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Failed Obstetric Tracheal Intubation and Postoperative Respiratory Support with the Proseal Laryngeal Mask Airway

Cook, Tim M. FRCA; Nolan, Jerry P. FRCA

doi: 10.1213/01.ANE.0000140807.72998.DC
Letters to the Editor: Letters & Announcements

Department of Anaesthesia, Royal United Hospital, Bath, England,

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To the Editor:

Keller and colleagues report use of the ProSeal™ LMA (PLMA) for airway rescue after failed obstetric intubation (1). The authors cite no other case of PLMA use for obstetric airway rescue or ICU ventilation.

We reported PLMA use after failed obstetrical intubation and difficult ventilation (2). The PLMA enabled excellent airway maintenance and uneventful completion of urgent surgery. We also reported two PLMA uses for ventilation of patients on ICU followed by bronchoscopic-guided percutaneous tracheostomy (3).

Electively, the PLMA was used in a pregnant, previously difficult to intubate, patient requiring electroconvulsive therapy (4) and for laparotomy in a patient with bronchial tree tumor impeding intubation (5).

Cases of PLMA airway rescue include after failed rapid sequence induction (6), after failed routine intubation with gastric distension (7), and after accidental extubation with failed reintubation on ICU (8). In all cases, the PLMA enabled uncomplicated further manage- ment.

These recent cases inform this rapidly evolving area of practice. We agree with Keller that 1) after failed intubation with difficult ventilation in a patient with a full stomach, or 2) where controlled ventilation on ICU with a supraglottic airway is required, the PLMA has advantages over other available devices.

Tim M. Cook, FRCA

Jerry P. Nolan, FRCA

Department of Anaesthesia

Royal United Hospital

Bath, England

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1. Keller C, Brimacombe J, Lirk P, Puhringer F. Failed obstetric tracheal intubation and postoperative respiratory support with the ProSeal laryngeal mask airway. Anesth Analg 2004;98:1467–70.
2. Awan R, Nolan JP, Cook TM. The use of a Proseal LMA for airway maintenance during emergency Caesarean section after failed tracheal intubation. Br J Anaesth 2004;92:144–6.
3. Cook TM, Taylor M, McKinstry C, et al. Use of the ProSeal laryngeal mask airway to initiate ventilation during intensive care and subsequent percutaneous tracheostomy. Anesth Analg 2003;97:848–50.
4. Ivascu Brown N, Fogarty Mack P, Mitera DM, Dhar P. Use of the ProSeal™ laryngeal mask airway in a pregnant patient with a difficult airway during electroconvulsive therapy. Br J Anaesth 2003;91:752–4.
5. Dalgleish D, Bromilow J. The ProSeal laryngeal mask. Anaesthesia 2003;97:848–50.
6. Baxter S, Brooks A, Cook TM. Use of the ProSeal laryngeal mask airway for airway management after failed intubation and inadequate ventilation with a classic laryngeal mask airway. Anaesthesia 2003;58:1132–3.
7. Rosenblatt WH. The use of the LMA-ProSeal™ in airway resuscitation. Anesth Analg 2003;97:1773–5.
8. Nixon T, Brimacombe J, Goldrick P, McManus S. Airway rescue with the ProSeal Laryngeal Mask Airway in the Intensive Care Unit. Anaesth Intensive Care 2003;31:475–6.
© 2005 International Anesthesia Research Society