Size 1 ProSeal??? Laryngeal Mask Airway in Neonates

Abstract

To the Editor: As anesthesiologists who assess neonatal airways, both for resuscitation and anesthesia, we are involved in evaluating the safety and efficacy of devices for airway control (1). Goldmann et al. (2) states that the ProSeal Laryngeal Mask Airway (PLMA) size 1½ facilitates gastric tube placement in infants and forms a more effective seal than the same size Classic LMA (cLMA), allowing higher peak airway pressure during positive pressure ventilation (PPV). In previous articles, Goldmann et al., (3,4) Lopez-Gil et al., (5,6) and Wheeler (7) assess pediatric PLMA sizes (1½, 2, and 2½) with similar conclusions. Although the results with the size 1½ PLMA were encouraging for patients weighing 5–6 kg or more, Goldmann et al. found that the 1½ PLMA is too large for neonates. In a manikin-based comparative study, we recently tested the neonatal size 1 PLMA and size 1 cLMA (8). With IRB approval, we recently summarized our clinical experience in seven neonates who required PPV at birth, in whom we used the size 1 PLMA (Table 1). Their median (range) weight was 3.455 g (2.210–4.190 g), and their median gestational age was 39 wk (35–40). In all cases, a PLMA size 1 was easily inserted on the first attempt. Because the introducer strap is small and the absence of an integral bite-block renders the device very flexible, we could not position the device using the fingertip technique which we traditionally used with adult-sized PLMAs. Instead, we used the specific introducer provided by the manufacturer. We inflated the PLMA cuff and connected the device to a self-inflating bag, allowing effective PPV. We recorded the time elapsed from insertion of the PLMA into the newborn's mouth to the first inflation of the infants' lungs. We successfully placed an 8 or 10F gastric tube in all cases. Pulmonary auscultation and chest movement demonstrated good bilateral ventilation in all cases. Stethoscopic auscultation of the neck, just lateral to the thyroid cartilage, revealed only a single case with an audible leak, which did not compromise ventilation. We removed the PLMA when the neonate no longer tolerated it.Table 1: Performances of the Size 1 ProSeal™ Laryngeal Mask Airway in NeonatesThese are the first experiences with the size 1 PLMA. More data are needed, but these clinical impressions are encouraging. Further research will establish whether a size 1 PLMA will be useful for neonates who need high airway pressures for ventilation, which cannot be reliably achieved with the cLMA. Massimo Micaglio, MD Matteo Parotto, MD Department of Pharmacology and Anesthesiology [email protected] Daniele Trevisanuto, MD Vincenzo Zanardo, MD Department of Pediatrics University of Padova Padova, Italy