A Comparison of the ProSeal and Classic Laryngeal Mask Airways for Airway Management by Inexperienced Personnel after Manikin-only Training

Abstract

We compared the ProSeal™ (PLMA) and Classic™ (LMA) laryngeal mask airway for airway management by inexperienced personnel. Nine nurses from the post-anaesthesia care unit, with no prior experience of LMA or PLMA insertion, were observed inserting the LMA and PLMA in 60 ASA 1 to 2 anaesthetized, paralysed adults following manikin-only training. The time to achieve an effective airway (2 consecutive expired tidal volumes (6 ml/kg; maximum 2 minutes allowed), the number of insertion attempts and the reasons for failure (inability to insert into pharynx or inadequate ventilation) were determined by analysis of digital video recordings. The first attempt success rate (LMA, 85%; PLMA, 83%), overall success rate (LMA, 88%; PLMA, 90%) and effective airway time (LMA, 39±13 s; PLMA, 43±19 s) were similar. Failure was from an inability to insert into the pharynx in five with the LMA and three with the PLMA, and inadequate ventilation with two from the LMA and three from the PLMA. Effective airway time and the number of failures were similar for the first and second device. Failure of both devices occurred in four patients. We conclude that airway management in anaesthetized, paralysed adults is equally successful for the LMA and PLMA by inexperienced personnel following manikin-only training. The PLMA is worthy of consideration as a tool for emergency airway management by inexperienced personnel.

Guided Insertion of the ProSeal Laryngeal Mask Airway Is Superior to Conventional Tracheal Intubation by First-Month Anesthesia Residents After Brief Manikin-Only Training

“…The ProSeal laryngeal mask airway (PLMA; Laryngeal Mask Company) is a variation of the LMA that is more suitable for cardiopulmonary resuscitation, as it has a modified cuff to improve the seal and a drain tube to provide a channel for regurgitated fluid, prevention of gastric insufflation, and insertion of a gastric tube (5). Coulson et al (6) showed that digital insertion of the PLMA and LMA by inexperienced personnel after manikin-only training was equally successful in anesthetized adults, with success rates of approximately 90% after 2 min. Howarth et al (7) described a new insertion technique for the PLMA with a success rate approaching 100% by experienced personnel.…”

The McIvor blade improves insertion of the LMA ProSeal™ in children

“…An 83% success rate has been reported for LMA ProSeal insertion by inexperienced personnel on their first attempt. 2 Several techniques have been introduced to improve the insertion success rate; the use of fibroscopy, 9 an EschmannÒ Tracheal Tube Introducer (i.e., gum-elastic bougie), 4,10 and a suction catheter. 11 However, these techniques do not leave enough oral space for LMA ProSeal insertion; leaving a larger space between the tongue and retropharynx and not requiring the introduction of an index finger would make insertion in children easier.…”

“…is an advanced form of the LMA with a softer and larger cuff to improve sealing and a drain tube to permit venting of the stomach. [1][2][3][4] However, when a larger cuff is used, it is more difficult to save space for inserting the LMA ProSeal in the patient's mouth, and the larger cuff is more likely to fold over. 5,6 In particular, LMA ProSeal insertion in pediatric patients may be impeded by a relatively large tongue, a floppy epiglottis, and the frequent presence of tonsillar hypertrophy.…”

Comparison of Supreme® and Soft Seal® laryngeal masks for airway management during cardiopulmonary resuscitation in novice doctors: a manikin study

“…Conventional types of LMAs, such as the LMA-Classic Ò , LMA-ProSeal Ò , or Soft Seal have been reported to be useful for airway rescue [14]. Compared to old types, the Supreme has various enhanced features.…”