Prospective, randomized comparison of ProSeal(TM) and Classic(TM) laryngeal mask airways in anaesthetized neonates and infants

Background. When compared with the ClassicTM laryngeal mask airway (cLMA), the recently introduced ProSealTM laryngeal mask airway (PLMA) has modified features to produce higher airway seal pressures and enable ventilation in circumstances where the cLMA might fail. The first neonatal size 1 PLMA recently became available. This study was designed to compare the effectiveness of the size 1 cLMA and PLMA during positive pressure ventilation in anesthetized neonates and infants. Methods. Forty-six consecutive patients undergoing elective cardiac surgical procedures were randomized for initial airway management with the cLMA or PLMA. Insertion time (IT), number of placement attempts, ease of placement, quality of the initial airway, maximum tidal volume (TVmax), and airway pressure at which an audible leak in the mouth (Pleak) occurred were collected. All data were recorded before performing tracheal intubations. Results. IT and success rate were similar for both LMAs. The initial quality of the airway was significantly better for the PLMA (P,0.05). TVmax and Pleak were significantly higher for PLMA (77 vs 58 ml, P,0.02 and 29.8 vs 24.4 cm H2O, P,0.02). No adverse events were recorded during the study. Conclusions. The size 1 PLMA forms a more effective seal than size 1 cLMA in neonates. This might allow the PLMA to be used in those newborn infants requiring high airway press- ures for ventilation