Performance of the PAXpress™ vs the ProSeal™ laryngeal mask airway during general anesthesia

Purpose: The PA(X)press (TM) (PA(x)(TM)) is a relatively new pharyngeal airway device that is easily inserted and effective in routine airway management. A prospective, randomized study was undertaken to compare the PA(X)(TM) with the ProSeal (TM) laryngeal mask airway (PLMA (TM)) during anesthesia with positive pressure ventilation. Methods: One hundred adult patients scheduled for elective surgery under general anesthesia were randomized to airway management with either the PA(X)(TM) (n = 50) or the PLMA (TM) (n = 50). All patients swallowed a methylene blue capsule before anesthesia. After insertion, leak and inspiratory pressures were measured. Fibrescopy was used to view the glottis. Devices were inspected for blood or methylene blue staining upon removal at the end of surgery. An interview was conducted postoperatively to evaluate the occurrence of sore throat, dysphagia and dysphonia. Results: Insertion time was longer for the PAx (TM) than for the PLMA (TM) (52 +/- 44s vs 34 +/- 23 sec; P = 0.003). Leak pressure was lower while peak inspiratory pressures, and EtCO2 values were higher (P = 0.016; 0.027 and 0.04 respectively) with the PAx (TM). Both devices provided comparable fibreoptic viewing of the glottis. There were no differences with respect to the incidence or pattern of blue stains upon removal. Blood was seen more often on the PAx (TM) (58% vs 19%) and clysphagia was also more frequent and severe with the PAx (TM). Conclusion: In comparison with the PLMA (TM), PA(X)(TM) inser tion time is longer and the ventilatory characteristics of this new device may be marginally inferior. The PA(X)(TM) is also more traumatic and is associated with more postoperative discomfort compared to the PLMA (TM).