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Prime the ProSeal^TM drain tube with lube from a tube!

Joseph Brimacombe, MD FRCA^* and Christian Keller, MD MSc

^* James Cook University, Cairns, Australia
Leopold-Franzens University, Innsbruck, Austria, E-mail: jbrimaco{at}bigpond.net.au

To the Editor:

Lubrication of the ProSeal^TM laryngeal mask airway drain tube is rarely performed pre-induction unless a guided insertion technique is planned.^1,2 However, passage of a guide may be needed for airway rescue, and passage of a gastric tube may be needed for the prevention of aspiration. Any delays in placement of either accessory is potentially hazardous for the patient. One of the authors recently experienced a considerable delay before attempting gum elastic bougie-guided insertion after failed digital insertion, as the tube of lubricant had gone missing (later found in the assistant’s pocket), and the sachet of lubricant could not easily be injected into the drain tube. A simple expedient to prevent these delays is to prime the drain tube with a column of lubricant before induction of anesthesia. We recommend the use of a tube rather than a sachet, as it can be firmly applied to the rim of the drain tube making the injection of a lubricant column easier, quicker and much less messy (Figure). Priming the drain tube also allows the tests of malposition, such as the suprasternal notch tap test and the bubble test, to be performed more rapidly.³

View larger version (124K): [in this window] [in a new window]   FIGURE Injection of a column of lubricant into the drain tube by pressing the tube flush against the opening of the drain tube.

References

1 Drolet P, Girard M. An aid to correct positioning of the ProSeal laryngeal mask (Letter). Can J Anesth 2001; 48: 718–9.[Free Full Text]

2 Brimacombe J, Keller C, Judd DV. Gum elastic bougie-guided insertion of the ProSeal laryngeal mask airway is superior to the digital and introducer tool techniques. Anesthesiology 2004; 100: 25–9.[Medline]

3 Brimacombe J. ProSeal LMA for Ventilation and Airway Protection. Laryngeal Mask Anesthesia. Principles and Practice. London: W.B. Saunders; 2003: 505–38.

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