The Effect of Placement of Proseal Laryngeal Mask Airway With C-Mac Videolaryngoscopy
Condition: Laryngeal Masks; Anesthesia, General; Videolaryngoscopy
Study type: Interventional

Summary: 
      The ProSeal laryngeal mask airway (ProSeal LMA; Intavent Orthofix, Maidenhead, UK) is a
      device with a double cuff to improve the seal and a drain tube to help prevent aspiration and
      gastric insufflation, facilitate passage of a gastric tube, and provide information about
      malposition. The manufacturer recommends inserting the ProSealTM LMA using digital
      manipulation or with an introducer tool, but both these techniques have lower success rates
      than the classic LMA.

      This prospective study that will investigated the usefulness of the C-MAC videolaryngoscopy
      for inserting a PLMA in anesthetized non-paralyzed patients and compared it with the index
      finger.
    

Detailed description: 
      Airway management is one of the cornerstones for modern anaesthesia and is vital for all
      patients undergoing general anaesthesia. Supraglottic airway devices (SADs) are increasingly
      used for managing airways.

      The ProSeal laryngeal mask airway (PLMA) (Laryngeal Mask Company, San Diego, CA, USA) is a
      supraglottic airway device with a larger cuff than the Classic laryngeal mask airway to
      produce a better seal. The PLMA is also equipped with a drainage tube to permit insertion of
      a gastric tube and evacuation of gastric content. The presence of the drainage tube reduces
      the risk of aspiration, which is the major concern of the Classic laryngeal mask airway,
      especially when the device is used with positive pressure ventilation. While a dedicated
      introducer (commonly known as an ''introducer tool'') is recommended by the manufacturer to
      facilitate insertion of the PLMA, difficulties can still be encountered during insertion. The
      PLMA insertion success rate at first attempt has been reported as 82-87%, which is lower than
      the insertion success rate of the Classic laryngeal mask airway.

      Malpositioning of the PLMA is common in clinical practice because its soft cuff can fold over
      onto itself. Malpositioning of the device can result in severe leaks and even obstruction of
      the airway, with potentially negative outcomes for the patient. Although the incidence of
      complications(e.g. airway trauma, obstruction, regurgitation, gastric distension with
      mechanical ventilation) is likely to be higher with an incorrectly placed SAD, clinical
      airway obstruction can result from other causes, such as laryngospasm and transient closure
      of the glottis.

      Many methods have been proposed to facilitate insertion of PLMAs, including insertion of a
      gastric tube,a suction catheter, or a gum elastic bougie into the drainage tube. These
      techniques help to prevent the PLMA soft cuff from folding over and help to decrease the
      incidence of malpositioning.

      This prospective study that will investigated the usefulness of the C-MAC videolaryngoscopy
      for inserting a PLMA in anesthetized non-paralyzed patients and compared it with the index
      finger.
    

Intervention name(s): C-MAC videolaryngoscope; Blind
Intervention type(s): Device; Device
Intervention description(s): An intubating device that is used for endotracheal intubation. PLMA will inserted by anesthesiologist with C-MAC videolaryngoscope.; PLMA will inserted by anesthesiologist with digital finger.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Screening
Keywords: Airway management; Videolaryngoscopy; General anesthesia