The CobraPLA™ During Anesthesia with Controlled Ventilation: A Clinical Trial of Efficacy

Abstract

TM(CPLA) is a relatively new supraglottic airway device that has not been sufficiently investigated.Here, we performed a prospective observational study to evaluate the efficacy of the CPLA during controlled ventilation. In 50 anesthetized and paralyzed patients undergoing elective surgery a CPLA was inserted and inflated to an intracuff pressure of 60 cm H2O. The success rate of insertion upon the first attempt was 82% (41/50), with a mean insertion time of 16.3 ± 4.5 seconds. The adequacy of ventilation was assessed by observing the end tidal CO2 waveform, movement of the chest wall, peak airway pressure (13.5 cm H2O), and leak fraction (4%). We documented the airway sealing pressure (22.5 cm H2O) and noted that the the site of gas leaks at that pressure were either at the neck (52%), the abdomen (46%), or both (2%). In 44 (88%) patients, the vocal cords were visible in the fiberoptic view through the CPLA. There was no gastric insufflation during the anesthesia. Respiratory and hemodynamic parameters remained stable during CPLA insertion. Postoperative blood staining of CPLA was minimal, occurring in 22% (11/50) of patients. Mild and moderate throat soreness was reported in 44% (22/50) and 4% (2/50) of patients, respectively. Lastly, mild dysphonia was observed in 6% (3/50) of patients and mild dysphagia in 10% (5/50) of patients. Our results indicated that the CPLA is both easy to place and allows adequate ventilation during controlled ventilation.

The Perilaryngeal Airway and the Laryngeal Tube in Short Ophthalmic Procedures in Adults: A Prospective Randomized Comparative Study

“…This too was consistent with other studies [25]. In this study, the first attempt success rate of the PLA at 88% was similar to this of Nam et al [6] at 82%, who used muscle relaxants. The first attempt insertion success rate with the LT was higher at 96%, which was similar to the findings of Wrobel at al.…”

“…Furthermore, the overall success rate was 100% for both. This was consistent with other reports, where the success rate of insertion ranged between 92 and 100% for the LT [12,[19][20][21][22][23][24] and between 95 and 100% for the PLA [4][5][6][25][26][27][28]. Despite the high success rate of insertion we found that the PLA was more difficult to insert than the LT.…”

“…The cobra-shaped distal end is softened and designed to provide passage of the device into the hypopharynx by bending in the direction of the glottis [5]. Once in place, the distal head holds the soft tissues and epiglottis in place and abuts the laryngeal inlet, allowing positive pressure ventilation [6].…”

A randomised, crossover comparison between the CobraPLA® and the LMA Classic™ in paralysed patients*

“…The primary outcome was the airway leak pressure. The sample size was based on previous studies with the CobraPLA [4] and was selected to detect a projected difference of 5 cmH 2 O between the groups with respect to airway leak pressure for a type I error of 0.05 and power of 0.9. For detailed comparison, secondary outcomes included the time for insertion, the number of insertion and reposition attempts, the anatomical position as determined by fibreoptic bronchoscopy, and peak and plateau airway pressure during controlled ventilation.…”

“…One of these devices, the CobraPLA Ò (Engineered Medical Systems, Inc., Indianapolis, IN, USA) is a relatively new supraglottic airway device that has been proven safe and effective in several clinical settings [1][2][3][4][5][6][7]. However, to the best of our knowledge, there is only one study that compares the performance of the CobraPLA with that of other supraglottic airways in paralysed patients and it did not examine the airway leak pressure.…”