This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Galante, D. Search for Related Content PubMed PubMed Citation Articles by Galante, D.

---

LETTER TO THE EDITOR

Transesophageal Doppler Probe and Proseal Laryngeal Mask Airway. A New Technique for Probe Insertion in Pediatric Anesthesia

University Department of Anesthesia and Intensive Care University Hospital; "Ospedali Riuniti" of Foggia, Italy; dario.galante{at}tin.it or dariogalante{at}anestesiapediatrica.it

To the Editor:

Several studies have shown that the pediatric Proseal laryngeal mask airway (PLMA) has a higher oropharyngeal leak pressure compared with the classic LMA and may be used as an alternative to a tracheal tube.1–5 We studied the concurrent use of both PLMA and esophageal Doppler probe in 102 pediatric patients undergoing genitourinary and abdominal surgery in general and blended anesthesia (caudal or epidural lumbar block together with general anesthesia).

Since the PLMA does not enter the trachea, it is less irritating to both the upper and lower airways than an endotracheal tube. Moreover, we observed that a well lubricated dorsal cuff of PLMA was useful for guiding and facilitating introduction of the probe into the proximal esophagus compared with a cuffed endotracheal tube that may externally occlude the esophagus.

The oropharyngeal leak pressures (23.7 ± 7.1 cm H₂O) were measured by closing the expiratory valve of the circle system at a fresh gas flow of 3 L/min and the PLMA cuff inflated to 60 cm H₂O. The presence of a gas leak was detected as an audible sound escaping from the mouth.

Ventilation was set with tidal volume 10 mL/kg and respiratory rate was adjusted to maintain end-tidal CO₂ (ETco₂) between 4.6 and 5.8 kPa (35–45 mm Hg).

The children studied were between the ages of 4 mo to 8 yr of age and in no case was it necessary to remove the transesophageal probe because of inadequate pulmonary ventilation.

The PLMA did not interfere with hemodynamic measurements and did not prevent rotation and depth of the probe during the insertion to find the optimal position and the typical waveform of blood flow velocity in the descending thoracic aorta.

To our knowledge, this technique has not been previously reported. In an earlier study, Uda et al.6 successfully inserted a similar probe through the drainage port of the PLMA but encountered a slight resistance. He also attempted insertion of the probe surrounded by a condom-type disposable probe jacket but the probe jacket did not allow the probe to pass through because of its relatively large diameter.

REFERENCES

1. Brimacombe J, Keller C. The ProSeal laryngeal mask airway: a randomized, crossover study with the standard laryngeal mask airway in paralyzed, anesthetized patients. Anesthesiology 2000;93: 104–9[Web of Science][Medline]
2. Brimacombe J, Keller C, Fullekrug B, Agrò F, Rosenblatt W, Dierdorf SF, Garcia de Lucas E, Capdevilla X, Brimacombe N. A multicenter study comparing the ProSeal and Classic laryngeal mask airway in anesthetized, nonparalyzed patients. Anesthesiology 2002;96:289–95[Web of Science][Medline]
3. Howath A, Brimacombe J, Keller C. Gum-elastic bougieguided insertion of the ProSeal laryngeal mask airway: a new technique. Anaesth Intensive Care 2002; 30:624–7[Web of Science][Medline]
4. Brimacombe J, Keller C, Judd DV. Gum elastic bougie-guided insertion of the ProSeal laryngeal mask airway is superior to the digital and introducer tool techniques. Anesthesiology 2004;100:25–9[Web of Science][Medline]
5. Monsel A, Salvat-Toussaint A, Durand P, Haas V, Baujard C, Rouleau P, El Aouadi S, Benhamou D, Asehnoune K. The transesophageal Doppler and hemodynamic effects of epidural anesthesia in infants anesthetized with sevoflurane and sufentanil. Anesth Analg 2007;105:46–50[Abstract/Free Full Text]
6. Uda R. Versatility of LMA-ProSeal for probe-passage. Anesthesiology 2002;96:1033[Web of Science][Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Galante, D. Search for Related Content PubMed PubMed Citation Articles by Galante, D.