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An unusual case of airway rescue in the prone position with the ProSeal laryngeal mask airway

Joseph Brimacombe, MD^* and Christian Keller, MD

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

To the Editor:

An obese 58-yr-old male was undergoing extensive lower back surgery in the prone position. His head was face down on a support ring and the tracheal tube was attached strongly with adhesive tape. Facemask ventilation in the supine position had been difficult and laryngoscope-guided tracheal intubation had been accomplished at the first attempt using a gum elastic bougie, as the patient had an unexpected high anterior larynx. Midway through the procedure ventilation became difficult due to a massive leak. A rapid inspection revealed that the tracheal tube had been displaced by approximately 5 cm. On the assumption that the distal portion of the tracheal tube might still be aligned with or within the glottic inlet, the cuff was deflated and a single attempt made to push the tracheal tube back into position, but this resulted in esophageal intubation. While rapid preparations were made to rotate the patient back into the supine position for airway rescue and with the SpO₂ still > 95%, the gum elastic bougie was inserted with its straight end first along the esophageally placed tracheal tube, the tracheal tube was removed and a ProSeal laryngeal mask airway (ProSeal LMA; The Laryngeal Mask Company, Henley-on-Thames, UK) railroaded along its drain tube into position in the pharynx. The air-way tube was immediately attached to the anesthesia breathing system and ventilation commenced with tidal volumes > 1000 mL at peak airway pressures of 25 cm H₂O. The ProSeal LMA was then taped into position, the gum elastic bougie removed and a gastric tube inserted. The case was completed with the ProSeal LMA in situ. There were no other problems.

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