Abstract
Purpose
To analyze and summarize the published literature relating to the ProSeal LMA (PLMA): a modification of the ‘classic LMA’ (cLMA) with an esophageal drain tube (DT), designed to improve controlled ventilation, airway protection and diagnosis of misplacement.
Source
Articles identified through Medline and EMBASE searches using keywords ‘Proseal’, ‘ProSeal’ and ‘PLMA’. Hand searches of these articles and major anesthetic journals from January 1998 to March 2005.
Principal findings
Searches identified 59 randomized controlled trials or clinical studies and 79 other publications. Compared to the cLMA, PLMA insertion takes a few seconds longer. First attempt insertion success for the PLMA is lower, but overall success is equivalent. Airway seal is improved by 50%. The DT enables early diagnosis of mask misplacement, allows gastric drainage, reduces gastric inflation and may vent regurgitated stomach contents. Evidence suggests, but does not prove, that the correctly placed PLMA reduces aspiration risk compared with the cLMA. PLMA use is associated with less coughing and less hemodynamic disturbance than use of a tracheal tube (TT). Comparative trials of the PLMA with other supraglottic airways favour the PLMA. Clinicians have extended the use of the PLMA inside and outside the operating theatre including use for difficult airway management and airway rescue.
Conclusions
The PLMA has similar insertion characteristics and complications to other laryngeal masks. The DT enables rapid diagnosis of misplacement. The PLMA offers significant benefits over both the cLMA and TT in some clinical circumstances. These and clinical experience with the PLMA are discussed.
Résumé
Objectif
Analyser et résumer les publications sur le ML ProSeal (MLP): une modification du «ML classique» (MLc), muni ďun tube de drainage œsophagien (TD), conçu pour améliorer la ventilation contrôlée, la protection des voies aériennes et le diagnostic dďune malposition.
Source
Articles trouvés dans les bases Medline et EMBASE à partir des mots clés «Proseal», «ProSeal» et «PLMA». Des recherches manuelles de ces articles et des principaux journaux dďanesthésie publiés de janvier 1998 à mars 2005.
Constatations principales
Nos recherches ont permis de découvrir 59 essais contrôlés et randomisés ou études cliniques et 79 autres publications. Ľinsertion du MLP, comparée à celle du MLc, prend quelques secondes de plus. Le taux ďinsertion réussie au premier essai avec le MLP est plus faible, mais le taux global est équivalent. Ľétanchéité de ďintubation est améliorée de 50 %. Le TD permet le diagnostic précoce ďune malposition du masque, assure le drainage gastrique, réduit le gonflement gastrique et permet de dégager les régurgitations de ľestomac. Il y a des indices, non des preuves, que le MLP bien placé, comparé au MLc, réduise le risque ďaspiration. Ľusage du MLP est associé à moins de toux et de perturbations hémodynamiques que ľusage du tube endotrachéal (TE). Des essais comparatifs du MLP et ďautres canules oropharyngées favorisent le MLP. Les cliniciens ont étendu ľusage du MLP à ľintérieur et à ľextérieur de la salle ďopération, entre autres pour ľintubation difficile ou le contrôle urgent des voies respiratoires.
Conclusion
Le MLP présente des caractéristiques ďinsertion et des complications semblables à celles ďautres masques laryngés. Le TD permet le diagnostic rapide ďune malposition. Le MLP offre des avantages significatifs par rapport au MLc et au TE dans certains contextes cliniques.
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Cook, T.M., Lee, G. & Nolan, J.P. The proseal™laryngeal mask airway: a review of the literature. Can J Anesth 52, 739–760 (2005). https://doi.org/10.1007/BF03016565
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DOI: https://doi.org/10.1007/BF03016565