A Randomized Crossover Comparison of the Size 2?? Laryngeal Mask Airway ProSeal??? Versus Laryngeal Mask Airway-Classic??? in Pediatric Patients

Abstract

The laryngeal mask airway (LMA)-ProSeal (P-LMA) forms a more effective seal than the LMA-Classic (C-LMA) and facilitates gastric tube (g-tube) placement in adults. The first pediatric sizes of P-LMA recently became available. In 30 anesthetized, nonparalyzed children, aged 7.7 +/- 2 yr and weighing 27 (20-35) kg, we inserted the size (1/2) P-LMA and C-LMA in random order. Ease of insertion, quality of initial airway, fiberoptic position, airway leak pressure, and maximum tidal volume were determined. G-tube placement was assessed for the P-LMA. Ease of insertion was similar for both devices. The quality of the initial airway was better for the P-LMA (P = 0.01). Airway leak pressure in neutral head position (22.6 versus 18.5 mbar; P = 0.003), maximum flexion (37 versus 26.3 mbar; P < 0.001), maximum extension (15.2 versus 13 mbar; P = 0.045), and maximum tidal volume (1088 versus 949 mL; P = 0.002) were significantly better for the P-LMA. Air entry into the stomach occurred with the C-LMA but not with the P-LMA (P = 0.014). G-tube placement was possible in all patients. The reliability of g-tube placement and the significantly increased airway leak pressure found in this investigation might have important implications for use of the size (1/2) P-LMA for positive pressure ventilation in children.

Usability and performance characteristics of the pediatric air-Q® intubating laryngeal airway

“…Our data on neutral OLP values and, commensurately, our V T max values for the air-Q ILA are lower than existing published data for the PLMA. [2][3][4]14 Our findings for air-Q ILA sizes 1.5 and 2.0 are similar to those previously published, 10,11 where the mean (standard deviation [SD]) OLP was 17.5 (6.4) cm H 2 O and 18.5 (1.6) cm H 2 O for size 1.5 and 15.7 (4.3) cm H 2 O for size 2.0. Our OLP findings for size 1 were higher than those by Sinha et al 11 who reported a mean (SD) OLP of 18.5 (2.1) cm H 2 O. Oropharyngeal leak pressures increase when the patient's neck is in the flexed position, a phenomenon also described with the PLMA.…”

“…Previously published studies of performance of new iterations of LMAs in adults and children have used similar group sizes. [2][3][4] Data are described with median [P25,P75] for continuous data and frequency (percent) for discrete and categorical data. Due to its observational design, this study was not powered for comparisons, and as such, no inferential methods of statistical analysis were employed.…”

“…Pediatric-sized PLMAs are also available and provide superior performance with respect to sealing pressures when compared with the LMA Classic. [2][3][4] The LMA Fastrach is a much bulkier device and is not available in pediatric sizes. Consequently, the SGD options for airway rescue in the difficult pediatric airway are limited.…”

Comparison of laryngeal mask airway (LMA)-Proseal™ and the LMA-Classic™ in ventilated children receiving neuromuscular blockade

“…Shimbori et al 18 performed a randomized, non-blinded study in 19 showed a difference in leak pressure between groups (PLMA 33 cm H 2 O; CLMA 26 cm H 2 O), as well as a higher incidence of gastric insufflation with the CLMA, with no difference in fibreoptic view. These mean leak pressures far exceed those observed in the studies previously described [15][16][17][18] as well as the current investigation. The inclusion of the size 3 PLMA, which has a posterior cuff, may account for the higher mean leak pressures observed, as well as compromisation of the fibreoptic view as seen in adult studies.…”

“…Randomized crossover studies of the PLMA vs CLMA sizes 1 ½, 15 2 16 and 2 ½ 17 have been published by Goldmann et al [15][16][17] In these studies, with the patient's head in the neutral position, the OPL by auscultation was higher for the PLMA (size 2 PLMA -18.8 cm H 2 O; size 2 CLMA -15.0 cm H 2 O). Gastric insufflation was more common for the CLMA and was absent for the PLMA.…”