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Canadian Journal of Anesthesia 51:193 (2004)
© Canadian Anesthesiologists' Society, 2004

Correspondence

Destruction of the LMA-ProSealTM with the Red Plug during steam autoclaving

Donald T. Jolly, MD FRCP, Armando Escalona, RRT and Donna Clarke, RRT

Edmonton, Alberta

To the Editor:

We would like to report a problem we have encountered with the laryngeal mask airway (LMA)-ProSealTM with the Red Plug (The Laryngeal Mask Company (UK) Limited, Northfield House, Northfield End, Henley on Thames, Oxon, UK).

The LMA-ProSealTM airway utilizes a unique double cuff arrangement that provides an exceptionally effective airway seal at low intra-cuff pressures. Steam autoclaving is the only recommended method for sterilization of this airway.1 The cuff must be completely deflated prior to autoclaving. Any air remaining in the cuff will expand in the high temperature and low pressure of the autoclave causing the cuff to distend until it ruptures. A Red Plug vent device has been integrated into the inflation valve-pilot balloon assembly of the LMA-ProSealTM in an attempt to assure that the cuff of the laryngeal mask can be completely deflated prior to and during autoclaving. The Red Plug should be open during the autoclave cycle to ensure that any air or moisture in the laryngeal airway cuff can escape. The Laryngeal Mask Company has provided the hospital staff responsible for cleaning LMAs with supplementary instructions for the proper cleaning and autoclaving of LMA-ProSealTM fitted with a Red Plug.2

Recently our department acquired the new LMA-ProSealTM with the Red Plug to replace aging and failing LMAs. As I opened the sterilized package containing the LMA-ProsealTM airway for my first patient of the day, I was surprised to find the airway as depicted in the FigureGo. A large portion of the posterior part of the cuff had been blown free of the airway. The cause of this destruction was evident from examining the Red Plug. Instead of being open to the atmosphere as directed by the manufacturer, the Red Plug was occluded. Clearly, the Red Plug had been occluded before the airway had been autoclaved, resulting in the destruction of the airway.



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  		FIGURE Laryngeal mask airway (LMA)-ProSealTM with Red Plug integrated into the Inflation Valve-Pilot Balloon. Note the occluded Red Plug.

 
Inquiries revealed that of our initial five ProSealTM airways with the Red Plug, four had been destroyed by their first autoclaving prior to patient use. Despite the best instructional efforts of the manufacturer, human error had destroyed these airways. The damaged airways were disposed of with none of the anesthesiologists being aware that there was a problem. Interestingly, our department’s respiratory therapists were aware of the problem and had attempted to resolve it. It is estimated that CDN $1,500 worth of ProSealTM airways with the Red Plug were destroyed before the problem was recognized. Additional airways have been destroyed subsequently. Educational programs for the employees responsible for the sterilization of these airways have been implemented. If these efforts fail, our hospital will no longer purchase the ProSealTM airway because of the costs generated by this problem.

References

1 LMA-ProSealTM Instruction Manual. Northfield House, Nothfield End, Henley on Thames, Oxon, UK, The Laryngeal Mask Company Limited, 2002. (www.LMACO.com).

2 LMA-ProSealTM Supplementary Instructions for Use. The Laryngeal Mask Company Limited, Northfield House, Northfield End, Henley on Thames, Oxon, UK. 2002. (www.LMACO.com).





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