Suction catheter guided insertion of the ProSeal™ laryngeal mask airway is superior to the digital technique

Objective: Pulmonary aspiration of gastric contents occurs 20 –30% of the time during cardiopulmonary resuscitation (CPR) of cardiac arrest. This is due to loss of protective airway reflexes, pressure changes generated during CPR, and positive pressure ventilation (PPV). Even though the American Heart Association (AHA) has recommended the laryngeal mask airway (LMA) as an acceptable alternative airway for use by EMS personnel, concerns over the capacity of the device to protect from pulmonary aspiration remain. We sought to determine the incidence of aspiration after LMA placement, CPR and PPV. Methods: We conducted a prospective study on 16 consecutive post-experimental mixed-breed domestic swine of either sex (mean mass 25.7 ±1.4 kgs). A standard size-4 LMA was modified so that a vacuum catheter could be advanced into and past the LMA diaphragm. The LMA was placed into the hypopharynx and its position confirmed using End-tidal CO 2 and direct visualization of lung expansion. Fifteen milliliters of heparinized blood were instilled into the pharynx. After 5 PPVs with a mechanical ventilator, chest compressions were performed for 60s with asynchronous ventilations continuing at a rate of 12 per minute. After chest compressions, a suction catheter was inserted through the cuff and suction applied for approximately 1 minute. The catheter was removed and inspected for signs of blood. The LMA cuff was deflated and the LMA removed. The intima of the LMA diaphragm was inspected for signs of blood. In a validation cohort of 4 animals, the LMA was reinserted, a cricothyrotomy performed and 5 mL of blood instilled directly into the trachea. Results: There were 0/16 (95% CI=0 –17%) with a positive tests for the presence of blood in both the vacuum catheter and the intima of the LMA diaphragm. In the validation cohort, all four were positive for blood in both the vacuum catheter and the intima of the LMA diaphragm. Conclusions: In this simple model of regurgitation of after LMA placement, there was no sign of pulmonary aspiration, and no evidence that blood had passed beyond the seal created by the LMA cuff. Concerns over aspiration with LMA use may be unfounded. Future studies should determine the frequency of pulmonary aspiration after LMA placement in the clinical setting.

Download Full-text

Comparison of videolaryngoscope-guided versus standard digital insertion techniques of the ProSeal™ laryngeal mask airway: a prospective randomized study

BMC Anesthesiology ◽

10.1186/s12871-019-0915-3 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Ulku Ozgul ◽

Feray Akgul Erdil ◽

Mehmet Ali Erdogan ◽

Zekine Begec ◽

Cemil Colak ◽

...

Keyword(s):

Laryngeal Mask Airway ◽

Success Rate ◽

Primary Outcome ◽

Randomized Study ◽

Peak Inspiratory Pressure ◽

Laryngeal Mask ◽

Tube Placement ◽

Insertion Technique ◽

Digital Technique ◽

Insertion Techniques

Abstract Background This study were designed to investigate the usefulness of the videolaryngoscope-guided insertion technique compared with the standard digital technique for the insertion success rate and insertion conditions of the Proseal™ laryngeal mask airway (PLMA). Methods Prospective, one hundred and nineteen patients (ASA I–II, aged 18–65 yr) were randomly divided for PLMA insertion using the videolaryngoscope-guided technique or the standard digital technique. The PLMA was inserted according to the manufacturer’s instructions in the standard digital technique group. The videolaryngoscope-guided technique was performed a C-MAC® videolaryngoscope with D-Blade, under gentle videolaryngoscope guidance, the epiglottis was lifted, and the PLMA was advanced until the tip of the distal cuff reached the oesophagus inlet. The number of insertion attempts, insertion time, oropharyngeal leak pressure, leak volume, fiberoptic bronchoscopic view, peak inspiratory pressure, ease of gastric tube placement, hemodynamic changes, visible blood on PLMA and postoperative airway morbidity were recorded. Results The first-attempt success rate (the primary outcome) was higher in the videolaryngoscope-guided technique than in the standard digital technique (p = 0.029). The effect size values with 95% confidence interval were 0.19 (0.01–0.36) for the first and second attempts, 0.09 (− 0.08–0.27) for the first and third attempts, and not computed for the second and third attempts by the groups, respectively. Conclusion Videolaryngoscope-guided insertion technique can be a help in case of difficult positioning of a PLMA and can improve the PLMA performance in some conditions. We suggest that the videolaryngoscope-guided technique may be a useful technique if the digital technique fails. Trial registration ClinicalTrials.gov NCT03852589 date of registration: February 22th 2019.

Download Full-text

Ease of ProSeal laryngeal mask airway insertion in children (after placement) using suction catheter: A comparison with conventional techniques

Indian Journal of Clinical Anaesthesia ◽

10.18231/2394-4994.2018.0040 ◽

2018 ◽

Vol 5 (2) ◽

pp. 216-221

Keyword(s):

Laryngeal Mask Airway ◽

Proseal Laryngeal Mask Airway ◽

Laryngeal Mask ◽

Suction Catheter ◽

Laryngeal Mask Airway Insertion

Download Full-text

TRACHEAL STENOSIS SURGERY

The Professional Medical Journal ◽

10.29309/tpmj/2010.17.04.3013 ◽

2010 ◽

Vol 17 (04) ◽

pp. 638-642

Author(s):

SHAFAQ AHMED ◽

SARFRAZ JANJUA

Keyword(s):

Laryngeal Mask Airway ◽

Endotracheal Tube ◽

Tracheal Stenosis ◽

Nasogastric Tube ◽

High Frequency ◽

Laryngeal Mask ◽

Alternative Methods ◽

High Frequency Ventilation ◽

Suction Catheter ◽

Mask Ventilation

Objective: To highlight the problems and solutions in airways management in patients with tracheal stenosis undergoing surgical interventions and to highlight the alternative methods of airway control where high frequency ventilatory facility is not available. Study Design: Case series study. Place and Duration: Combined Military Hospital Rawalpindi from 1st Jan 2004 to 30th June 2007. Patients and Methods: Twenty nine patients of both sex and all age groups presenting with difficulty in breathing due to tracheal stenosis undergoing surgical intervention on trachea have been included. All the patients were managed under general anaesthesia. Nasogastric tube 10 Fr, suction catheter, laryngeal mask airway or mask ventilation was used for initial ventilation where conventional endotracheal tube of even smallest size did not work. Results: Small size endotracheal tube were used in twenty four patients. Difficulty was faced in five patients. In these patients endotracheal tube of smallest size available could not be passed and we had to provide ventilation by innovative measures like nasogastric tube 10Fr in one, suction catheter 10Fr in two, laryngeal mask airway in one and mask ventilation in one. There was no mortality. Conclusions: Adequate ventilation during tracheal stenosis surgery can be very difficult in some cases. Therefore a thorough understanding, a tier of flexible plans and a variety of ventilating means should be arranged before administering anaesthesia.Nasogastric tube 10Fr or suction catheter of similar size are suitable alternative if facility for high frequency ventilation is not available.

Download Full-text

Gum Elastic Bougie-guided Insertion of the ProSeal™ Laryngeal Mask Airway Is Superior to the Digital and Introducer Tool Techniques

Anesthesiology ◽

10.1097/00000542-200401000-00008 ◽

2004 ◽

Vol 100 (1) ◽

pp. 25-29 ◽

Cited By ~ 100

Author(s):

Joseph Brimacombe ◽

Christian Keller ◽

Dana Vosoba Judd

Keyword(s):

Laryngeal Mask Airway ◽

Occult Blood ◽

Proseal Laryngeal Mask Airway ◽

Laryngeal Mask ◽

Drain Tube ◽

Laryngeal Mask Airway Insertion ◽

Test Results ◽

Digital Technique ◽

End Tidal ◽

Digital Or

Background The authors compare three techniques for insertion of the ProSeal laryngeal mask airway. Methods Two hundred forty healthy patients aged 18-80 yr were randomly allocated for ProSeal laryngeal mask airway insertion using the digital, introducer tool (IT), or gum elastic bougie (GEB)-guided techniques. The digital and IT techniques were performed according to the manufacturer's instructions. The GEB-guided technique involved priming the drain tube with the GEB, placing the GEB in the esophagus under direct vision, and inserting the ProSeal laryngeal mask airway using the digital technique with the GEB as a guide. Failed insertion was defined by any of the following criteria: (1) failed pharyngeal placement; (2) malposition (air leaks, negative tap test results, or failed gastric tube insertion if pharyngeal placement was successful); and (3) ineffective ventilation (maximum expired tidal volume < 8 ml/kg or end-tidal carbon dioxide > 45 mmHg if correctly positioned). Any visible or occult blood was noted. Sore throat, dysphonia, and dysphagia were assessed 18-24 h postoperatively. Results Insertion was more frequently successful with the GEB-guided technique at the first attempt (GEB, 100%; digital, 88%; IT, 84%; both P < 0.001), but success after three attempts was similar (GEB, 100%; digital, 99%; IT, 98%). The time taken to successful placement was similar among groups at the first attempt but was shorter for the GEB-technique after three attempts (GEB, 25 +/- 14 s; digital, 33 +/- 19 s; IT, 37 +/- 25 s; both: P < 0.003). There were no differences in the frequency of visible blood, but occult blood occurred less frequently with the GEB-guided technique (GEB, 12%; digital, 29%; IT, 31%; both: P < 0.02) but was similar among techniques if insertion was successful at the first attempt. There were no differences in postoperative airway morbidity. CONCLUSION The GEB-guided insertion technique is more frequently successful than the digital or IT techniques. The authors suggest that the GEB-guided technique may be a useful backup technique for when the digital and IT techniques fail.

Download Full-text

A Comparison of Sex- and Weight-based ProSeal™ Laryngeal Mask Size Selection Criteria

Anesthesiology ◽

10.1097/00000542-200408000-00014 ◽

2004 ◽

Vol 101 (2) ◽

pp. 340-343 ◽

Cited By ~ 23

Author(s):

Shinichi Kihara ◽

Joseph R. Brimacombe ◽

Yuichi Yaguchi ◽

Noriko Taguchi ◽

Seiji Watanabe

Keyword(s):

Gas Exchange ◽

Laryngeal Mask Airway ◽

Mucosal Injury ◽

Proseal Laryngeal Mask Airway ◽

Adult Patients ◽

Laryngeal Mask ◽

Leak Pressure ◽

Digital Technique ◽

Size Selection ◽

Oropharyngeal Leak Pressure

Background The authors compared the manufacturer's weight-based formula (size 3 for weight < 50 kg, size 4 for weight 50-70 kg, and size 5 for weight > 70 kg) with a sex-based formula (size 4 for women and size 5 for men) for selecting the appropriate size of ProSeal laryngeal mask airway. Methods Two hundred thirty-seven healthy, anesthetized, paralyzed adult patients (American Society of Anesthesiologists physical status I or II; age, 18-80 yr) were randomly allocated for weight- or sex-based size selection. An experienced user inserted the ProSeal laryngeal mask airway with the digital technique. The following were compared: ease of insertion, oropharyngeal leak pressure, ease of ventilation, gas exchange, location of gas leak, anatomic position, mucosal injury, and postoperative pharyngolaryngeal problems. Intraoperative and postoperative data collection were unblinded and blinded, respectively. Results Ease of insertion, anatomic position, gas exchange, mucosal injury, and postoperative pharyngolaryngeal problems were similar between groups. For the sex-based group, larger ProSeal laryngeal mask airways were selected more frequently (P < 0.0001), oropharyngeal leak pressure (P = 0.02) was higher, leak volume (P = 0.004) and leak fraction (P = 0.007) were lower, and oropharyngeal leaks (P = 0.03) were detected less frequently. Conclusion Size selection for the ProSeal laryngeal mask airway is equally effective using the manufacturer's weight-based formula or the sex-based formula in healthy, anesthetized, paralyzed adult patients, but leakage of small volumes of air from the mouth occurs less frequently with the sex-based formula.

Download Full-text

Airway Obstruction Caused by Sputa in Heat and Moisture Exchange Filter During Ventilation Using Supra-Laryngeal Mask Airway: A Case Report

Journal of Anaesthesia and Critical Care Reports ◽

10.13107/jaccr.2021.v07i03.184 ◽

2021 ◽

Vol 7 (3) ◽

Author(s):

Naoya Kobayashi ◽

Masanori Yamauchi

Keyword(s):

Laryngeal Mask Airway ◽

Tracheal Tube ◽

Carbon Dioxide Concentration ◽

Peak Inspiratory Pressure ◽

Laryngeal Mask ◽

Inspiratory Pressure ◽

Positive Pressure ◽

Suction Catheter ◽

Moisture Exchange ◽

Heat And Moisture

Introduction: Supra-laryngeal mask airway (LMA) is widely accepted as an alternative to the tracheal tube. However, compared to the use of a tracheal tube, it may take longer to identify the many different causes of sudden respiratory distress. In particular, heat and moisture exchange filters are one of the most overlooked causes. Case presentation: The case was that of a 76-year-old male Japanese patient (161.9 cm, 66.5 kg) who underwent an open renal biopsy. He presented with chronic obstructive pulmonary disease, with a Hugh–Jones dyspnea score of 2. The patient did not discontinue smoking prior to the operation. Anesthesia was induced using propofol (100 mg), fentanyl (100 ?g), and remifentanil (0.3 ?g/kg/min). I-gel™ #4 was inserted following neuromuscular blockade with rocuronium (40 mg). Anesthesia was maintained with 3–6% desflurane under positive pressure ventilation. After induction in the left lateral and jackknife positions, the following ventilator settings were used: volume-controlled ventilation with tidal volumes of 450 mL, respiratory rate of 12 breaths per minute, an inspiratory: expiratory ratio of 1:2, and a positive end expiratory pressure of 5 cmH2O. With these settings, the peak inspiratory pressure was 16 cmH2O. Five minutes after initiating the operation, the peak inspiratory pressure steadily increased to 30 cmH2O. Although we administered rocuronium, the peak inspiratory pressure and end-tidal carbon dioxide concentration increased over time. When we disconnected the heat and moisture exchange filter and LMA, we noticed a large quantity of sputa. A suction catheter was passed down the LMA and the sputa was removed, but the LMA was not obstructed. The peak inspiratory pressure continued to increase with tidal volumes of only 20–30 mL. Despite a normal external appearance of the heat and moisture exchange filter, we replaced it with a new one. The ability to ventilate improved immediately and the SpO2 recovered from 92% to 100%. Conclusions

Download Full-text

Ease of Proseal Laryngeal Mask Airway Insertion and its Fibreoptic view after Placement using Gum Elastic Bougie: A Comparison with Conventional Techniques

Anaesthesia and Intensive Care ◽

10.1177/0310057x0903700306 ◽

2009 ◽

Vol 37 (3) ◽

pp. 435-440 ◽

Cited By ~ 5

Author(s):

S. Taneja ◽

M. Agarwal ◽

J. S. Dali ◽

G. Agrawal

Keyword(s):

Laryngeal Mask Airway ◽

Elective Surgery ◽

Lateral Approach ◽

Proseal Laryngeal Mask Airway ◽

Laryngeal Mask ◽

Laryngeal Mask Airway Insertion ◽

Digital Technique ◽

Number Of Patients ◽

Airway Tube ◽

Induction Of Anaesthesia

The Proseal Laryngeal Mask Airway (PLMA) is routinely inserted by the digital and introducer tool techniques but a newer Gum Elastic Bougie (GEB) guided insertion technique has been described. The aims and objectives were to compare the ease of PLMA insertion and fibreoptic view of PLMA after placement using GEB and conventional techniques. Ninety-six ASA I or II patients of either gender, aged 18 to 60 years, scheduled for elective surgery under general anaesthesia in the supine position were included in this study. Following induction of anaesthesia, a PLMA was inserted using a GEB, introducer tool or digital technique in Groups G, I and D respectively (n=32). Correct placement of the PLMA was confirmed by using clinical tests along with fibreoptic assessment. Ease of PLMA insertion was assessed by the number of attempts, time taken and number of patients requiring lateral approach for insertion. The fibreoptic view of PLMA placement through the airway tube was graded on a scale from 4 (best view) to 1 (worst view). GEB-guided PLMA insertion was more successful both after the first attempt (G 100%, I 69%, D 72%, P <0.01) and after two attempts (G 100%, I 78%, D 84%, P <0.05). Time taken for successful placement was significantly shorter in the GEB-guided group after two attempts (G 22∓2 seconds, I 31.9±18.8 seconds, D 29.5±18.6 seconds, P <0.05). The fibreoptic view through the airway tube was significantly better in the GEB-guided group (P <0.01). Incidence of trauma was significantly less in the GEB-guided group (P <0.05).

Download Full-text