The Proseal laryngeal mask airway in children: a comparison between two insertion techniques

The Proseal laryngeal mask airway (PLMA) is a relatively new supraglottic airway device with a drain tube to minimize the risk of gastric insufflation and aspiration. We compared introducer tool (IT) and gum elastic bougie (GEB)-guided techniques for insertion of the Proseal LMA in children.

One hundred and twenty-four children aged 1-12 years, weight 8-29 kg, ASA I-II, undergoing peripheral surgery were studied. Patients were randomly divided into either IT group (n = 64) or GEB group (n = 60). Following a standardized anesthesia protocol, the IT technique was performed according to the manufacturer's instruction. The GEB-guided technique involved priming the drain tube with a GEB, placing the distal end of the GEB into the esophagus under gentle laryngoscopy and railroading the Proseal LMA into position. All insertions of Proseal LMA were performed by two experienced investigators. Data were collected regarding rate of successful insertion, incidence of oral, gastric and drain tube air leak, ease of gastric tube placement and frequency of airway-related complications.

Insertion was equally successful at the first attempt (IT 96.9%, GEB 95.0%) in both groups. Efficacy of seal was better in the GEB group (oral leak, IT 35.9%, GEB 18.3%, P < 0.05; gastric leak, IT 21.9%, GEB 5.0%, P < 0.05; drain tube leak, IT 7.8%, GEB 0%, P < 0.05). Position of Proseal LMA in relation to the glottis was better in the IT group (grade I, IT 0%, GEB 11.7%; grade II, IT 29.7%, GEB 23.3%; grade III, IT 28.1%, GEB 25.0%; grade IV, IT 42.2%, GEB 40.0%; P < 0.05). Gastric tube placement was equally successful (IT 100%, GEB 100%) and frequency of airway-related problems was similar for both groups (IT 3.2%, GEB 6.1%).

A gum elastic bougie-guided insertion technique in children is comparable with the IT technique in terms of success rate and may be useful as a backup technique when the IT technique fails.