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GENERAL ARTICLES

A Comparison of the Laryngeal Mask Airway ProSeal^TM and the Laryngeal Tube Airway in Paralyzed Anesthetized Adult Patients Undergoing Pressure-Controlled Ventilation

Joseph Brimacombe, MB ChB, FRCA, MD^*, Christian Keller, MD, and Lawrence Brimacombe, MB ChB^*

*Department of Anaesthesia and Intensive Care, Cairns Base Hospital, The Esplanade, Cairns, Australia; and Department of Anaesthesia and Intensive Care Medicine, Leopold-Franzens University, Innsbruck, Austria

Address correspondence and reprint requests to Professor Joseph Brimacombe, Department of Anaesthesia and Intensive Care, Cairns Base Hospital, The Esplanade, Cairns 4870, Australia. Address e-mail to jbrimacombe{at}austarnet.com.au

We compared the laryngeal mask airway ProSeal^TM (PLMA^TM) and the laryngeal tube airway (LTA), two new extraglottic airway devices, with respect to: 1) insertion success rates and times, 2) efficacy of seal, 3) ventilatory variables during pressure-controlled ventilation, 4) tidal volume in different head/neck positions, and 5) airway interventional requirements. One-hundred-twenty paralyzed anesthetized ASA physical status I and II adult patients were randomly allocated to the PLMA^TM or LTA for airway management. A standardized anesthesia protocol was followed by two anesthesiologists experienced with both devices. The criteria for an effective airway included a minimal expired tidal volume of 6 mL/kg during pressure-controlled ventilation at 17 cm H₂O with no oropharyngeal leak or gastric insufflation. First attempt success rates at achieving an effective airway were similar (PLMA^TM: 85%; LTA: 87%), but after 3 attempts, success was more frequent for the PLMA^TM (100% versus 92%, P = 0.02). Effective airway time was similar. Oropharyngeal leak pressure was larger for PLMA^TM at 50% maximal recommended cuff volume (29 ± 7 versus 21 ± 6 cm H₂O, P < 0.0001), but was similar at the maximal recommended cuff volume (33 ± 7 versus 31 ± 8 cm H₂O). Tidal volumes (614 ± 173 versus 456 ± 207 mL, P < 0.0001) were larger and ETCO₂ (33 ± 9 versus 40 ± 11 mm Hg, P = 0.0001) lower for the PLMA^TM. The number of airway interventions was significantly less frequent for the PLMA^TM. Airway obstruction was more common with the LTA. When comparing mean tidal volumes in different head/neck positions, the quality of airway was unchanged in 56 of 60 patients (93%) with the PLMA^TM and 42 of 55 (76%) with the LTA (P = 0.01). The PLMA^TM offers advantages over the LTA in most technical aspects of airway management in paralyzed patients undergoing pressure-controlled ventilation.

IMPLICATIONS: The laryngeal mask airway ProSeal^TM offers advantages over the laryngeal tube airway in most technical aspects of airway management in paralyzed patients undergoing pressure-controlled ventilation.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999