Usefulness of the ProSeal laryngeal mask airway in anesthesia for gynecological laparoscopic surgery

In laparoscopic surgery, tracheal intubation has been usually more acceptable because the laryngeal mask airway dose not fit to laryngeal portion when intra tracheal pressure highly increase. The ProSeal laryngeal mask (PLMA) is an advanced device with a modified cuff to improve fitness to airway. We used the PLMA in ten ASA 1 or 2 adult female patients undergoing gynecological laparoscopic surgery. A Size 3 PLMA was inserted in all patients after induction of general anesthesia with thiamylal, fentanyl and vecuronium bromide. A gastric tube was inserted through PLMA. Anesthetic maintenance was achieved with oxygen, air and sevoflurane. Then we evaluated difficulty of PLMA insertion and gastric tube insertion, changes of three pressures (airway sealing pressure, cuff pressure and airway pressure). We also investigated its safety and the incidence of intraoperative and postoperative complications. Insertion of PLMA and gastric tube was relatively easy. PLMA achieved effective seal (mean sealing pressure >25 cmH₂0) and no complication was observed during operations. Three patients complained of slight sore throat, hoarseness and cough, respectively. In conclusion, use of PLMA in anesthesia for gynecological laparoscopic surgery may be as safe as tracheal intubation with few postoperative complications.