LETTERS TO THE EDITOR: Letters & Announcements
We thank Drs. Matioc and Arndt for their interest in our case of difficult insertion of the ProSeal™ laryngeal mask airway (PLMA™) with backward folding of the tip and occlusion of the drainage tube (1). The Portex introducer, which functions as an artificial palate, was first described by Dingley et al. (2) in 1994 and has shown promise as an insertion tool for the classic laryngeal mask airway (2,3). Matioc and Arndt’s preliminary work hints that it might also be useful with the PLMA™. Other insertion tools that function as artificial palates include a desert spoon (4) and a set of plastic measuring spoons (5). There are two potential advantages to using artificial palates with the PLMA™. First, the cuff does not touch the mucosa during the first part of insertion and the risk of trauma may be reduced. Second, impaction against the posterior oropharyngeal wall is avoided and the risk of folding over and failed insertion may be reduced. However, there are four potential disadvantages. First, the room available in the mouth for digital intraoral manipulation is reduced. Second, the cuff will be closer to the tongue (because the artificial palate occupies the space behind it), making impaction with the tongue more likely. Third, the artificial palate itself could cause trauma during insertion and removal. Fourth, the position of the PLMA™ could be disturbed during removal of the artificial palate. Further work will be required to determine the net effects of these advantages/disadvantages on the utility of artifical palates for insertion of the PLMA™.
J. Brimacombe, MBChB, FRCA, MD
M. Howes, MB, BS
C. Keller, MD
A. Berry, MBChB, FRCA
1. Brimacombe J, Keller C, Berry A. Gastric insufflation with the ProSeal laryngeal mask. Anesth Analg 2001; 92: 1614–5.
2. Dingley J, Whitehead MJ, Wareham K. A comparative study of the incidence of sore throat with the laryngeal mask airway. Anaesthesia 1994; 49: 251–4.
3. Dingley J, Baynham P, Swart M, Vaughan RS. Ease of insertion of the laryngeal mask airway by inexperienced personnel when using an introducer. Anaesthesia 1997; 52: 756–60.
4. Harding JB. A “skid” for easier insertion of the laryngeal mask airway. Anaesthesia 1993; 48: 80.
5. Kao YJ. Spoons to assist the insertion of the laryngeal mask airway. Anesthesiology 1995; 83: 1381.