Document Detail

Glottic insertion of the ProSeal LMA occurs in 6% of cases: a review of 627 patients.
MedLine Citation:
PMID:  15684263     Owner:  NLM     Status:  MEDLINE    
PURPOSE: Glottic insertion of the ProSeal Laryngeal Mask Airway (PLMA) has received little attention in the anesthesiology literature. We investigated the incidence and depth of insertion associated with this important cause for a failed insertion attempt with the PLMA. METHODS: With Institutional Review Board approval, we reviewed 15-months' use of the PLMA. Diagnosis of glottic insertion involved a test with children's bubble solution placed on the drain tube port, as well as a fibreoptic examination of the airway of patients experiencing airway obstruction. Patients were anesthetized and paralyzed and the PLMA was inserted deflated with the fingertip method (women size 4, men size 5). The cuff was inflated and a soap membrane established on the drain tube port. Glottic insertion was diagnosed by applying fingertip pressure to the patient's chest wall and observing pulmonary exhalation via the drain tube and bubble formation. The PLMA was then removed and reinserted without further assessment. For all patients, we used a fibrescope to determine the cause of unexplained airway obstruction after the PLMA was considered successfully inserted. RESULTS: There were 627 patients (391 women, 236 men). We diagnosed glottic insertion in 38/627 (6.1%) patients, 37 by the soap membrane test and one with airway obstruction and direct fibreoptic visualization of malposition. Following glottic insertion, successful reinsertion of the PLMA behind the larynx was always associated with greater depth of insertion by an average 2.0 cm. CONCLUSION: Glottic insertion can be easily and quickly diagnosed and our results suggest the incidence and importance of malposition are under-reported in the literature.
Cornelius J O'Connor; Michael S Stix; Dennis R Valade
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Canadian journal of anaesthesia = Journal canadien d'anesthésie     Volume:  52     ISSN:  0832-610X     ISO Abbreviation:  Can J Anaesth     Publication Date:  2005 Feb 
Date Detail:
Created Date:  2005-02-01     Completed Date:  2005-06-24     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  8701709     Medline TA:  Can J Anaesth     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  199-204     Citation Subset:  IM    
Department of Anesthesiology, Lahey Clinic, 41 Mall Road, Burlington, MA 01805, USA.
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MeSH Terms
Aged, 80 and over
Airway Obstruction / etiology*
Anesthesia, Inhalation
Fiber Optic Technology
Glottis / injuries*
Laryngeal Masks / adverse effects*
Membranes, Artificial
Middle Aged
Retrospective Studies
Treatment Failure
Reg. No./Substance:
0/Membranes, Artificial; 0/Soaps
Comment In:
Can J Anaesth. 2005 Oct;52(8):885-6; author reply 886   [PMID:  16189346 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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