The ProSeal laryngeal mask airway in children

The ProSeal (PLMA) is a new laryngeal mask device with a modified cuff to improve the seal and a drain tube to provide access to the gastrointestinal tract. We assessed the performance of the size 2 (which has no dorsal cuff) and size 3 (which has a dorsal cuff) in terms of insertion success, efficacy of seal, tidal volume, gas exchange, fiberoptic position, gastric tube placement and frequency of problems.

Eighty children undergoing minor surgery were studied (n = 40, size 2 PLMA, weight 10-25 kg; n = 40, size 3 PLMA, weight >25-50 kg). Induction was with remifentanil and propofol. Insertion was with the introducer tool and by experienced users. Maintenance was with propofol or sevoflurane and pressure controlled ventilation.

The first-time and overall insertion success rate was 84 and 100%, respectively. Oropharyngeal leak pressure was 31 +/- 5 cmH2O. There were no gastric or drain tube air leaks. Tidal volume and gas exchange was adequate in all patients, other than two brief episodes of hypoxia because of airway reflex activation. The vocal cords and epiglottis were visible in 99 and 80%, respectively, via the airway tube. The first-time and overall insertion success rate for gastric tube insertion was 87 and 100%, respectively. During maintenance, the PLMA was removed in one patient with airway reflex activation and another required epinephrine for bronchospasm. There were no differences in performance between the sizes 2 and 3 PLMA.

The PLMA is an effective airway device in children and isolates the glottis from the esophagus when correctly positioned. Despite the lack of a dorsal cuff, the performance of the size 2 was similar to the size 3 PLMA in the age groups tested.