Name: ACA- Hung 4e- Technique of Placement of Extraglottic Devices: Proseal-LMA

Description: ACA- Hung 4e- Technique of Placement of Extraglottic Devices: Proseal-LMA

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Upload Date: 2023-11-24T00:00:00.0000000

Transcript: Language: EN.
Segment:0 .
[Dr. Hung] The ProSeal LMA is a laryngeal mask variant that incorporates several modifications of the LMA Classic. It lacks aperture bars, has a deeper bowl, and incorporates an esophageal drain tube to provide access to the esophagus. This drain tube and the deeper bowl of the cuff make it difficult for the epiglottis to occlude the distal aperture. The ProSeal LMA also has a flexible, wire-reinforced airway tube to improve flexibility, and an incorporated bite block to reduce the danger of obstruction secondary to biting.
An introducer is available as a reusable device to facilitate ProSeal LMA placement. Its distal end fits into the insertion strap of the ProSeal, and the proximal end clips to the airway tube above the bite block. Number 18 French gauge or smaller gastric tubes can be inserted through the conduit to facilitate gastric decompression. The ProSeal LMA can be inserted similarly to the LMA by using the digital technique involving the placement of the index finger under the insertion strap during insertion.
Alternatively, prior to its placement, the ProSeal LMA can be loaded onto an introducer by placing the distal end of a metal introducer in an insertion strap on the ProSeal LMA. The airway tube is folded around the introducer and clipped into a proximal matching slot. However, to optimally place the tip of the ProSeal LMA cuff in the hypopharynx, it is probably most reliable to use a tracheal introducer, such as an Eschmann introducer.
The head and neck of the patient should be placed in a sniffing position. Following the placement of the tracheal introducer into the esophagus, under direct vision with a laryngoscope, the ProSeal LMA is guided into a position by placing the tracheal introducer through the esophageal conduit. The tracheal introducer is removed following placement of the ProSeal LMA above the hypopharynx.
Proper placement of the ProSeal LMA can be confirmed by a number of techniques. Air leaks through the drainage tube at low airway pressures suggest malposition of the ProSeal LMA. Though air leaks are ordinarily easily detected by auscultation or by feeling air exiting the drainage tube, a small volume leak is probably best detected by the soap bubble test.
Other tests have been used, these include passing a gastric tube through the drainage tube or passing a fiberoptic bronchoscope through the drainage tube.

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