Efficacy and Safety Performance of ProsealTM Laryngeal Mask Airway in Laparoscopic Surgery: Experience of 1000 Cases

The ProSeal TM laryngeal mask airway (PLMA) has been especially designed for positive pressure ventilation and protection against aspiration. We tested the efficacy and safety of the PLMA as a ventilatory device for a variety of commonly performed laparoscopic surgeries. The PLMA was used for the airway management of one thousand; consecutive anaesthetized, paralysed patients, aged 13-86 years belonging to ASA physical status I-III scheduled for elective laparoscopic and extraperitoneal endoscopic surgeries. Details of insertion, oropharyngeal seal pressure (OSP), ventilatory performance and safety data of the PLMA were recorded. During surgery, oxygenation and ventilation variables were adjusted to maintain SpO2 > 95 %, as measured by pulse oximetry and EtCO2 < 46 mm Hg, respectively. The success rate of PLMA insertion and gastric tube placement was 100 %. One patient had short lived SpO2 of 94 % while three patients showed transient increase in EtCO2 > 55 mm Hg. Twenty five (2.5%) patients showed gastric regurgitation, suctioned through the oesophageal channel of the PLMA, but no case of pulmonary aspiration was detected. Median OSP was 36 cm H2 O. The median peak inspiratory pressure (PIP) before and after CO2 - insufflation were 10 and 18 cm H2 O, respectively (P < 0.001). Our study demonstrated that the PLMA, in experienced hands, is an efficient and safe airway tool for the airway management of patients undergoing elective laparoscopic surgery.