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PEDIATRIC ANESTHESIA

A Randomized Crossover Comparison of the Size 2 Laryngeal Mask Airway ProSeal^TM Versus Laryngeal Mask Airway-Classic^TM in Pediatric Patients

Department of Anaesthesia and Intensive Care Therapy, Philipps University Marburg, Germany

Address correspondence and reprint requests to Kai Goldmann, MD, DEAA, Department of Anesthesia and Intensive Care Therapy, Philipps University Marburg, 35033 Marburg, Germany. Address e-mail to Kaigoldmann1{at}aol.com.

The laryngeal mask airway (LMA)-ProSeal^TM (P-LMA) forms a more effective seal than the LMA-Classic^TM (C-LMA) and facilitates gastric tube (g-tube) placement in adults. The first pediatric sizes of P-LMA recently became available. In 30 anesthetized, nonparalyzed children, aged 7.7 ± 2 yr and weighing 27 (20–35) kg, we inserted the size P-LMA and C-LMA in random order. Ease of insertion, quality of initial airway, fiberoptic position, airway leak pressure, and maximum tidal volume were determined. G-tube placement was assessed for the P-LMA. Ease of insertion was similar for both devices. The quality of the initial airway was better for the P-LMA (P = 0.01). Airway leak pressure in neutral head position (22.6 versus 18.5 mbar; P = 0.003), maximum flexion (37 versus 26.3 mbar; P < 0.001), maximum extension (15.2 versus 13 mbar; P = 0.045), and maximum tidal volume (1088 versus 949 mL; P = 0.002) were significantly better for the P-LMA. Air entry into the stomach occurred with the C-LMA but not with the P-LMA (P = 0.014). G-tube placement was possible in all patients. The reliability of g-tube placement and the significantly increased airway leak pressure found in this investigation might have important implications for use of the size P-LMA for positive pressure ventilation in children.

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