The ProSeal laryngeal mask airway: fibreoptic visualization of the glottic opening is associated with ease of insertion of the gastric tube

Purpose: To verify if correct ProSeal laryngeal mask airway (PLMA) placement may condition blind insertion of a gastric tube via the PLMA. Methods: The PLMA was studied in 150 anesthetized patients using a size #4 in (females) and #5 in (males). Its position was determined by inserting a fibrescope in the airway tube. A lubricated gastric tube was inserted through the PLMA drainage tube, recording the number of attempts at insertion. The relationship between fibreoptic glottic visualization score and attempts at gastric tube insertion using the PLMA was tested statistically. Results: Insertion success rate of the PLMA and of the gastric tube was 93.3% and 99.3%, respectively. Ventilation was satisfactory in all patients, irrespective of fibreoptic score value. A significant correlation (Spearman's rank correlation, P = 0.0186) was present between attempts at gastric tube insertion and fibreoptic score. Conclusion: Partial or total visualization of the vocal cords makes the success of gastric tube insertion more probable. Considering that fibreoptic visualization of the glottic aperture is associated with ease of insertion of a gastric tube (P < 0.02), the authors recommend adjusting or reinserting the PLMA if difficulty during the initial positioning of the gastric tube is experienced.