title: The ProSeal laryngeal mask airway: a review of the literature.
abstract: OBJECTIVE
  To analyze and summarize the published literature relating to the ProSeal LMA (PLMA): a modification of the "classic LMA" (cLMA) with an esophageal drain tube (DT), designed to improve controlled ventilation, airway protection and diagnosis of misplacement.
  
  
  METHODS
  Articles identified through Medline and EMBASE searches using keywords "Proseal", "ProSeal" and "PLMA". Hand searches of these articles and major anesthetic journals from January 1998 to March 2005.
  
  
  RESULTS
  Searches identified 59 randomized controlled trials or clinical studies and 79 other publications. Compared to the cLMA, PLMA insertion takes a few seconds longer. First attempt insertion success for the PLMA is lower, but overall success is equivalent. Airway seal is improved by 50%. The DT enables early diagnosis of mask misplacement, allows gastric drainage, reduces gastric inflation and may vent regurgitated stomach contents. Evidence suggests, but does not prove, that the correctly placed PLMA reduces aspiration risk compared with the cLMA. PLMA use is associated with less coughing and less hemodynamic disturbance than use of a tracheal tube (TT). Comparative trials of the PLMA with other supraglottic airways favour the PLMA. Clinicians have extended the use of the PLMA inside and outside the operating theatre including use for difficult airway management and airway rescue.
  
  
  CONCLUSIONS
  The PLMA has similar insertion characteristics and complications to other laryngeal masks. The DT enables rapid diagnosis of misplacement. The PLMA offers significant benefits over both the cLMA and TT in some clinical circumstances. These and clinical experience with the PLMA are discussed.
authors.affiliation: Department of Anaesthesia, Royal United Hospital, Combe Park, Bath BA1 3NG, UK. timcook@ukgateway.net
authors.forename: Tim M
authors.initials: TM
authors.lastname: Cook
authors.forename: Gene
authors.initials: G
authors.lastname: Lee
authors.forename: Jerry P
authors.initials: JP
authors.lastname: Nolan
mesh_terms: D004867:Equipment Design; D004947:Esophagus; D006801:Humans; D007440:Intubation / Q000295:instrumentation; D007442:Intubation, Intratracheal / Q000295:instrumentation; D017214:Laryngeal Masks; D016032:Randomized Controlled Trials as Topic