proseal LMA as an aid to endotracheal intubation

ABSTRACT

The Proseal laryngeal mask airway [PLMA] is a new laryngeal mask device with a modified cuff to improve seal and a drainage tube to provide a channel for regurgitated fluid and gastric tube placement. In the present randomized study, the PLMA was tested as an aid to endotracheal intubation. Sixty paralyzed, anesthetized adult patients were studied. Group I [n=20], the gum elastic bougie was passed into PLMA through a self-sealing port in the elbow connector aiming at insertion into the trachea. After insertion of the gum-elastic bougie, the PLMA was withdrawn and a proper size endotracheal tube [ETT] was railroaded over the bougie into the trachea. Group II [n=20], the light-guided bougie was passed into PLMA the same way as in Group I When the light-guided bougie entered the glottic opening, a circumscribed glow was seen in the anterior neck. Again, the PLMA was withdrawn and a proper size ETT was railroaded over the lighted-bougie into the trachea Group III [n=20], the fiberoptic bronchoscope [FOB] was passed through a tube exchanger and the combination was passed into PLMA through a self-sealing port in the elbow connector which allows ventilation during the procedure. The FOB-tube exchanger combination was passed through the larynx into the trachea under direct vision and when it reached the carina, the FOB and the PLMA were carefully withdrawn leaving the tube exchanger in the trachea. Proper size endoiracheal tube [ETT] was railroaded over the tube exchanger into the trachea Hemodynamic changes, success rate and the time taken between initial disconnection of the PLMA from the anesthesia breathing system to final successful tracheal intubation were recorded. Finally, any complications that occurred during the procedure were documented. Successful intubation using the -gum elastic bougie [Group I] was 75% at the first attempt and 20% at the second attempt Successful intubation using the light-guided bougie [Group II] was 25% at both the first and the second attempts. Failure of intubation was 5% and 50% in group I and group II, respectively. Successful intubation was 100% in Group III [FOB-tube exchanger combination], Time required for successful intubation after initial disconnection of the PLMA from the anesthesia breathing system was significantly shorter in Group I [18 +/- 2.5 s] compared to Group II [24.5 +/- 3.7 s] and Group III [22.5 +/- 2.6 s][P<0.05]. Intubation through PLMA was 100% successful using FOB-tube exchanger combination. The gum elastic bougie had a higher success rate of intubation than the light-guided bougie. Finally, the gum elastic bougie had the shortest intubation time