Ultrasonographic assessment of ProSeal laryngeal mask airway position pre- and post-laparoscopic surgery: A pilot study

Background: Second-generation supraglottic airway devices, such as the ProSeal laryngeal mask airway (PLMA), are increasingly used for laparoscopic surgeries; however, a commonly perceived limitation in their being most widely accepted is a concern regarding their malposition due to the persistent pneumoperitoneum during surgery. Ultrasonography (US) provides a non-invasive method for the assessment of PLMA position.

Aims and Objectives: This pilot study aimed to determine the incidence of PLMA malposition at the end of laparoscopic surgery using US, after confirming the initial correct placement, also by the same technique.

Materials and Methods: A total of 30 adult patients of American Society of Anesthesiologists physical status grade I–II undergoing elective laparoscopic surgery were enrolled. After clinically acceptable PLMA positioning, the same was checked by US, and corrected if required, to obtain an acceptable US confirmed placement. US reassessment for ascertaining the position was repeated at the end of surgery.

Results: After insertion of PLMA, US detected unacceptable positioning in 9 (30%) patients, all of which were corrected before commencement of surgery guided by the imaging. At the end of laparoscopic procedures, 4 (13.3%) PLMAs were found to be malpositioned by US despite being in a clinically acceptable position.

Conclusion: The high incidence of malpositioned PLMAs (30%) detected using US, even when the position was clinically acceptable, signifies a perceived need to use the bedside, non-invasive tool of US for aiding and confirming the correct position of the airway device. Further, considering the significant incidence (13.3%) of PLMA malpositioning that occurred during laparoscopic surgery, there may be a need to carry out repeated intraoperative checks for PLMA positioning during the laparoscopic procedures in view of enhanced patient safety.