Department of Anaesthesiology, Hospital Clínic de Barcelona, Villarroel 170, Barcelona 08036, Spain.
Br J Anaesth. 2011 Aug;107(2):265-71. doi: 10.1093/bja/aer104. Epub 2011 May 15.
The laryngeal mask airway (LMA) has been successfully used in patients in the prone position either for rescue or elective airway management. The reusable Proseal™ LMA (PLMA) and the single use Supreme™ LMA (SLMA) have been reported to be suitable for this purpose but few comparative data are available. In this study, we compared the clinical use of both devices in adult patients anaesthetized in the prone position.
One hundred and twenty patients undergoing surgery in the prone position were randomized to receive either the PLMA or the SLMA for airway management. Patients positioned themselves in the prone position and after pre-oxygenation, anaesthesia was induced using a target-controlled i.v. infusion of propofol and remifentanil. All PLMAs and SLMAs were inserted by experienced anaesthetists using a guided and a standard technique respectively. Ease of facemask ventilation, time and number of attempts needed for insertion, quality of ventilation, airway seal pressure, fibreoptic view, and complications were compared.
There were no differences between groups in insertion time or first attempt success (100% vs. 98%). The PLMA required fewer manipulations (3% vs. 15%; P=0.02) to achieve effective ventilation and provided a higher seal pressure (mean [sd] 31 [4] vs. 27 [4] cm H2O; P<0.01). The fibrescopic view of the vocal cords was similar, although easier to achieve with the PLMA. The complication rate was low and similar between the groups. Blood was present on masks in 7% vs. 8% and sore throat in 3% vs. 5% of patients with the PLMA and SLMA, respectively.
Airway management in patients anaesthetized in the prone position was efficient with both devices, although the PLMA required fewer manipulations and achieved a higher seal pressure.
喉罩气道（LMA）已成功用于俯卧位患者的抢救或选择性气道管理。可重复使用的 Proseal™ 喉罩（PLMA）和一次性使用的 Supreme™ 喉罩（SLMA）已被报道适用于此目的，但可用的比较数据很少。在这项研究中，我们比较了两种设备在麻醉后俯卧位患者中的临床应用。
120 例在俯卧位下接受手术的患者被随机分为 PLMA 或 SLMA 组，用于气道管理。患者取俯卧位，预充氧后，采用丙泊酚和瑞芬太尼靶控静脉输注诱导麻醉。所有 PLMA 和 SLMA 均由经验丰富的麻醉医师分别采用引导和标准技术插入。比较面罩通气的难易程度、插入所需的时间和尝试次数、通气质量、气道密封压、纤维光学视图以及并发症。
两组的插入时间或首次尝试成功率（100% vs. 98%）无差异。PLMA 需要更少的操作（3% vs. 15%；P=0.02）来实现有效通气，并提供更高的密封压（平均[标准差]31[4] vs. 27[4]cm H2O；P<0.01）。声带的纤维光学视图相似，但 PLMA 更容易实现。并发症发生率低，两组相似。PLMA 和 SLMA 组分别有 7%和 8%的患者面罩上有血迹，3%和 5%的患者有咽痛。
两种装置均能有效管理麻醉后俯卧位患者的气道，但 PLMA 所需的操作更少，达到的密封压更高。
