ProsealTM LMA : a review of literature

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ProsealTM LMA a review of literature
Journal conference 07-09-21
CAN J ANESTH 2005

• R2 ? ? ?

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ProsealTM LMA

• Dr. Archie Brain ? ?? ??.
• 2000?? ???.
• cLMA ? ???? modification
• GI, respiratory tract? ??? ? ???.
• Airway seal??
• Controlled ventillation? mask misplacement? ????
  ?.

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Design

• Airway tube, bowl, cuff? ??
• cLMA? ???
• Bowl grille? ?? larger and deeper
• Mask cuff? post. Extension
• Drainage tube? ??.
• Silicone bite block? ??.
• Introducer? ???? ?? ? ?? ant. Pocket? ??.

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Seperation of respiratory GI trascts

• ???? ????? ??
• airway orifice? glottis?? ????
• DT tip ? cricoid cartilage? ?? ????? ?????.

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Size

• Size 3-5? 2000?? ?????? 11/2 21/2? 2004?? ???.

• ??????(2 studies)
• ?????? airway seal?? Best compromise
• Male 5
• Female 4

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Practical aspect, cost

• Reusable recommended product life 40
  sterilization
• lt Tip flattener gt
  lt Introducer gt
• Cost cLMA?? 110 - 130

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Insertion technique

• 1. Digital insertion
• 2. Introducer insertion
• 3. Gum-elastic-bougie guided insertion

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1. Digital insertion

• Head extension, lower neck flexion
• Index finer? retaining strap? ???.
• Hard palate? ??? hypopharynx? resistence ? ??????
  ??.
• Retaining strap?? ???? occiput??? ??? ?? ??
  sniffing position? ????? counter-press

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2. Introducer insertion

• Introducer
• Distal end retaining strap? ??
• Proximal end airway tube? DT??? notch? ??
• ????? digital method? ???? remove ? ?? ??.
• Remove ? cuff inflation pressure ? 60 cmH2O ?
  ??.
• Position ? ????? bite block? 50??? ?? ??? ?????.
  
• Bite block? ?? ???? ?? misplace

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3. Gum-elastic-bougie(GEB) guided insertion

• Laryngoscope ???? GEB?esophagus? ?? ? DT ? ???
  railroading.

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• Three insertion technique??(240 pts)
• Digital /
  introducer / GEB
• First time success 84 / 88 / 100
• 3? ???? ? no difference
• GEB??? laryngoscope?? ? ???? ?? ?? ? ???? ???
  mask? ??? ?? ??? ?? ?? ???? ? ?? ?? ? ???? ??.

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Correct position??? ?? DT ??

1. Air pr. ? 20 cmH2O ????? DT? gel ? ejection?? ??
   ? misplacement ?? False negative? ??? ???? gel
   ? ??? 5mm?? ???? ??? nontoxic liquid soap? ??

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Misplacement
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Misplacement 1

• lt Mask tip folds gt
• 3.5 case?? ??
• ? ? Bite block protrusion 83
• ??? insertion ? ?????? ?? ?? 92
• Higher airway pr. than average
• OGT? passage ???.
• Negative suprasternal notch test

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Misplacement 2,3
lt incomplete insertion gt
lt glottic insertion gt
gel and soap test ? positive ventilation?
??bubble formation.
Chest compression? ??bubble formation.
??? ?? ?? mask full deflation, tip flttening?
insertion, ?? ??? insertion?? extrusion ?? ???
??.
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• Further use of DT of PLMA
• Esophageal tube
• Cathter
• Doppler probe
• Esophageal stethoscope
• Temperature probe

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Complications

• Mucosal injury sore throat
• Mucosal injury remove? PLMA? blood? ?? ??? ??.
  ?? 10.2 ??
• Sore throat ?? 18 ??.
• Gastric inflation, regurgitation aspiration
• cLMA? ?? PLMA? aspiration risk??.
• Airway obstruction
• DT tip? glottis ? ???? ??
• Fold
• Tip? larynx??? compression?? ??
• Esophageal gastric inflation

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PLMA vs cLMA

• 
  PLMA cLMA
• Insertion success- 1st 85 93
• 2nd 99.3
  100
• Insertion time PLMA? ?? ? ??.a few
  seconds(negliable)
• PLMA? ? ??? ??
• Larger, deeper, softer bowl
• DT? ?? leading edge? non-linear
• PLMA? ???? ???? 20-30? ??? insertion? ??.

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Clinical experience

• Laparoscopic cholecystectomy
• PLMA vs TT (109 pts)
• Surgeon ? op field?? stomach distension? ????
  ???? ??
• Non-obese pts.?? both group? ventilation??? ???.
• PLMA?? smoother emergence(coughing? ??? ??)
• PLMA vs cLMA
• PLMA require more insertion attempts
• Gas inflation? Ventilaton? both group??
  successful
• ??? pneumoperitoneum ? cLMA?? 20? ventilation
  fail
• cLMA? 3 case ?? gastric inflation??
• ??? LC?? cLMA?? PLMA? ? ????? ???.

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Clinical experience

• Obstetric practice
• No report for using PLMA during elective c/sec
• During CPR
• PLMA? cLMA? ?? ? ??
• Improved airway seal
• Ability to drain the stomach (reduce aspiration)
• Manikin study cLMA, ILMA, PLMA, uniqe LMA ??
• PLMA? TT? ????? chest compression ?? ?? airway?
  ?? function? ? ??.

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Clinical experience

• Other potential use
• Cardiac anesthesia?
• Hemodynamic stimulation???
• Smooth recovery ??
• Carotid endarterectomy?
• Airway manipulation? hemodynamic stability ??
• Neuroanesthesia?
• Tracheal intubation? extubation? ????? vascular
  and intracranial HTN ???

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Conclusion

• PLMA? controlled ventilation??? cLMA?? ?????.
• Introducer? insertion? ???? ??? ???? ??? ????
• Bougie-guided insertion ? ??? ??? ?.
• Drain Tube? misplacement detect? gastric access?
  ???? ??? airway seal??? gastric inflation? ?????.

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• 88? ???? face mask? TT?? ????
• cLMA? ?? ???? ?????? regurgitation? risk? ???.
• PLMA? ? cLMA? TT??? gap? ?? bridge??? ?? ??.