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LETTER TO THE EDITOR

Size 1 ProSeal^TM Laryngeal Mask Airway in Neonates

Department of Pharmacology and Anesthesiology; m.micaglio{at}libero.it (Micaglio, Parotto) Department of Pediatrics; University of Padova; Padova, Italy (Trevisanuto, Zanardo)

To the Editor:

As anesthesiologists who assess neonatal airways, both for resuscitation and anesthesia, we are involved in evaluating the safety and efficacy of devices for airway control (1). Goldmann et al. (2) states that the ProSeal Laryngeal Mask Airway (PLMA) size 1 facilitates gastric tube placement in infants and forms a more effective seal than the same size Classic LMA (cLMA), allowing higher peak airway pressure during positive pressure ventilation (PPV). In previous articles, Goldmann et al., (3,4) Lopez-Gil et al., (5,6) and Wheeler (7) assess pediatric PLMA sizes (1, 2, and 2) with similar conclusions. Although the results with the size 1 PLMA were encouraging for patients weighing 5–6 kg or more, Goldmann et al. found that the 1 PLMA is too large for neonates.

In a manikin-based comparative study, we recently tested the neonatal size 1 PLMA and size 1 cLMA (8). With IRB approval, we recently summarized our clinical experience in seven neonates who required PPV at birth, in whom we used the size 1 PLMA (Table 1). Their median (range) weight was 3.455 g (2.210–4.190 g), and their median gestational age was 39 wk (35–40). In all cases, a PLMA size 1 was easily inserted on the first attempt. Because the introducer strap is small and the absence of an integral bite-block renders the device very flexible, we could not position the device using the fingertip technique which we traditionally used with adult-sized PLMAs. Instead, we used the specific introducer provided by the manufacturer. We inflated the PLMA cuff and connected the device to a self-inflating bag, allowing effective PPV. We recorded the time elapsed from insertion of the PLMA into the newborn's mouth to the first inflation of the infants' lungs. We successfully placed an 8 or 10F gastric tube in all cases. Pulmonary auscultation and chest movement demonstrated good bilateral ventilation in all cases. Stethoscopic auscultation of the neck, just lateral to the thyroid cartilage, revealed only a single case with an audible leak, which did not compromise ventilation. We removed the PLMA when the neonate no longer tolerated it.

These are the first experiences with the size 1 PLMA. More data are needed, but these clinical impressions are encouraging. Further research will establish whether a size 1 PLMA will be useful for neonates who need high airway pressures for ventilation, which cannot be reliably achieved with the cLMA.

Footnotes

Dr. Goldmann does not wish to respond.

REFERENCES

1. Trevisanuto D, Micaglio M, Pitton M, et al. Laryngeal mask airway: is the management of neonates requiring positive pressure ventilation at birth changing? Resuscitation 2004;62:151–7.[Web of Science][Medline]
2. Goldmann K, Roettger C, Hinnerk W. The size 1 ProSeal^TM Laryngeal Mask Airway in infants: a randomized, crossover investigation with the Classic^TM Laryngeal Mask Airway. Anesth Analg 2006;102:405–10.[Abstract/Free Full Text]
3. Goldmann K, Jakob C. Size 2 ProSeal laryngeal mask airway: a randomized, crossover investigation with the standard laryngeal mask airway in paediatric patients. Br J Anaesth 2005;94:385–9.[Abstract/Free Full Text]
4. Goldmann K, Jakob C. Randomized, crossover comparison of the size 2 LMA-ProSeal versus LMA-Classic in pediatric patients. Anesth Analg 2005;100:1605–10.[Abstract/Free Full Text]
5. Lopez-Gil M, Brimacombe J. The ProSeal laryngeal mask airway in children. Paediatr Anaesth 2005;15:229–34.[Medline]
6. Lopez-Gil M, Brimacombe J, Garcia G. A randomized non-crossover study comparing the ProSeal and the Classic laryngeal mask airway in anaesthetized children. Br J Anaesth 2005;95:827–30.[Abstract/Free Full Text]
7. Wheeler M. ProSeal laryngeal mask airway in 120 pediatric surgical patients: a prospective evaluation of characteristics and performance. Paediatr Anaesth 2006;16:297–301.[Medline]
8. Micaglio M, Doglioni N, Parotto M, et al. Training for neonatal resuscitation with the laryngeal mask airway: a comparison of the LMA-ProSeal and the LMA-Classic in an airway management manikin. Paediatr Anaesth. In press.

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