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• W1978740076 abstract "The LMA ProSeal® laryngeal mask airway (PLMA, Intavent Orthofix, Maidenhead, UK) was introduced into UK practice in 2001. The design features are expected to improve efficacy of ventilation, separate the respiratory and gastro-intestinal tracts and allow diagnosis of misplacement of the device [1]. We have examined the effect of the introduction of the PLMA into practice in a district general hospital on anaesthetic airway management. The PLMA was introduced to our hospital in January 2002. We interrogated our theatre database (Operating Room Scheduling and Office System (ORSOS, Per-se Technologies Inc., GA, USA) to determine the method of airway management for all general anaesthesia cases between 2002 and 2006. Cases managed by facemask were excluded. Approximately 12–14 000 general anaesthesia cases were undertaken each year. PLMA use increased from 0.4% (48/12 713) in 2002 to 11.1% (1598/14 299) in 2006. The use of a tracheal tube remained relatively constant, changing from 32.6% (4148/12 713) in 2002 to 31.0% (4428/14 299) in 2006. Use of the LMA Classic® laryngeal mask airway (cLMA, Intavent Orthofix) declined from 60.4% (7685/12 713) to 55.6% (7949/14 299) (Fig. 1). In the emergency theatre, approximately 1800 general anaesthesia cases were performed annually. Tracheal intubation varied between 68% and 72% between 2002 and 2006 with no obvious trend: the number of intubations exceeded 1200 each year. The use of the PLMA rose from 0.3% to 5.2% and use of the cLMA fell from 29% to 26% (Fig. 2). Percentage of all general anaesthesia cases each year managed with the LMA Classic, the LMA Proseal, or a tracheal tube. Percentage of emergency general anaesthesia cases each year managed with the LMA Classic, LMA Proseal, or a tracheal tube. The introduction of the cLMA was previously reported as causing a decline in the number of tracheal intubations performed, particularly during ‘daytime’ hours, with potential effects on anaesthetic training [2]. In this hospital, the introduction of the PLMA has not exacerbated this decline: over 5 years the number of tracheal intubations has shown little change. Of note, more than 4400 intubations take place in the hospital per year: (potentially ∼ 200 intubations per trainee). However, use of the cLMA has declined. We conclude that the PLMA is usually being used in preference to the cLMA for selected patients, most likely where some protection against regurgitation or higher airway seal pressures are considered to be indicated. In the emergency theatre, use of both cLMA and tracheal tube has fallen slightly. Although this might slightly reduce the number of tracheal intubations available to trainees, it is unlikely to reduce the number of ‘rapid sequence inductions’, as these cases would not be suitable for management with the PLMA. We interpret our data as suggesting the PLMA is generally being used as a refinement of the cLMA, rather than as a substitute for the tracheal tube. The use of the PLMA offers clear advantages over the cLMA in certain situations. The PLMA has added another ‘string to the bow’ of anaesthetists' airway management skills. The widespread availability of the device and its regular use has ensured trainees and consultants are both confident and competent in its use. Use of the PLMA is one of the recommendations in the Difficult Airway Society guidelines for management of failed intubation at rapid sequence induction [3]; during the 5 years that the PLMA has been available in our hospital it has been used for both airway rescue and in several difficult airway settings [4–10]. Most trainees leave here enthusiastic about its utility. It is likely that our hospital is not typical of many hospitals as our PLMA usage is higher than most. Despite this, our data suggest that widespread introduction of the PLMA, while increasing the spectrum of airway management possibilities, need not impact on opportunities for training in tracheal intubation. Dr Cook has been paid by Intavent Orthofix and the LMA Company, both of which manufacture laryngeal masks, for lecturing. Neither company had any involvement in this letter." @default.
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• W1978740076 date "2007-07-13" @default.
• W1978740076 modified "2023-09-26" @default.
• W1978740076 title "Introducing the ProSeal™laryngeal mask airway need not prevent training in tracheal intubation" @default.
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• W1978740076 doi "https://doi.org/10.1111/j.1365-2044.2007.05209.x" @default.
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