Airway Management in Anesthetized Spontaneosly Breathing Patients: Proseal Versus Classic Laryngeal Mask Airways

Background: Since the development of the classic laryngeal mask airway (cLMA) in 1988, airway management becomes more advanced in recent years. This advancement is demonstrated by the introduction of a wide variety of new alternative airway devices including the ProSeal laryngeal mask airways (PLMA). Aim of the study: To compare the PLMA with the cLMA in anesthetized nonparalyzed adult patients with respect to insertion characteristics, airway sealing pressure (ASP) and incidence of related complications. For the PLMA, we also compared the efficacy of the introducer tool (IT). Methods: Sixty adult patients scheduled for elective minor surgery were categorized into three equal groups; we inserted cLMA in group I, PLMA using the IT in group II, and PLMA with finger insertion technique in group III. Results: The first attempt insertion success rate in group I and II was higher (100%) than in group III (95%). Insertion time (mean ± SD) differed significantly between the groups, and was 8.7 ± (0.92), 13.35 ± (1.66), and 16.95 ± (1.39) seconds in group-I, II and III, respectively. The ASP (cmH2O) was significantly higher in group II (29.15 ± 1.39) and III (28.9 ± 1.17) than in group I (18.35 ± 0.88). The complications encountered were gastric inflation in group I (10%), gagging in all groups (10% in each of group I and II, and 15% in group-III), and in group III, soft tissue injury (5%) and airway obstruction (5%). Conclusion: In anesthetized, spontaneously breathing patients the cLMA is easier and quicker to insert but the PLMA provides a more effective ASP. PLMA insertion using the IT is easier than the finger insertion technique, and causes fewer complications.
Airways, laryngeal mask, PLMA, insertion