The Proseal™ laryngeal mask airway and the transesophageal Doppler probe: the TED-PLMA Technique

Abstract

To the Editor, We read with great interest the article by Hwang et al. about the use of the McIvor blade to improve insertion of the Proseal laryngeal mask airway (PLMA) in children. We suggest that complementary information on other devices used together with the PLMA may help readers in clinical practice. In our institution, we have extensive experience in the insertion of supraglottic airway devices in pediatric patients. It is well known that the PLMA has a higher oropharyngeal leak pressure compared with the Classic laryngeal mask airway, and this relatively high PLMA leak pressure can be useful clinically. We completed a study using a PLMA and an esophageal Doppler probe concurrently in 102 pediatric patients aged four months to eight years. The children underwent genitourinary and abdominal surgery under general anesthesia with or without caudal or epidural block. The preliminary results of this study have since been published. It is important to point out that the probe is placed immediately after PLMA insertion, and it is advanced under the dorsal cuff, not through the drainage gastric port. The measured oropharyngeal leak pressures were 23 (7) cm H20 with the PLMA cuff inflated to 60 cm H20. No gas leak was registered with adequate volumeor pressurecontrolled ventilation (end-tidal CO2 was 4.6-5.8 kPa in all children). Uda et al. reported a negative experience when they advanced a probe with the PLMA, but probe insertion was done through the drainage port, hence our technique is different and unique. The concurrent use of both a PLMA and an esophageal Doppler probe has become routine in our pediatric clinical practice, allowing us to ventilate and measure hemodynamic parameters without having to intubate the trachea. This technique is possible owing to the higher leak pressure of the PLMA. We decided to name our technique ‘‘TEDPLMA’’ (TransEsophageal Doppler Proseal Laryngeal Mask Airway).