingly, the attempt to insert a lubricated size 14 F aspiration catheter met with strong resistance inside the drainage tube. The PLMA was removed and reinserted with equal ease, after verifying the patency of the drainage tube. Again, even if the PLMA provided an excellent airway, it proved impossible to pass the aspiration catheter. We then presumed that the tip of the PLMA, where the opening of the drainage tube is located, was somehow kinked during insertion. We elected to reinsert the PLMA, but we allowed the aspiration catheter to protrude 4 to 5 cm at the end of the drainage tube during insertion (Figure
). The aspiration catheter acted as a guide, directing itself and the tip of the mask towards the upper esophageal sphincter. The catheter was easily advanced in the stomach where gastric fluid was aspirated. Subsequently, the catheter was removed and reinserted successfully, demonstrating that the PLMA and its drainage tube were correctly positioned, without obstruction.
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References
1 Brimacombe J, 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.[Medline]
2
Brain AI, Verghese C, Strube PJ. The LMA ‘ProSeal’—a laryngeal mask with an oesophageal vent. Br J Anaesth 2000; 84: 650–4.
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