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 Table of Contents  
LETTER TO EDITOR
Year : 2019  |  Volume : 6  |  Issue : 3  |  Page : 381-382

Severed inflation line of ProSeal Laryngeal Mask Airway: repaired using tissue dilator of central venous catheter


1 Department of Trauma and Emergency, All India Institute of Medical Sciences, Patna, India
2 Anaesthesia and Critical Care, All Institute of Medical Sciences, Patna, India
3 Department of Anaesthesia and Critical Care, All India Institute of Medical Sciences, Delhi, India

Date of Submission01-Aug-2018
Date of Acceptance09-Jan-2019
Date of Web Publication29-Aug-2019

Correspondence Address:
MD Neeraj Kumar
Room No. 216, PG-1, AIIMS Campus, Patna, 801507
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/roaic.roaic_63_18

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How to cite this article:
Kumar N, Sinha C, Kumar A, Kumar B. Severed inflation line of ProSeal Laryngeal Mask Airway: repaired using tissue dilator of central venous catheter. Res Opin Anesth Intensive Care 2019;6:381-2

How to cite this URL:
Kumar N, Sinha C, Kumar A, Kumar B. Severed inflation line of ProSeal Laryngeal Mask Airway: repaired using tissue dilator of central venous catheter. Res Opin Anesth Intensive Care [serial online] 2019 [cited 2019 Nov 18];6:381-2. Available from: http://www.roaic.eg.net/text.asp?2019/6/3/381/265724



The ProSeal (Teleflex® Inc., Wayne, PA, USA) laryngeal mask airway (PLMA) is a commonly used device to manage difficult airway in anesthesia practice. Structurally, it consists of four components: mask with a cuff, an airway tube, a draining tube and an inflation line terminating in the pilot balloon with attached valve for mask inflation as well as deflation. It is available as a reusable device, because it is made up of medical-grade silicone that can be autoclaved 40 times [1],[2]. Its life span depends on the number, temperature and duration of the autoclave cycles. A 48-year-old male, ASA grade I, was posted for laparoscopic cholecystectomy under general anesthesia. After institution of standard monitoring in the form ECG, NIBP, SPO2 and EtCO2, anesthesia was induced with fentanyl 2 μg/kg and propofol 2.5 mg/kg body weight. The airway was secured using PLMA size 3, which was inserted into the oral cavity using the conventional index finger insertion technique. The cuff was inflated with 15–20 ml of air, but air leak was detected, and on close inspection, air leak was from the inflation line. This damage was probably owing to improper storage. Unfortunately, replacement of the same size was not available, and instead of changing it, we applied a simple innovation by cutting ∼3-cm distal segment of tissue dilator of 7 F triple lumen central venous catheter. As the external diameter of 7 F central line tip of the tissue dilator is 1.2 mm and tapering length is ∼9 mm [3], it was used as an internal stent to oppose the transected ends of the inflation line of the PLMA. The internal diameter of the PLMA inflation line provided a snugly fitting of the distal end of tissue dilator as the internal diameter of the inflation tube of PLMA is 1.5 mm [4] on the completely severed segment of inflation line. After that a proper air seal was achieved and we inflated the cuff effectively using pressure monitoring device without any leak ([Figure 1]). The diameter of the tip of tissue dilator is smaller and rigid than the internal diameter of inflation tube in PLMA, which is soft, being responsible for providing tight fitting and seal. The tapering length further facilitates quick insertion. The repaired PLMA satisfactorily provided adequate seal and without any loss of airway pressures in patients. The main limitation of using this technique was nonautoclavable portion of CVP tissue dilator. The tissue dilator of the central line is easily available, and it can be kept in 2% glutaraldehyde solution (Cidex, Johnson & Johnson Medical, India) for later use. Cost of PLMA is high on comparing it with central line or endotracheal tube, and with the use of this simple innovation, a severed PLMA can be reused.
Figure 1 Arrow showing the tissue dilator as internal stent on ProSeal laryngeal mask airway with no leak.

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Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Doneley S, Brimacombe J, Keller C, von Goedecke A. The ProSeal™ has a shorter life span than the classic TM laryngeal mask airway. Anesth Analg 2005; 100:590–593.  Back to cited text no. 1
    
2.
Wong DT, McGuire GP. Fractured LMA. Can J Anesth 2000; 47:716.  Back to cited text no. 2
    
3.
Takahashi T, Morita M, Shimada Y. Evaluation of dilators for central venous catheterization using an experimental model. J Anesth 2005; 19:131–135.  Back to cited text no. 3
    
4.
Kundra P, Nisha B. Damaged ProSeal™ LMA inflation line can be repaired. Indian J Anaesth 2010; 54:481.  Back to cited text no. 4
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