Abstract
Purpose
Glottic insertion of the ProSealTM 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.
Résumé
Objectif
L’insertion glottique du masque laryngé ProSealTM (MLP) a reçu peu d’attention dans les publications sur l’anesthésiologie. Nous avons vérifié l’incidence et la profondeur de l’insertion associée à cette importante cause d’échec de l’insertion du MLP.
Méthode
Avec l’accord du Comité d’examen de l’institution, nous avons passé en revue l’utilisation du MLP sur 15 mois. Le diagnostic d’insertion glottique relève d’un test réalisé avec du savon à bulles pour les enfants placé sur l’ouverture du tube de drainage et d’un examen fibroscopique des voies aériennes obstruées. Les patients ont été anesthésiés et paralysés et un MLP dégonflé a été inséré avec le bout des doigts (femmes: taille 4, hommes: taille 5). Le ballonnet gonflé, une pellicule savonneuse a été créée sur l’ouverture du tube de drainage. L’insertion glottique a été diagnostiquée en pressant la paroi thoracique du patient du bout des doigts et en observant l’expiration pulmonaire par le tube de drainage et la formation de bulles. Ensuite, le MLP a été retiré et réinséré sans évaluation supplémentaire. Chez tous les patients, l’usage d’un fibroscope nous a permis de définir la cause de l’obstruction non expliquée des voies aériennes après que l’insertion du MLP a été considérée comme réussie.
Résultats
Il y avait 627 patients (391 femmes, 236 hommes). Une insertion glottique a été diagnostiquée chez 38/627 (6,1 %) patients, 37 par le test de la pellicule savonneuse et une par l’obstruction des voies aériennes et la visualisation fibroscopique directe de la mauvaise position. Après l’insertion glottique, la réinsertion réussie du MLP derrière le larynx était toujours associée à une insertion plus profonde selon une moyenne de 2,0 cm.
Conclusion
L’insertion glottique peut être facilement et rapidement diagnostiquée et l’incidence et l’importance d’une malposition sont peu diffusées.
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O’Connor, C.J., Stix, M.S. & Valade, D.R. Glottic insertion of the ProSealTM LMA occurs in 6% of cases: A review of 627 patients. Can J Anaesth 52, 199–204 (2005). https://doi.org/10.1007/BF03027729
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DOI: https://doi.org/10.1007/BF03027729