Prolonged use of the ProSeal laryngeal mask in ICU

Prolonged Use of the Laryngeal Mask Airway ProSealTM: A Report of Seven Cases Lasting 5-11 h

“…The only problem that occurred was a mild sore throat in one patient. There have been four previous reports and one case series of prolonged use of the LMA ProSeal TM : i) middle ear surgery lasting 5 h [8], ii) urgent cesarean section and postoperative ventilation lasting about 9 h [7], iii) prolonged use as an airway rescue device in ICU lasting 40 h [5], iv) subcostal laparatomy lasting 8 h 40 min [6] and a case series with 24 adult patients undergoing peripheral plastic surgery lasting in mean 3 h [9]. In addition to these cases, two of the authors (JB, CK) have experience of using the LMA ProSeal TM in 5000 patients for procedures lasting from 3 to 5 h without any major problems.…”

“…The LMA ProSeal TM is a laryngeal mask device with a modified cuff to facilitate ventilation and a drain tube to provide airway protection. In principle, the LMA ProSeal TM should be more suitable than the LMA Classic TM for prolonged procedures; however, there are only four reports [5][6][7][8] and one case series [9]. We describe the use of the LMA ProSeal TM in seven patients in a variety of clinical situations for procedures lasting more than 5 h.…”

Laryngopharyngeal mucosal injury after prolonged use of the ProSealTM LMA in a porcine model: A pilot study

“…[8][9][10] Recently, different authors have reported prolonged use of the PLMA for postoperative respiratory support. 11,12 In fact, the PLMA could be used routinely for prolonged surgical procedures or postoperative respiratory support. However, this might incur problems that have not yet been observed during short surgical procedures.…”

ProSeal LMA — how long is too long?

“…Some of the potential advantages may be off-set by additional risks in settings where the original guidelines are extended or ignored, such as non-fasted patients, parturients, 3 morbid obesity, 4 prone positioning 5 or prolonged use. 6,7 Each time a marginal application is proposed, it is appropriate to re-examine the risk/benefit equation to ensure that safety trumps success. Do relatively small case series that fail to identify infrequent complications justify the widespread adoption for such indications?…”

“…Certains des avantages potentiels pourraient être contrebalancés par des risques supplé-mentaires dans les contextes où les indications initiales sont soit étendues soit ignorées, par exemple lors de l'utilisation du masque laryngé chez des patients n'étant pas à jeun, des parturientes, 3 des patients obèses morbides, 4 lors d'une position en procubitus 5 ou d'une utilisation prolongée. 6,7 Chaque fois qu'une application marginale est suggérée, il convient de réexaminer la balance risque/bienfait afin de s'assurer que la sécurité demeure le maître mot du succès. Est-ce que des séries de cas relativement réduites, qui n'identifient pas de complications rares, justifient l'adoption répandue de telles indications ?…”