Detection, frequency and prediction of problems in the use of the proseal laryngeal mask airway in children

Objectives: Our objective was to assess the use of several tests of ProSeal LMA (PLMA) position and function that had been previously published but not studied in the pediatric population in a wide variety of clinical cases. Background: The PLMA is widely used in pediatric anesthesia practice but complication rates have only been studied in small series while tests of function suggested for adults have not been studied at all. Methods: We prospectively collected data, after placement of the PLMA by the digital method, on depth of insertion (DOI), 'suprasternal notch' test, 'chest pressure test', leak pressure, maximum minute ventilation (MMV), resting minute ventilation (RMV), success rate of insertion and success rate of passage of a gastric tube. Perioperative complication rates were recorded. Results: A total of 222 cases were analyzed, 47 were laparoscopic or open abdomen, 15 nonsupine. Ages were 2 months to 20 years and weight 5.4-116 kg. Two hundred seven (91%) were placed successfully at first attempt and 100% at third attempt. One hundred fifty-four of 156 (99%) gastric tubes were placed successfully. Four patients had signs of inadequate ventilation. All of these had MMV/RMV ratios < 2. A total of nine had MMV/RMV ratio < 2. Eight had DOI score <= 2. Conclusions: The PLMA can be used in a large variety of cases with a high degree of success. Clinical tests described for adults, such as MMV/RMV ratio and DOI are also associated with complications in the pediatric population.