Analysis of 1000 consecutive uses of the ProSeal laryngeal mask Airway™ by one anaesthetist at a district general hospitals

Background. The ProSeal laryngeal mask airway (PLMA), introduced to UK practice in late 2001, offers potential performance and safety benefits over other airways such as the classic laryngeal mask airway. There are no large series reporting its use. Methods. Data from a prospective, consecutive series of 1000 size 3-5 PLMA uses, by one anaesthetist, were analysed to examine whether performance in routine and advanced practice is similar to that reported in formal trials. Results. Patients were female in 52% of cases, median age 52 (range 8-101) yr, median weight 78 kg (10% over 100 kg, 24% over 90 kg). Procedures included 12% laparoscopic and 5% open abdominal surgery. Overall insertion success was 99.4%, (first and second attempt success 85% and 12%, respectively). Median insertion time was 12 s (93% < 30 s). Insertion success did not differ between genders, or between mask sizes. Median airway seal was 32 cm H2O (range 8-40, 94% seal > 20 cm H2O). Specific tests confirmed correct positioning in 98.5% of cases. Of six failures, two occurred during management of difficult airways. Minor airway obstruction occurred in 2.7%. Blood was visible on 8% of removed PLMAs and more commonly after more than one insertion attempt (38 vs 4.7%, X-2 p < 0.0001). In three cases minor regurgitation without aspiration occurred. Conclusions. In the hands of a regular user, the PLMA was associated with a high rate of insertion success during routine and advanced use in relatively unselected patients. Correct placement rates approached 100%. The incidence of complications was low.