Maclean Jennyl, Tripathy Dk, Parthasarathy S, Ravishankar M
Department of Anaesthesiology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India.
Indian J Anaesth. 2013 May;57(3):248-52. doi: 10.4103/0019-5049.115604.
The ProSeal laryngeal mask airway (PLMA) is a unique laryngeal mask with a modified cuff to improve seal and a channel to facilitate gastric tube placement. This is a better device in difficult airway situations compared to classic laryngeal mask airway. This prompted us to study the ease of insertion and positioning of PLMA in patients with simulated restricted neck mobility while using gum elastic bougie (GEB) group or introducer tool (group IT) to aid insertion.
Sixty ASA I or II patients, aged between 18 years and 60 years, undergoing minor non-head and neck surgeries in the supine position were studied. A rigid neck collar was used to simulate restricted neck mobility in all patients. After anaesthetising the patients with a standard protocol, the PLMA was inserted using either of the technique using the tongue depressor to open the mouth. The ease of insertion, positioning, haemodynamic responses to insertion and other complications related to the procedure were noted.
Regarding demographic variables, both groups were similar. The mean time taken for insertion of PLMA in group GEB was 67.80 s as compared to 46.79 s in group IT (P<0.05). Patients of group GEB had better positioning assessed by an intubating fiberscope with less end tidal carbon-di-oxide (ETCO2) values. Systolic and diastolic blood pressures were similar. The incidence of sore throat, dysphagia, and dysphonia were higher in IT group in the 12 h, but similar in 24 h.
Guided insertion technique with GEB took a longer time, but had a better positioning and lower ETCO2 values when compared to IT technique.
ProSeal喉罩气道（PLMA）是一种独特的喉罩，其套囊经过改良以改善密封效果，并有一个通道便于放置胃管。与传统喉罩气道相比，在困难气道情况下，这是一种更好的装置。这促使我们研究在使用弹性橡胶探条（GEB）组或导入器工具（IT组）辅助插入时，PLMA在模拟颈部活动受限患者中的插入和定位难易程度。
研究60例年龄在18岁至60岁之间、仰卧位接受非头颈小手术的美国麻醉医师协会（ASA）I或II级患者。使用硬颈托模拟所有患者的颈部活动受限。按照标准方案对患者进行麻醉后，使用压舌板开口，采用两种技术之一插入PLMA。记录插入的难易程度、定位情况、插入时的血流动力学反应以及与该操作相关的其他并发症。
在人口统计学变量方面，两组相似。GEB组插入PLMA的平均时间为67.80秒，而IT组为46.79秒（P<0.05）。通过插管纤维镜评估，GEB组患者的定位更好，呼气末二氧化碳（ETCO2）值更低。收缩压和舒张压相似。IT组在12小时内咽痛、吞咽困难和声音嘶哑的发生率较高，但在24小时时相似。
与IT技术相比，使用GEB的引导插入技术耗时更长，但定位更好，ETCO₂值更低。
