title: The Size 1 ProSeal™ laryngeal mask airway in infants: a randomized, noncrossover study with the Classic™ laryngeal mask airway.
abstract: BACKGROUND
  In recent years, numerous scientific publications have endorsed the superiority of the ProSeal™ laryngeal mask airway (PLMA) over the Classic™ laryngeal mask airway (cLMA) in adults, children, and infants. The PLMA forms a better seal for both the respiratory and gastrointestinal tracts, provides easier access to the gastrointestinal tract, and exerts lower mucosal pressures for a given seal pressure. This study aims to determine whether this superiority can also be observed for the size 1 PLMA used in anesthetized neonates and infants with positive pressure ventilation.
  
  
  METHODS
  Sixty consecutive neonates and infants undergoing elective surgical procedures were randomized to airway management with the size 1 PLMA or cLMA. For all patients, we recorded ease of insertion, effective airway time, number of placement attempts, oropharyngeal leak pressure, fiberoptic position, audible leaks, mask displacement, number of reinsertions during maintenance, gastric insufflation, and frequency of blood stain.
  
  
  RESULTS
  Ease of insertion, successful insertion in <3 attempts, fiberoptic position of the airway tube, and frequency of blood stain were similar in both groups. Effective airway time was lower for the PLMA group (30.5 vs 35.6 s). Oropharyngeal leak pressure was higher with the PLMA (32.9 vs 22.2 cm H(2)O, P < 0.001) and gastric insufflation less common (0% vs 6%, P = 0.492). There were fewer mask displacements during maintenance of anesthesia with the PLMA (0% vs 26.7%, P < 0.001). Mask reinsertion was not necessary during maintenance of anesthesia with the PLMA, although it was necessary in 14 cases in the cLMA group (0% vs 46%, P < 0.001). Audible leaks were less common with the PLMA (0% vs 46%, P < 0.001).
  
  
  CONCLUSIONS
  We conclude that the size 1 PLMA is a stable, safe, and efficacious airway control device during neonatal and infant anesthesia, allowing higher peak airway pressure during positive pressure ventilation, with fewer mask displacements and gastric insufflations than the cLMA.
authors.affiliation: Department of Anaesthesia and Reanimation, Gregorio Marañón University Hospital, Madrid, Spain. mlopezgi@yahoo.es
authors.forename: Maite
authors.initials: M
authors.lastname: López-Gil
authors.forename: Ignacio
authors.initials: I
authors.lastname: Mantilla
authors.forename: Teresa
authors.initials: T
authors.lastname: Blanco
authors.forename: Enrique
authors.initials: E
authors.lastname: Teigell
authors.forename: Mónica
authors.initials: M
authors.lastname: Hervias
authors.forename: Rosa
authors.initials: R
authors.lastname: Fernández-López
mesh_terms: D058109:Airway Management; D000769:Anesthesia, Inhalation; D018685:Anesthetics, Inhalation; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007327:Insufflation; D007441:Intubation, Gastrointestinal; D007442:Intubation, Intratracheal / Q000379:methods; D017214:Laryngeal Masks / Q000009:adverse effects; D008297:Male; D008738:Methyl Ethers; D012121:Respiration, Artificial; D018401:Sample Size; D000077149:Sevoflurane; D014839:Vomiting / Q000209:etiology
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane