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OBSTETRIC ANESTHESIA

Failed Obstetric Tracheal Intubation and Postoperative Respiratory Support with the ProSeal^TM Laryngeal Mask Airway

Christian Keller, MD^*, Joseph Brimacombe, MBChB FRCA, MD, Philipp Lirk, MD^*, and Fritz Pühringer, MD^*

*Department of Anaesthesia and Intensive Care Medicine, Leopold-Franzens University, Innsbruck, Austria and James Cook University, Department of Anaesthesia and Intensive Care, Cairns Base Hospital, Cairns, Australia

Address correspondence to Prof. J. Brimacombe, Department of Anaesthesia and Intensive Care, Cairns Base Hospital, The Esplanade, Cairns 4870, Australia. Address email to jbrimaco{at}bigpond.net.au

The ProSeal^TM laryngeal mask airway (ProSeal^TM LMA) provides a better seal and probably better airway protection than the classic laryngeal mask airway (classic LMA). We report the use of the ProSeal^TM LMA in a 26-yr-old female with HELLP syndrome for failed obstetric intubation and postoperative respiratory support. Both laryngoscope-guided tracheal intubation and face mask ventilation failed, but a size 4 ProSeal^TM LMA was easily inserted and high tidal volumes obtained. A gastric tube was inserted through the ProSeal^TM LMA drain tube and 300 mL of clear fluid was removed from the stomach. There were no hemodynamic changes during ProSeal^TM LMA insertion. Postoperatively, the patient was transferred to the intensive care unit, where she was ventilated via the ProSeal^TM LMA for 8 h until the platelet count had increased and she was hemodynamically stable. Weaning and ProSeal^TM LMA removal were uneventful. There is anecdotal evidence supporting the use of the LMA devices for failed obstetric intubation (19 cases) and for postoperative respiratory support (8 cases). In principle, the ProSeal^TM LMA may offer some advantages over the classic LMA in both these situations.

IMPLICATIONS: We report the successful use of the ProSeal^TM laryngeal mask airway for failed obstetric intubation and postoperative respiratory support in a patient with HELLP syndrome.

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