COMPARISON OF THE LMA SUPREMETM WITH THE LMA PROSEALTM FORAIRWAY MANAGEMENT IN PATIENTS ANAESTHETIZED IN PRONEPOSITION

A. M. LO´PEZ*, R. VALERO, P. HURTADO, P. GAMBU´ S, M. PONS AND T. ANGLADA

Background

The laryngeal mask airway (LMA) has been successfully used in patients in the prone position either for rescue or elective airway management.

The reusable ProsealTM LMA (PLMA) and the single use SupremeTM 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.

Methods 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.

Results There were no differences between groups in

insertion time or first attempt success (100% vs 98%).

The PLMA required fewer manipulations (3% vs 15%; P¼0.02) to achieve effective ventilation and provided a higher seal pressure (mean [SD] 31 [4] vs 27 [4] cm H2O).

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.

Discussion Under the conditions of our study, both the PLMA

and SLMA were successfully inserted and provided each patient with an effective airway with low rate of complications, results that are in line with previous series reporting the feasibility of the PLMA14 or the SLMA17 18 in patients anaesthetized in prone position.

However, we found slight but significant differences in clinical performance between the two devices.

The PLMA required fewer adjustment manueuvres to achieve optimal ventilation and reached higher airway seal pressures than the SLMA.

Conclusions

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.