Comparison of the LMA Supreme™ with the LMA Proseal™ for airway management in patients anaesthetized in prone position

Background. The laryngeal mask airway (LMA) has been successfully used in patients in the prone position either for rescue or elective airway management. The reusable Proseal (TM) LMA (PLMA) and the single use Supreme (TM) LMA (SLMA) have been reported to be suitable for this purpose but few comparative data are available. In this study, we compared the clinical use of both devices in adult patients anaesthetized in the prone position. Methods. One hundred and twenty patients undergoing surgery in the prone position were randomized to receive either the PLMA or the SLMA for airway management. Patients positioned themselves in the prone position and after pre-oxygenation, anaesthesia was induced using a target-controlled i.v. infusion of propofol and remifentanil. All PLMAs and SLMAs were inserted by experienced anaesthetists using a guided and a standard technique respectively. Ease of facemask ventilation, time and number of attempts needed for insertion, quality of ventilation, airway seal pressure, fibreoptic view, and complications were compared. Results. There were no differences between groups in insertion time or first attempt success (100% vs 98%). The PLMA required fewer manipulations (3% vs 15%; P = 0.02) to achieve effective ventilation and provided a higher seal pressure (mean [SD] 31 [4] vs 27 [4] cm H(2)O; P<0.01). The fibrescopic view of the vocal cords was similar, although easier to achieve with the PLMA. The complication rate was low and similar between the groups. Blood was present on masks in 7% vs 8% and sore throat in 3% vs 5% of patients with the PLMA and SLMA, respectively. Conclusions. Airway management in patients anaesthetized in the prone position was efficient with both devices, although the PLMA required fewer manipulations and achieved a higher seal pressure.