Ease Of Gastric Tube Placement Research Articles

Comparison of videolaryngoscope-guided versus standard digital insertion techniques of the ProSeal\u2122 laryngeal mask airway: a prospective randomized study

BackgroundThis study were designed to investigate the usefulness of the videolaryngoscope-guided insertion technique compared with the standard digital technique for the insertion success rate and insertion conditions of the Proseal™ laryngeal mask airway (PLMA).MethodsProspective, one hundred and nineteen patients (ASA I–II, aged 18–65 yr) were randomly divided for PLMA insertion using the videolaryngoscope-guided technique or the standard digital technique. The PLMA was inserted according to the manufacturer’s instructions in the standard digital technique group. The videolaryngoscope-guided technique was performed a C-MAC® videolaryngoscope with D-Blade, under gentle videolaryngoscope guidance, the epiglottis was lifted, and the PLMA was advanced until the tip of the distal cuff reached the oesophagus inlet. The number of insertion attempts, insertion time, oropharyngeal leak pressure, leak volume, fiberoptic bronchoscopic view, peak inspiratory pressure, ease of gastric tube placement, hemodynamic changes, visible blood on PLMA and postoperative airway morbidity were recorded.ResultsThe first-attempt success rate (the primary outcome) was higher in the videolaryngoscope-guided technique than in the standard digital technique (p = 0.029). The effect size values with 95% confidence interval were 0.19 (0.01–0.36) for the first and second attempts, 0.09 (− 0.08–0.27) for the first and third attempts, and not computed for the second and third attempts by the groups, respectively.ConclusionVideolaryngoscope-guided insertion technique can be a help in case of difficult positioning of a PLMA and can improve the PLMA performance in some conditions. We suggest that the videolaryngoscope-guided technique may be a useful technique if the digital technique fails.Trial registrationClinicalTrials.gov NCT03852589 date of registration: February 22th 2019.

A prospective, randomized comparison of the LMA-protector\u2122 and i-gel\u2122 in paralyzed, anesthetized patients

BackgroundIn the present study, we compare the LMA-Protector™ and the i-gel™ in terms of adequacy of the airway seal, insertion time, ease and accuracy of insertion, and the incidence of postoperative sore throat.MethodsIn 110 anesthetized and paralyzed adult patients, the i-gel™ (n = 55) or the LMA-Protector™ (n = 55) was inserted. The primary outcome was airway leak pressure. The secondary outcomes included the first-attempt success rate, insertion time, ease and accuracy of the device insertion, ease of gastric tube placement, blood staining on the device after removal, and incidence and severity of postoperative sore throat.ResultsThe airway leak pressure was higher with the LMA-Protector™ than with the i-gel™ (31 [7] cmH2O vs. 27 [6] cmH2O, respectively; P = 0.016). Insertion time was longer with the LMA-Protector™ than with the i-gel™ (27 [16] sec vs. 19 [16] sec, respectively, P < 0.001), but ease of insertion and the first-attempt success rate were not different between the two groups. The LMA-Protector™ provided a worse fiberoptic view of the vocal cords and more difficult gastric tube insertion than the i-gel™ (both P < 0.001). Blood staining on the device was more frequent with the LMA-Protector™ than with the i-gel™ (P = 0.033). The incidence and severity of postoperative sore throat were not different between the two groups.ConclusionThe LMA-Protector™ provided a better airway sealing effect than the i-gel™. However, it required a longer insertion time, provided a worse fiberoptic view of the vocal cords, and caused more mucosal injury compared to the i-gel™.Trial registrationClinicalTrials.gov (NCT03078517). Registered prior to patient enrollment, Date of registration: Mar 13, 2017.

Comparison of Clinical Performance of Supraglottic Airway Devices I– gel vs LMA-Proseal in Paediatric Elective Surgeries

Comparison of Clinical Performance of Supraglottic Airway Devices I– gel vs LMA-Proseal in Paediatric Elective Surgeries

Comparison of i-gel with LMA ProSeal for ease of insertion in adultanaesthetised paralysed patients: a prospective randomized trial

Background: i-gel,a recently developed non-inflatable supraglottic airway device, a suitable better alternative to cuffed inflatable suprglottic airway device like LMA ProSeal.Aim and objectives: This study aimed to compare the ease of insertion to achieve early successful airway between LMA ProSeal and i-gel. The secondary objectives were to compare hemodynamic parameters and any airway complications.Materials and methods: This prospective randomized study done in fifty (n=25, each group) ASA I and II adult patients, aged between 20 and 65 years of either sex scheduled for elective surgeries. Patients airway was secured with appropriate size eitherLMA ProSeal or i-gel. The time taken for successful insertion, number of attempts and ease ofgastric tube placement were recorded. Hemodynamic parameters at basal (pre operative), 1, 3 & 5 minutes after insertion were recorded. Blood stain of device and any postoperative airway complications were noted.Results: Time taken for successful insertion was significantly less in i-gel group [Group 1(LMA ProSeal) 20.56±2.00, Group 2 (i-gel) 12.08±1.53, p=0.001*]. Time taken for gastric tube placement was significantly less in i-gel group [Group 1(LMA ProSeal) 31.96±4.58, Group 2 (i-gel) 21.48±2.55, p=0.001*]. Among hemodynamic parameters, heart rate immediately after insertion of device was stable in i-gel group. The numbers of insertion attempts were also less with i-gel group.Conclusion: In our study, ease ofinsertion with less number of attempts was observed with i-gel group.So i-gel found to be the better alternative to LMA ProSeal.

Comparison of clinical performance of I-Gel with LMA-Proseal in elective surgeries under general anesthesia

Aim: To compare insertion characteristics of two different supraglottic devices [I-gel and LMA-Proseal] and to observe any associated complications. Materials and Methods: This prospective, randomized study was conducted in 60 patients [Group A- LMAProseal (n = 30) and Group B - I-Gel (n =30)] of ASA grades I/II, of either sex in the age group 18-60 years. Both groups were compared with respect to haemodynamic response to device insertion, success rate of insertion, time taken for insertion, ease of gastric tube placement, airway trauma by post operative blood staining of the device, tongue, lip and dental trauma and 24 hours after surgery we watched for sore throat, hoarseness and dysphonia. Result: Haemodynamic response to device insertion were comparable in both the groups (p >0.05). Mean insertion time for the I-gel (11.47 ± 1.914 sec) was significantly lower than that of the PLMA (13.53 ± 3.92 sec) (P = 0.0002). I-gel was easier to insert with a better anatomic fit. The success rate at first attempt of insertion were 29/30 (96.67%) for I-gel & 28/30 (93.3%) for LMA - ProSeal (P=0.0002). Ease of gastric tube insertion was significantly higher in I-gel group (P = 0.116). Blood staining of the device, trauma (tongue, lip and dental) and 24 hrs complications after surgery were more with Group A. Conclusion: I-Gel is better than LMA-Proseal in terms of faster insertion and ease of insertion with a low incidence of pharyngolaryngeal morbidity

Comparative study between LMA-Proseal™ and Air-Q® Blocker for ventilation in adult eye trauma patients

BackgroundThe disposable Air-Q® Blocker Masked Laryngeal Airway (MLA) is a new supraglottic device used for intubation, rescue ventilation, and for esophageal suctioning. Laryngeal Mask Airway-Proseal™ is a well known supraglottic device in clinical practice. The aim of the study was to compare Air-Q® Blocker against LMA-Proseal™ as supraglottic devices for ventilation.MethodsSixty adult healthy patients scheduled for eye trauma surgeries under general anesthesia were randomly allocated into 2 groups; Group A (n = 30), where Air-Q® Blocker is used, Group P (n = 30), where LMA-Proseal™ is used. The success rate and time of their insertion were measured. Laryngeal view grading was assessed by fiberoptic bronchoscope. Ease of gastric tube placement and any post-operative complications (airway edema, sore throat or hoarseness) were also measured. Stress response of device insertion was measured using the vital sign measurements.ResultsSuccess of insertion at 1st attempt was (90%) in Group A and (83.3%) in Group P. Insertion time was 18.37 ± 3.77 s in Group (A), while 23.43 ± 3.54 s in Group P, (p < 0.001). Airway seal pressure was comparable in both groups. Full view of vocal cords amounted to (76.7%) in Group A, and (56.7%) in Group P respectively. 1st Attempt Gastric Tube Insertion was (93.3%) in Group A, and (83.3%) in Group P. comparison of previous data in both groups showed no statistical significant differences between them. The incidence of postoperative complications and post insertion hemodynamic stress response was statistically nonsignificant when compared between the 2 groups.ConclusionThe Air-Q® Blocker demonstrated to be remarkably good as a ventilatory device, with adequate airway seal pressure, and improved facilitation of gastric tube insertion compared to LMA-Proseal™. Minimal pressor response was achieved after insertion with no statistical significance.

English

Pro Seal laryngeal mask airway (PLMA) is a new development among supraglottic airway management devices. The modified cuff and drain tube in PLMA makes it a better device over classic Laryngeal mask airway (LMA). This retrospective study was done to know the effectiveness of PLMA in gastrointestinal surgeries. Thirty adult patients of ASA I, II or III who underwent gastrointestinal surgery under general anesthesia with PLMA were reviewed. The following parameters were reviewed: hemodynamic response, ventilatory parameters, ease of gastric tube placement and adverse effects. PLMA was inserted in the first attempt in 28 out of 30 patients. The change in heart rate was 4.9%; mean increase in systolic and diastolic blood pressure after insertion of PLMA was 2% and 1.49% respectively. 100% success was achieved in Ryle’s tube insertion. These parameters are comparatively low when compared with previous studies. This shows PLMA is a less invasive alternative to traditional endotracheal intubation.

Comparison of Size 2 LMA-ProSeal™ and LMA-Supreme™ in Spontaneously Breathing Children: a Randomised Clinical Trial.

The aim of this study was to compare size 2 Laryngeal Mask Airway ProSeal and size 2 Laryngeal Mask Airway Supreme in spontaneously breathing children undergoing lower abdominal elective surgery of <1 hour duration. Randomized clinical trial. Sixty children aged 1-7 years, weighing 10-20 kg, ASA I physical status were randomly allocated to the Laryngeal Mask Airway ProSeal and Laryngeal Mask Airway Supreme. There were no differences in demographic variables, ease of gastric tube placement, ease of insertion and ventilation, number of insertion attempts, hemodynamic changes on insertion, postoperative complications and bloodstaining between the groups. Gastric insufflation was detected and gastric tube was placed in all patients except one in LMA Supreme. Postoperative cuff volumes were comparable with the preoperative values in group itself. Oropharyngeal leak pressures were higher in Laryngeal Mask Airway ProSeal (24.6±5.5 vs 21.3±4.2, respectively; p<0.01). As a result Laryngeal Mask Airway ProSeal and Laryngeal Mask Airway Supreme can safely be used in spontaneously breathing pediatric population undergoing lower abdominal elective surgery.

Comparison of clinical performance of the I-gel with LMA proseal

Aim:To compare insertion characteristics of 2 different supraglottic devices [I-gel and Proseal laryngeal mask airway (PLMA)] and to observe any associated complications.Study Design:This prospective, randomized study was conducted in 80 patients [Group I - I-gel insertion (n = 40) and Group P - LMA Proseal insertion (n =40)] of ASA grades I/II, of either sex in the age group 18-65 years. Both groups were compared with respect to ease of insertion, insertion attempts, fiberoptic assessment, airway sealing pressure, ease of gastric tube placement, and other complications.Materials and Methods:All patients were asked to fast overnight. Patients were given alprazolam 0.25 mg orally at 10 p.m. the night before surgery and again 2 hours prior to surgery with 1-2 sips of water. Glycopyrrolate 0.2 mg, metoclopramide 10 mg, and ranitidine 50 mg were administered intravenously to the patients 45 minutes prior to the surgery. Once adequate depth of anesthesia was achieved either of the 2 devices, selected using a random computerized table, was inserted by an experienced anesthesiologist. In group I, I-gel was inserted and in patients of group P, PLMA was inserted.Statistical Analysis:Student t-test and Mann-Whitney test were employed to compare the means; for categorical variables, Chi-square test was used.Result:Mean insertion time for the I-gel (11.12 ± 1.814 sec) was significantly lower than that of the PLMA (15.13 ± 2.91 sec) (P = 0.001). I-gel was easier to insert with a better anatomic fit. Mean airway sealing pressure in the PLMA group (29.55 ± 3.53 cm H2O) was significantly higher than in the I-gel group (26.73 ± 2.52 cm H2O; P = 0.001). Ease of gastric tube insertion was significantly higher in the I-gel group (P = 0.001). Incidence of blood staining of the device, sore throat and dysphagia were observed more in PLMA group. No other complications were observed in either of the groups.

A randomized equivalence trial comparing the i‐gel and laryngeal mask airway Supreme in children

The laryngeal mask airway Supreme (Supreme) is a new single-use supraglottic device with gastric access capability now available in all sizes for children. To compare the i-gel with the Supreme in children for routine airway maintenance. One hundred and seventy children, aged 3 months to 11 years, 5-50 kg in weight, were randomly assigned to receive either the i-gel or the Supreme. The primary outcome measured was airway leak pressure. Secondary outcomes included the following: ease and time for insertion, insertion success rate, fiberoptic grade of view, ease of gastric tube placement, number of airway manipulations, quality of airway during anesthetic maintenance, and complications. A total of 168 patients were assessed for the outcomes. The median (IQR [range]) airway leak pressure for the i-gel was higher than with the Supreme, 20 (18-25 [9-40]) cm H(2)O vs 17 (14-22 [10-40]) cm H(2)O, respectively (P = 0.001). There were no differences in the time for device insertion, fiberoptic grade of view, quality of airway, and complications. Median (IQR[range]) time of successful insertion of a gastric tube was faster with the Supreme, 12 (9.2-14.3 [5.2-44.2]) s than with the i-gel, 14 (11.9-19 [6.9-75]) s; P = 0.01. The number of airway manipulations during placement was higher with the i-gel than with the laryngeal mask airway Supreme (12 vs 13 patients), P = 0.02. In infants and children, when a single-use supraglottic device with gastric access capabilities is required, the i-gel demonstrated higher airway leak pressures and can be a useful alternative to the Supreme.

A randomised comparison of the LMA Supreme™ and LMA ProSeal™ in children

We conducted a randomised trial comparing the size-2 LMA Supreme™ with the LMA ProSeal™ in 60 children undergoing surgery. The outcomes measured were airway leak pressure, ease and time for insertion, fibreoptic examination, incidence of gastric insufflation, ease of gastric tube placement, quality of the airway during anaesthetic maintenance and complications. There were no statistically significant differences between the LMA Supreme and LMA ProSeal in median (IQR [range]) insertion time (12 (10-15 [7-18]) s vs 12 (10-13 [8-25]) s; p = 0.90), airway leak pressures (19 (16-21 [12-30]) cmH(2) O vs 18 (16-24 [10-34]) cmH(2) O; p = 0.55), fibreoptic position of the airway or drain tube, ease of gastric access and complications. Both devices provided effective ventilation requiring minimal airway manipulation. The LMA Supreme can be a useful alternative to the LMA ProSeal when single-use supraglottic devices with gastric access capabilities are required.

A randomised trial comparing the laryngeal mask airway Supreme™ with the laryngeal mask airway Unique™ in children*

We conducted a randomised controlled trial comparing the laryngeal mask airway Supreme(™) with the laryngeal mask airway Unique(™) in children. Fifty children presenting for elective surgery were randomly assigned to receive either the laryngeal mask airway Supreme or laryngeal mask airway Unique. The outcomes measured were airway leak pressure, ease and time for insertion, insertion success rate, fibreoptic examination, incidence of gastric insufflation, ease of gastric tube placement through the laryngeal mask airway Supreme, quality of airway during anaesthetic maintenance and complications. Median (IQR [range]) time to successful device placement was shorter with the laryngeal mask airway Unique, 14.5 [13.5-16.3 (10.0-23.6)] s than with the laryngeal mask airway Supreme, 17.4 [14.8-19.8 (11.5-29.2)] s; p = 0.007. Median (IQR [range]) airway leak pressures for the laryngeal mask airway Supreme and laryngeal mask airway Unique were 20 [16-21 (12-22)] cmH(2)O and 15 [14-18 (10-24)] cmH(2)O, respectively (p = 0.001). The incidence of gastric insufflation was lower with the laryngeal mask airway Supreme (zero vs six patients), p = 0.01. In conclusion, the laryngeal mask airway Supreme performed as well as the laryngeal mask airway Unique and is a useful alternative for airway maintenance, particularly in children who require evacuation of gastric contents during anaesthesia.

The Laryngeal Mask Airway SupremeTM– a single use laryngeal mask airway with an oesophageal vent. A randomised, cross‐over study with the Laryngeal Mask Airway ProSealTM in paralysed, anaesthetised patients

The LMA Supreme is a new extraglottic airway device which brings together features of the LMA ProSeal, Fastrach and Unique. We test the hypothesis that ease of insertion, oropharyngeal leak pressure, fibreoptic position and ease of gastric tube placement differ between the LMA ProSeal and the LMA Supreme in paralysed anesthetised patients. Ninety-three females aged 19-71 years were studied. Both devices were inserted into each patient in random order. Two attempts were allowed. Digital insertion was used for the first attempt and guided insertion for the second attempt. Oropharyngeal leak pressure and fibreoptic position were determined during cuff inflation from 0 to 40 ml in 10 ml increments. Gastric tube insertion was attempted if there was no gas leak from the drain tube. First attempt and overall insertion success were similar (LMA ProSeal, 92% and 100%; LMA Supreme 95% and 100%). Guided insertion was always successful following failed digital insertion. Oropharyngeal leak pressure was 4-8 ml higher for the LMA ProSeal over the inflation range (p < 0.001). Intracuff pressure was 16-35 cm higher for the LMA ProSeal when the cuff volume was 20-40 ml (p < 0.001). There was an increase in oropharyngeal leak pressure with increasing cuff volume from 10 to 30 ml for both devices, but no change from 0 to 10 ml and 30-40 ml. There were no differences in the fibreoptic position of the airway or drain tube. The first attempt and overall insertion success for the gastric tube was similar (LMA ProSeal 91% and 100%; LMA Supreme 92% and 100%). We conclude that ease of insertion, gastric tube placement and fibreoptic position are similar for the LMA ProSeal and LMA Supreme in paralysed, anaesthetised females, but oropharyngeal leak pressure and intracuff pressure are higher for the LMA ProSeal.

The Proseal™ laryngeal mask airway in children: a comparison between two insertion techniques

The Proseal laryngeal mask airway (PLMA) is a relatively new supraglottic airway device with a drain tube to minimize the risk of gastric insufflation and aspiration. We compared introducer tool (IT) and gum elastic bougie (GEB)-guided techniques for insertion of the Proseal LMA in children. One hundred and twenty-four children aged 1-12 years, weight 8-29 kg, ASA I-II, undergoing peripheral surgery were studied. Patients were randomly divided into either IT group (n = 64) or GEB group (n = 60). Following a standardized anesthesia protocol, the IT technique was performed according to the manufacturer's instruction. The GEB-guided technique involved priming the drain tube with a GEB, placing the distal end of the GEB into the esophagus under gentle laryngoscopy and railroading the Proseal LMA into position. All insertions of Proseal LMA were performed by two experienced investigators. Data were collected regarding rate of successful insertion, incidence of oral, gastric and drain tube air leak, ease of gastric tube placement and frequency of airway-related complications. Insertion was equally successful at the first attempt (IT 96.9%, GEB 95.0%) in both groups. Efficacy of seal was better in the GEB group (oral leak, IT 35.9%, GEB 18.3%, P < 0.05; gastric leak, IT 21.9%, GEB 5.0%, P < 0.05; drain tube leak, IT 7.8%, GEB 0%, P < 0.05). Position of Proseal LMA in relation to the glottis was better in the IT group (grade I, IT 0%, GEB 11.7%; grade II, IT 29.7%, GEB 23.3%; grade III, IT 28.1%, GEB 25.0%; grade IV, IT 42.2%, GEB 40.0%; P < 0.05). Gastric tube placement was equally successful (IT 100%, GEB 100%) and frequency of airway-related problems was similar for both groups (IT 3.2%, GEB 6.1%). A gum elastic bougie-guided insertion technique in children is comparable with the IT technique in terms of success rate and may be useful as a backup technique when the IT technique fails.

Bougie-guided insertion of the ProSeal™ laryngeal mask airway has higher first attempt success rate than the digital technique in children

We tested the hypothesis that bougie-guided insertion of the ProSeal laryngeal mask airway (ProSeal LMA) has higher success rate than the digital technique in children. One hundred and twenty children (ASA I-II, aged 1-16 yr) were randomly allocated for ProSeal LMA insertion using the digital or bougie-guided technique. The digital technique was performed according to the manufacturer's instructions. The bougie-guided technique involved priming the drain tube with a bougie, placing the bougie in the oesophagus under direct vision and railroading the ProSeal LMA into position. Unblinded data were collected about ease of insertion (number of attempts and time taken to provide an effective airway), efficacy of seal, ease of gastric tube placement, haemodynamic responses and blood staining. Blinded data were collected about postoperative airway morbidity. The first attempt success rate was higher for the bougie-guided technique (59/60 vs 52/60, P=0.015), but effective airway time was longer (37 vs 32 s, P<0.001). There were no differences in efficacy of seal, ease of gastric tube placement, haemodynamic responses, blood staining or postoperative airway morbidity. We conclude that bougie-guided insertion of the ProSeal LMA has a higher first attempt success rate than the digital technique in children.

A randomized non-crossover study comparing the ProSeal™ and Classic™ laryngeal mask airway in anaesthetized children

We tested the hypothesis that ease of insertion, oropharyngeal leak pressure, fibreoptic position, gastric insufflation, and the frequency of mucosal trauma differ between the ProSeal laryngeal mask airway (PLMA) and the classic laryngeal mask airway (cLMA) in anaesthetized children. For the PLMA, we also assessed the ease of gastric tube placement via the PLMA drain tube and measure residual gastric volume. 240 consecutive ASA I-III children aged 1-16 yr were randomized for airway management with the ProSeal or cLMA. The time taken to provide an effective airway, the number of insertion attempts, fibreoptic position of the airway tube and frequency of mucosal trauma were similar, but oropharyngeal leak pressure was higher (33 vs 26 cm H(2)O, P<0.0001) and gastric insufflation less common (0 vs 6%, P<0.01) for the PLMA. Gastric tube insertion was successful at the first attempt in 106 of 120, and at the second attempt in 14 of 120. The mean (sd; range) value for residual gastric volume was 2.2 (5.9; 0-30) ml. There were no differences in performance among sizes for the PLMA and the cLMA. We conclude that ease of insertion, fibreoptic position, and frequency of mucosal trauma are similar for the PLMA and cLMA in children, but oropharyngeal leak pressure is higher and gastric insufflation less common for the PLMA. Gastric tube insertion has a high success rate, provided the PLMA is correctly positioned.

The ProSeal laryngeal mask: results of a descriptive trial with experience of 300 cases

The ProSeal laryngeal mask airway (PLMA) is a new laryngeal mask device with a modified cuff and a drainage tube. We assessed the PLMA in 300 anaesthetized adults either paralysed or breathing spontaneously. We assessed insertion characteristics, airway seal pressures, haemodynamic response to insertion, ease of gastric tube placement, gastric insufflation, and postoperative sore throat. Insertion was successful in 294 patients (98%) and graded as easy in 274 patients (91%). We found no difference in ease of insertion or success rate with either the introducer or the finger insertion method, or in paralysed or non-paralysed patients. Mean airway seal pressure was 29 cm H2O, and 59 patients (20%) had seal pressures greater than 40 cm H2O. No gastric insufflation was detected. Gastric tube placement was successful in 290 of 294 patients (98.6%). There was no cardiovascular response to insertion, with a small reduction in heart rate 5 min after insertion and significant decreases in mean arterial pressure at 1 and 5 min after insertion. Sore throat was noted in 23% patients after operation and in 16% of patients after 24 h, with 90% of the sore throats described as mild. The PLMA is a reliable airway management device that can give an effective glottic seal in paralysed and non-paralysed patients. The device allows the easy passage of a gastric tube, causes a minimal haemodynamic response to insertion, and an acceptable incidence of sore throat.

The Laryngeal Mask Airway ProSeal(TM) as a temporary ventilatory device in grossly and morbidly obese patients before laryngoscope-guided tracheal intubation.

We determined the efficacy of the laryngeal mask airway ProSeal(TM) (PLMA) as a temporary ventilatory device in morbidly obese patients before laryngoscope-guided tracheal intubation. Sixty patients (body mass index 35--60 kg/m(2)) scheduled for elective surgery, who preferred airway management under general anesthesia, were studied. The induction of anesthesia was with midazolam/fentanyl/propofol and maintenance was with sevoflurane 1%--3% in oxygen 100%. The PLMA was inserted and an effective airway established. Rocuronium was given IV for paralysis. Oropharyngeal leak pressure, ease of gastric tube placement, residual gastric volume, fiberoptic position of the airway/drainage tube, and ease of ventilation at a tidal volume of 8 mL/kg was determined. The PLMA was then removed and laryngoscope-guided tracheal intubation attempted. The number of insertion/intubation attempts (maximum two each) and time taken to establish an effective airway with each device were recorded. An effective airway was obtained at the first insertion attempt in 90% of patients (54/60) and at the second attempt in 10% (6/60). The time taken to provide an effective airway was 15 plus minus 7 s (7--42 s). Oropharyngeal leak pressure was 32 plus minus 8 cm H(2)O (12--40 cm H(2)O). The residual gastric volume was 36 plus minus 46 mL (0--240 mL). Positive pressure ventilation without air leaks was possible in 95% of patients (57/60). The vocal cords were seen from the airway tube in 75% of patients (45/60), but the esophagus was not seen. The fiberoptic view from the drainage tube revealed mucosa in 93% of patients (56/60) and an open upper esophageal sphincter in 7% (4/60). Tracheal intubation was successful at the first attempt in 90% of patients (54/60), at the second attempt in 7% (4/60), and failed in 3% (2/60). In these latter two patients, the PLMA was reinserted and surgery performed uneventfully with the PLMA. The time taken to tracheally intubate the patient was 13 plus minus 10 s (8--51 s). There were no episodes of hypoxia (SpO(2) <90%) or other adverse events. There were no differences in insertion success rate, or the time to successful insertion between the PLMA and laryngoscope-guided intubation. We conclude that the PLMA is an effective temporary ventilatory device in grossly or morbidly obese patients before laryngoscope-guided tracheal intubation. The laryngeal mask airway ProSeal(TM) is an effective temporary ventilatory device in grossly and morbidly obese patients before laryngoscope-guided tracheal intubation.