ProSeal Laryngeal Mask Airway Insertion Research Articles

Comparison of Dexmedetomidine-Propofol versus Fentanyl-Propofol on Insertion Conditions of Proseal Laryngeal Mask Airway.

Proseal Laryngeal Mask Airway (PLMA) is a newer supraglottic airway device that requires adequate depth of anaesthesia and suppression of upper airway reflexes thereby providing optimal insertion conditions. To compare dexmedetomidine and fentanyl for co-induction with propofol with respect to PLMA insertion conditions, haemodynamic variation and the total dose requirement of propofol. This was a prospective randomized double-blinded study conducted in 60 cases of American Society of Anaesthesiologists (ASA) class I/II undergoing elective surgery under general anaesthesia. They were randomly divided into two equal groups, D and F, each receiving 1μg/kg of dexmedetomidine and fentanyl respectively followed by Propofol 2.5mg/kg as per protocol. The ease of PLMA insertion was Young's Criteria and Modified scheme of Lund and Stovener. The haemodynamic parameters (mean heart rate, mean arterial pressure, Respiratory rate, SPO2) were monitored at: Baseline, Pre-medication, Pre PLMA, Post LMA (at insertion), 1, 3, 5, 10, 15 and 20 minutes. PLMA insertion conditions and haemodynamics were comparable between the dexmedetomidine-propofol and fentanyl-propofol groups according to the Young's criteria and Modified scheme of Lund and Stovener. Total induction dose of propofol and its increments were significantly reduced in the dexmedetomidine group. Dexmedetomidine and fentanyl when both used individually for co-induction with propofol for PLMA insertion give excellent overall insertion conditions with haemodynamic stability. Dexmedetomidine also significantly reduces the requirements of induction dose propofol for PLMA insertion.

Comparison of midazolam and dexmedetomidine as an adjuvant for proseal laryngeal mask airway insertion: A randomized control trial

Comparison of midazolam and dexmedetomidine as an adjuvant for proseal laryngeal mask airway insertion: A randomized control trial

Comparison of three insertion techniques of ProSeal laryngeal mask airway: A randomized clinical trial.

Background and Aims:We aimed to compare three techniques for insertion of ProSeal laryngeal mask airway (PLMA).Material and Methods:Two hundred ten patients (American Society of Anaethesiologists I-II, aged 18–60 years) undergoing general anesthesia using the PLMA as an airway management device were randomly allocated to digital (D), rotational (R), or pharyngoscopic (P) techniques. In the D group (n = 70), the PLMA insertion was performed by using digital manipulation. In the R group (n = 70), the PLMA was inserted into the mouth, rotated anticlockwise through 90° and advanced into the hypopharynx. In the P group (n = 70), the PLMA was inserted after gentle pharyngoscopy using laryngoscope. Success rate at the first attempt, insertion time, airway manipulations required, and postoperative complications were noted.Results:Insertion at first attempt was more successful with P technique than the R and D groups (100% vs. 98.5% vs. 81.4% respectively, P < 0.01). Insertion time was shortest for the P group which was statistically significant compared to the group D (P < 0.001), but comparable with the R group. None of the patients required manipulation in the P group compared to the group R (P = 0.04) and D (P < 0.001). Blood staining (group P = 2.8% vs. group R = 2.8% vs. group D = 22%, P < 0.0001) and sore throat (group P = 0% vs. group R = 6.9% vs. group D = 16.7%, both: P < 0.005) were lower with the pharyngoscopic technique.Conclusion:We conclude that the pharyngoscopic technique for PLMA insertion is more successful with lower incidence of complications (mucosal bleeding and sore throat).

Head elevation by 3 vs. 6cm in ProSeal laryngeal mask airway insertion: a randomized controlled trial.

BackgroundThe sniffing position (neck flexion by head elevation and head extension) is commonly used for insertion of a laryngeal mask airway. However, the appropriate degrees of head elevation and head extension are unclear. In the present study, the success rate of ProSeal™ laryngeal mask airway (LMA ProSeal) insertion using two degrees of head elevation was evaluated.MethodsThis prospective randomized, controlled study included 80 adult patients aged 18 to 90 years. In the 3 cm (n = 40) and 6 cm (n = 40) groups, the LMA ProSeal was inserted while the head was elevated 3 cm and 6 cm, respectively, using a pillow of the corresponding height. The success rate, and incidence of blood staining on cuff, sore throat and hoarseness were assessed. The alignments of laryngeal and oral axes were also evaluated.ResultsThe first attempt success rate was higher in the 3 cm than the 6 cm group (87 % vs. 60 %, P = 0.014). In 86 % of patients in the 6 cm group and 50 % of patients in the 3 cm group in whom the second attempt failed, the third insertion attempt was successful by using a pillow height of the opposite group. The alignments of the two axes were not different between the two groups (P > 0.05).ConclusionsThe first attempt success rate of ProSeal laryngeal mask insertion was higher with 3 cm than 6 cm head elevation in adult patients.Trial registrationIdentifiers: NCT02058030 (08/05/2015), Unique Protocol ID: phdkim1.

Comparação da concentração de sevoflurano para a inserção de ML proseal e intubação traqueal em crianças (correlação com BIS)

BackgroundSevoflurane is an inhalational agent of choice in paediatric anaesthesia. For management of airways in children a suitable alternative to ETT is a paediatric proseal laryngeal mask airway (benchmark second generation SAD). Various studies have shown that less sevoflurane concentration is required for LMA insertion in comparison to TI. BIS is a useful monitor of depth of anaesthesia. AimsTo compare concentration of sevoflurane (end tidal and MAC value) required for proseal laryngeal mask airway insertion and tracheal intubation in correlation with BIS index. MethodThe prospective randomised single blind study was done in children between 2 and 9 years of ASA I and II and they were randomly allocated to Group P (proseal laryngeal mask airway insertion) and Group TI (tracheal intubation). No sedative premedication was given. Induction was done with 8% sevoflurane and then predetermined concentration was maintained for 10min. Airway was secured either by proseal laryngeal mask airway or endotracheal tube without using muscle relaxant. End tidal sevoflurane concentration, MAC, BIS, and other vital parameters were monitored every minute till insertion of an airway device. Insertion conditions were observed. Statistical analysis was done by Anova and Student's t test. ResultsDifference between ETLMI (2.49±0.44) and ETTI (2.81±0.65) as well as MACLMI (1.67±0.13) and MACTI (1.77±0.43) was statistically very significant, while BISLMI (49.05±10.76) and BISTI (41.25±3.25) was significant. Insertion conditions were comparable in both the groups. ConclusionWe can conclude that in children airway can be secured safely with proseal laryngeal mask airway using less sevoflurane concentration in comparison to tracheal intubation and this was supported by BIS index.

Effect of Paralysis at the Time of ProSeal Laryngeal Mask Airway Insertion on Pharyngolaryngeal Morbidities. A Randomized Trial.

Neuromuscular block results in the loss of muscular tone in the upper airway, which might contribute to the increased postoperative airway morbidity followed by ProSeal laryngeal mask airway (PLMA) insertion. We compared the pharyngolaryngeal discomfort exerted by the PLMA according to the neuromuscular block. One hundred sixty patients undergoing surgery for breast disease or inguinal hernia were anesthetized with propofol and remifentanil by target controlled infusion. Rocuronium 0.6 mg/kg (NMBA group, n = 80) or normal saline (No-NMBA group, n = 80) was administered after the loss of consciousness, and one anesthesiologist inserted the PLMA. Postoperative pharyngolaryngeal discomfort was evaluated at postoperative 1 h. Traumatic event was recorded based on the blood trace on the surface of the PLMA cuff. Insertion time, insertion attempt number, sealing pressure, and fiberoptic brochoscopic grades were evaluated. Patients’ characteristics and the PLMA insertion condition (insertion time, successful insertion attempt number, fiberoptic bronchoscopic grade, and sealing pressure) were similar between the two groups. The PLMA can be successfully inserted in non-paralyzed patients with less postoperative pharyngolaryngeal discomfort than when a neuromuscular blocking agent is used (13.8% vs. 30.0%, P = 0.021). The incidence of traumatic events is also reduced when no neuromuscular blocking agent is used (16.3% vs. 32.5%, P = 0.026). Regardless of whether or not a surgical procedure requires muscular relaxation, there is no need to administer neuromuscular blocking agents solely for the purpose of PLMA insertion.Trial RegistrationClinicalTrials.gov NCT01035021

Comparison of ventilatory efficacy and airway dynamics between ProSeal laryngeal mask airway and endotracheal tube in adult patients during general anesthesia.

Background and Aims:Studies have demonstrated minimal hemodynamic variation and postoperative complications with ProSeal laryngeal mask airway (PLMA) compared to endotracheal tube (ETT). Hence, a study was conducted to compare the ventilatory parameters and airway dynamics required to maintain normocarbia and stable hemodynamics with PLMA and ETT.Material and Methods:A prospective, randomized, single blinded study was conducted on 60 patients aged 20-40 years of American society of anesthesiologists class I and II, divided into Group PLMA and Group ETT. Standard anesthesia protocol was instituted. Group PLMA received PLMA sizes as per manufacturer's recommendations and group ETT received appropriate sized cuffed ETT. Patients were initially ventilated at 14 bpm, I:E ratio 1:2, tidal volume (Vt) 6 ml/kg and later adjusted to maintain end tidal carbon dioxide (EtCO2) between 35 and 40 mmHg. Peak airway pressure (Ppeak), compliance (Compl.), Vt, airway resistance (Raw), hemodynamic parameters, oxygen saturation (SpO2) and EtCO2 were recorded throughout surgery. Postoperative complications if any, were noted.Results:Demographic parameters, Raw, EtCO2, SpO2 were comparable between groups. Ppeak was lower and Vt needed to maintain EtCO2 of 35-40 mmHg was lesser in Group PLMA. Compl was low for 5 min after insertion of PLMA. Heart rate was significantly reduced at 1 min post insertion; blood pressures were significantly lower upto 2 min after insertion and post removal in group PLMA. Incidence of cough was significantly lower in group PLMA.Conclusion:ProSeal laryngeal mask airway maintains adequate ventilation at lower Vts and minimal peak pressures, has lesser hemodynamic variations and lower incidence of postoperative cough compared to ETT.

Comparison of sevoflurane concentration for insertion of proseal laryngeal mask airway and tracheal intubation in children (correlation with BIS)

BackgroundSevoflurane is an inhalational agent of choice in paediatric anaesthesia. For management of airways in children a suitable alternative to ETT is a paediatric proseal laryngeal mask airway (benchmark second generation SAD). Various studies have shown that less sevoflurane concentration is required for LMA insertion in comparison to TI. BIS is a useful monitor of depth of anaesthesia. AimsTo compare concentration of sevoflurane (end tidal and MAC value) required for proseal laryngeal mask airway insertion and tracheal intubation in correlation with BIS index. MethodThe prospective randomised single blind study was done in children between 2 and 9 years of ASA I and II and they were randomly allocated to Group P (proseal laryngeal mask airway insertion) and Group TI (tracheal intubation). No sedative premedication was given. Induction was done with 8% sevoflurane and then predetermined concentration was maintained for 10min. Airway was secured either by proseal laryngeal mask airway or endotracheal tube without using muscle relaxant. End tidal sevoflurane concentration, MAC, BIS, and other vital parameters were monitored every minute till insertion of an airway device. Insertion conditions were observed. Statistical analysis was done by ANOVA and Students t test. ResultsDifference between ETLMI (2.49±0.44) and ETTI (2.81±0.65) as well as MACLMI (1.67±0.13) and MACTI (1.77±0.43) was statistically very significant, while BISLMI (49.05±10.76) and BISTI (41.25±3.25) was significant. Insertion conditions were comparable in both the groups. ConclusionWe can conclude that in children airway can be secured safely with proseal laryngeal mask airway using less sevoflurane concentration in comparison to tracheal intubation and this was supported by BIS index.

Trapezius Squeeze Test Versus Jaw Thrust to Assess the Depth of Anaesthesia for Proseal Laryngeal Mask Airway Insertion in Children

Background: “Trapezius squeeze test” (TST) is a simple test to perform in which 1–2 inches of trapezius muscle is held and squeezed in full thickness and response is evaluated in the form of toe/body movement. We compared the effectiveness of the trapezius squeeze test (TST) with the Jaw thrust (JT) as clinical indicators for optimal anaesthesia depth for Proseal laryngeal mask airway (PLMA) insertion in spontaneously breathing children under sevoflurane anaesthesia. Materials and methods: 60 children between 2 to 8 years of age, weighing 10 to 20 kg, of ASA physical status I & II undergoing minor surgical procedures were randomly allocated to the group T (TST, n=30) and the group J (JT, n=30). Anaesthesia was induced using 4% sevoflurane in O2. As the child lost the eyelash reflex, TST or JT was performed in respective group & repeated every 15 sec till it became negative. When it became negative, a well lubricated size 2 P LMA was inserted. Insertion time of PLMA; end-tidal and MAC value of sevoflurane at the time of PLMA insertion; ease of PLMA insertion and complications as well as hemodynamic parameters were recorded. Results: In Group T, Mean time for TST to become negative was 4.48 ± 0.6 minutes and insertion condition was excellent in 30 patients (100%) compared to 4.85 ± 0.71 minutes and excellent condition in 27 patients (90%) in group J. In group T, PLMA was successfully inserted in 1st attempt in 100 % while in 97% in group J. coughing was observed in 2 patients in group J.

A comparative study of three methods of ProSeal laryngeal mask airway insertion in children with simulated difficult laryngoscopy using a rigid neck collar

BackgroundCombined introducer tool and stylet technique of ProSeal laryngeal mask airway (PLMA) insertion was compared with the conventional digital manipulation and introducer tool technique in children with a rigid neck collar. MethodsThis was a randomized, single blinded, prospective study. Ninety ASA Grade I–II children weighing 10–20 kg were randomly allocated for PLMA insertion using the digital, introducer tool (IT) or combined IT and stylet techniques. Each group contained 30 patients. Difficult laryngoscopy was simulated using a rigid neck collar. The laryngoscopic view was graded prior to PLMA insertion. The digital and IT techniques were performed according to the manufacturer's instructions. The combined technique involved attaching the IT to the PLMA and inserting a flexible stylet through the drain tube. ResultsThe median Cormack and Lehane grade was 2 in all three groups. Insertion was more frequently successful with the combined technique at the first attempt (combined 100%, digital 65.38%, IT 66.67%; p < 0.05), but success after three attempts was similar (combined 100%, digital 86.67%, IT 90%; p > 0.05). The time taken for successful placement was similar among groups at the first attempt, but was shorter for the combined technique for overall attempts (combined 18.33 ± 1.27 seconds, digital 27.85 ± 9.05 seconds, IT 26.89 ± 7.17 seconds; p < 0.05). There was no difference in postoperative airway morbidity. ConclusionPLMA insertion with combined IT and stylet technique was more frequently successful than the digital or IT technique in pediatric patients without cervical spine motion.

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.

Suction catheter guided insertion of ProSeal laryngeal mask airway: Experience by untrained physicians

Background:The use of suction catheter (SC) has been shown to improve success rate during ProSeal laryngeal mask airway (PLMA) insertion in expert users.Aims:The aim of this study was to compare insertion of PLMA performed by untrained physicians using a SC or the digital technique (DT) in anaesthetised non-paralysed patients.Methods:In this prospective randomised double-blind study, conducted in the operating setting, 254 patients (American Society of Anaesthesiologists I-II, aged 18-65 years), undergoing minor surgery were enrolled. Exclusion criteria were body mass index >35 kg/m2, laryngeal or oesophageal varices, risk of aspiration or difficult face mask ventilation either referred or suspected (Langeron's criteria ≥2) and modified Mallampati classification score >2. Participants were randomly allocated to one of the two groups in which PLMA was inserted using DT (DT-group) or SC (SC-group).Statistical Analysis:Chi-square test with Yates’ correction, Mann-Whitney U-test or Student's t-test were carried-out as appropriate.Results:The final insertion success rate was greater in SC-groupcompared with DT-group 90.1% (n = 109) versus 74.4% (n = 99) respectively (P = 0.002). Mean airway leak pressure was higher in SC-group compared to DT-group (23.7 ± 3.9 vs. 21.4 ± 3.2 respectively; (P = 0.001). There were no differences in insertion time, post-operative airway morbidity and complications.Conclusion:The findings of this study suggest that SC-technique improves the success rate of PLMA insertion by untrained physicians.

ProSeal laryngeal mask airway and endotracheal tube in elderly hypertensive patients undergoing routine surgical procedures: A comparison of hemodynamic parameters

Background/PurposeThe effects of ProSeal laryngeal mask airway (PLMA) removal and tracheal extubation on cardiovascular responses were studied in elderly hypertensive patients in a randomized double-blind study. MethodsA total of 60 elderly hypertensive American Society of Anesthesiologists I–II patients were randomly allocated to two groups (n = 30 of each) for PLMA insertion or endotracheal intubation. A standardized anesthetic sequence was used for induction and maintenance of anesthesia. The two groups were then compared for pressor response at the time of extubation/PLMA removal. ResultsIn PLMA group, heart rate and rate pressure product increased during PLMA removal but remained elevated for only 3 minutes while mean arterial pressure remained elevated for only 2 minutes. The elevations of heart rate, mean arterial pressure, and rate pressure product were exaggerated in the extubation group and persisted for more than 5 minutes. No complication was observed in any patient and no difficulty was encountered in insertion of PLMA in any patient. ConclusionElderly hypertensive patients are at risk of exaggerated pressor response at the time of extubation. PLMA removal is associated with fewer hemodynamic changes than tracheal extubation and should be preferred wherever possible.

Difficulty in proseal laryngeal mask airway insertion: An unusual cause

Difficulty in proseal laryngeal mask airway insertion: An unusual cause

Negative pressure pulmonary oedema following use of ProSeal LMA

Negative pressure pulmonary oedema (NPPO) is a life threatening condition, manifested due to upper airway obstruction in a spontaneously breathing patient. Upper airway obstruction caused by classic laryngeal mask airway (cLMA) and ProSeal laryngeal mask airway (PLMA) has been reported, and NPPO has also been reported following the use of cLMA. Search of literature did not confirm NPPO following the use of PLMA. We encountered a female patient of NPPO scheduled for incision and drainage of an abscess who had signs of airway obstruction following PLMA insertion. Multiple attempts were made to get patent airway without success. PLMA was replaced with endotracheal tube following which pink frothy secretion appeared in breathing circuit. Patient was managed successfully with ICU care.

Comparative evaluation of gum-elastic bougie and introducer tool as aids in positioning of ProSeal laryngeal mask airway in patients with simulated restricted neck mobility

Background:The ProSeal laryngeal mask airway (PLMA) is a unique laryngeal mask with a modified cuff to improve seal and a channel to facilitate gastric tube placement. This is a better device in difficult airway situations compared to classic laryngeal mask airway. This prompted us to study the ease of insertion and positioning of PLMA in patients with simulated restricted neck mobility while using gum elastic bougie (GEB) group or introducer tool (group IT) to aid insertion.Methods:Sixty ASA I or II patients, aged between 18 years and 60 years, undergoing minor non-head and neck surgeries in the supine position were studied. A rigid neck collar was used to simulate restricted neck mobility in all patients. After anaesthetising the patients with a standard protocol, the PLMA was inserted using either of the technique using the tongue depressor to open the mouth. The ease of insertion, positioning, haemodynamic responses to insertion and other complications related to the procedure were noted.Results:Regarding demographic variables, both groups were similar. The mean time taken for insertion of PLMA in group GEB was 67.80 s as compared to 46.79 s in group IT (P<0.05). Patients of group GEB had better positioning assessed by an intubating fiberscope with less end tidal carbon-di-oxide (ETCO2) values. Systolic and diastolic blood pressures were similar. The incidence of sore throat, dysphagia, and dysphonia were higher in IT group in the 12 h, but similar in 24 h.Conclusion:Guided insertion technique with GEB took a longer time, but had a better positioning and lower ETCO2 values when compared to IT technique.

Comparison of effects of propofol and ketamine–propofol mixture (ketofol) on laryngeal mask airway insertion conditions and hemodynamics in elderly patients: a randomized, prospective, double-blind trial

The objective of this study was to compare the effects of ketamine-propofol mixture (ketofol) and propofol on ProSeal laryngeal mask airway (PLMA) insertion conditions and hemodynamics in elderly patients. Eighty elderly patients, American Society of Anesthesiologists (ASA) physical status I and II, were randomly divided into two groups to receive either propofol 0.15 ml/kg (n = 40), or ketofol (using a 1:1 single-syringe mixture of 5 mg/ml ketamine and 5 mg/ml propofol) (n = 40) before induction of anesthesia. Sixty seconds after induction, the PLMA was inserted. Heart rate and arterial blood pressure (systolic [S] BP) were recorded prior to the induction of anesthesia, immediately following induction, immediately after PLMA insertion, and 5 and 10 min after PLMA insertion. PLMA insertion conditions were scored according to mouth opening, swallowing, coughing, head and body motion, laryngospasm, and ease of PLMA insertion by the same experienced anesthesiologist, who did not know which agents were used. There were no differences in PLMA insertion conditions between the groups. The number of patients in need of ephedrine (P = 0.043) and the total dose of ephedrine (P = 0.022) were significantly lower, and apnea duration (P < 0.001) was significantly higher in the ketofol group compared with the propofol group. SBP was significantly higher in the ketofol group than in the propofol group immediately after PLMA insertion and 5 min after PLMA insertion. The same PLMA insertion conditions were found with ketofol and propofol. The number of patients in need of ephedrine and the total ephedrine dose were lower and apnea duration was increased in the ketofol group.

I-Gel: A Rescue Intubation Device in Unanticipated Difficult Intubation for Emergency Laparotomy

The “i-gel” is a newer, non-inflatable supraglottic airway device for clinical use and also for resuscitation purposes. It has also been found to be a useful ventilation and intubation device in anticipated simulated difficult airway situations. However, its use in unanticipated difficult airway situations in emergency set up has not been explored. We describe a case of 24 year male posted for emergency laparotomy that turned out to have an unanticipated difficult airway. Attempts to intubation and ProSeal Laryngeal Mask Airway insertion failed. However, “i-gel” proved to be a very handy intubating conduit in this critical situation.

A randomized comparative study of intraocular pressure and hemodynamic changes on insertion of proseal laryngeal mask airway and conventional tracheal intubation in pediatric patients

Objective:To assess the influence of proseal laryngeal mask airway (PLMA) insertion on intraocular pressure (IOP).Aim:We compared the effects of PLMA insertion and laryngoscopic intubation on IOP and hemodynamic response in pediatric patients.Background:Previous studies have shown that there is no hemodynamic response to PLMA insertion similar to classic LMA insertion, but there is no published report about the influence of PLMA insertion on IOP. Conventional laryngoscopic tracheal intubation evokes a rise in IOP and cardiovascular response and has been traditionally used to secure the airway in pediatric patients undergoing ophthalmic surgery.Materials and Methods:59 patients, less than 14 years of age, scheduled for elective ophthalmic surgery were randomly divided into two groups, group P, in which the patient's airway was secured with PLMA (using introducer tool technique), and group T, in which the airway was secured with laryngoscopy-guided endotracheal intubation. Heart rate, blood pressure, and IOP were measured just before insertion of the airway device and subsequently three times at intervals of 1 min after insertion of the airway device.Results:In group T, there was a significant rise in IOP as well as hemodynamic parameters recorded. In group P, there was no significant rise in hemodynamic parameters, but a significant rise in IOP was found though the rise was less than in group T.Conclusion:We conclude that the PLMA use is associated with lesser cardiovascular response and rise in IOP as compared to tracheal intubation.

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

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).