Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 96666

AbstractMaterial and MethodsResultsDiscussionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
Knowledge is treasure of a wise man. The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help ones reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journalsNo manuscriptsNo authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2011 | Month : October | Volume : 5 | Issue : 5 | Page : 940 - 943

LMA Classic and LMA Proseal: A Comparative Study in Paralyzed Anaesthetized Patients

UDAY AMBI, RAMESH KOPPAL, CHHAYA JOSHI, PRAKASHAPPA D.S., HEMLATA IYER

Corresponding Author. Associate Professor, Dept. of Anaesthesiology, SN Medical College and HSK Hospital, Bagalkot, Karnataka, India. Assistant Professor, Dept. of Anaesthesiology, SN Medical College and HSK Hospital, Bagalkot, Karnataka, India. Professor and Head, Dept. of Anaesthesiology, SN Medical College and HSK Hospital, Bagalkot, Karnataka, India. Ex-Professor , Dept. of Anaesthesiology, T N Medical College and B Y L Nair Ch. Hospital, Mumbai, Maharashtra, India.

Correspondence Address :
Uday Ambi
Assistant Professor, Dept. of Anaesthesiology,
SN Medical College and HSK Hospital,
Bagalkot, Karnataka, India-587101,
Phone: +918354-235400.
E-mail: udayambi@ymail.com

Abstract

Introduction: Airway management is a fundamental aspect of the anaesthesia practice and of emergency and critical care medicine.The proseal laryngeal mask airway (PLMA), a modified version of the classic laryngeal mask airway (LMA), is being considered as an alternative airway device for a wide range of surgical procedures. The aim of the study was to assess the use of the PLMA as a ventilatory device in anaesthetized, paralyzed patients for various elective procedures.

Materials and Methods: This prospective study comprised of 50 patients between the ages of 18-60 years, of either sex andbelonging to the physical status ASA I and ASA II. We assessed the haemodynamic responses to the insertion of the PLMA, ventilatory parameters, the ease of the gastric tube placement, gastric insufflation and any postoperative complications.

Results: The statistically analyzed results showed that the PLMA caused minimum haemodynamic responses to the insertion and that it was a reliable airway management device which ensured adequate ventilation and provided an effective glottic seal.

Conclusion: We conclude that the Proseal LMA is capable of achieving a better seal than the LMA and facilitating gastric placement, but later is more difficult to insert.

Keywords

Equipment, Mask anaesthesia; Airway, Pressure, Regurgitation, Pulmonary aspiration

Introduction
Although endotracheal intubation has a long history as one of the most widely accepted techniques in anaesthesia practice, it is not without complications, most of which arise from the need to visualize and penetrate the laryngeal opening.

The laryngeal mask airway (LMA) was invented by Archie Brain in 1981 and the advantages of LMA over the endotracheal intubation include the absence of the need of muscle relaxants and a decreased risk of post operative sore throat. A potential risk of LMA is an incomplete mask seal which causes gastric insufflation or oropharyngeal air leakage. The use of a new variant of “LMA, “LMA–Proseal” (PLMA), which incorporates a second tube which is lateral to the airway tube, was intended to separate the alimentary and the respiratory tracts. It permitted access to or the escape of fluids from the stomach and reduced the risks of gastric insufflation and pulmonary aspiration. It can also determine the correct positioning of the mask (1).

In this prospective study, we attempted to compare the ease of insertion of the airway seal, the ease of gastric tube placement and post operative complications following general anaesthesia with those of Classic LMA or Proseal LMA in paralyzed patients.

Material and Methods

With the approval of the institutional ethics committee and the written informed consent of the patients, 50 patients (ASA 1-2, aged 18-60 yrs) who underwent elective non abdominal surgeries were randomly allocated (by opening a sealed envelope) for airway management with PLMA or LMA. Patients with a known history of difficult airway, cervical spine disease, mouth opening < 2.5 cm and those who were at a risk of aspiration were excluded from the study, so as to make the groups comparable.

A standard anaesthesia protocol was followed and routine monitoring was applied. The patients were premedicated with IV Glycopyrrolate 0.004 mg/kg, IV Midaozolam 0.03 mg/kg, IV Fentanyl 2 micro gm/kg, IV Ranitidine 1 mg/kg and IV Metaclopramide 0.2 mg/kg. Anaesthesia was induced with IV Propofol 2mg/ kg, with patients in the supine position. Maintenance was achieved with Propofol infusion at 3-6 mg/kg/hr with 50% oxygen and nitrous oxide. Neuromuscular blockade was achieved with Vecuronium 0.08-1 mg/kg and it was maintained with 0.02 mg/kg boluses to maintain a train- of four count of <1. The patients’ lungs were ventilated with a face mask until the neuromuscular block was complete.

The Proseal LMA was inserted by using an introducer tool as was recommended by the manufacturer. The insertion technique for both the devices was the same. The number of insertion attempts was recorded for both PLMA/LMA. A failed attempt was defined as the removal of the device from the mouth. Three attempts were allowed before the device was considered as a failure. The time between picking up the LMA/PLMA and obtaining an effective airway was recorded. If an effective airway could not be achieved, one attempt with the other device was allowed. If an effective airway was not achievable with the alternate device (PLMA/LMA), then the airway was achieved with an endotracheal tube, the case was considered as a failure and it was documented. The gastric tube (14-16 no) was inserted through the drainage tube of the PLMA. The time which was taken to insert the gastric tube was recorded, and the placement was confirmed by the synchronous injection of air and epigastric auscultation during apnoea. In case of a difficulty in introducing the gastric tube, two attempts were tried with the manipulation of the introducer. The inability to insert the gastric tube (if any) was recorded.

The airway sealing pressure was determined by closing the APL valve of the closed circuit at a fixed gas flow of 4lt/min and by noting the pressure at which an equilibrium was reached by using a Portex aneroid gauge. The maximum allowed pressure was 40 cms H2O. The location of the airway gas leak at the airway sealing pressure was determined as-mouth (audible leak), stomach (epigastric auscultation) and drainage tube with PLMA, which was determined by the gel displacement test i.e. bubbling of the lubricant which was placed on the proximal end of the drainage tube.

The ventilation was controlled with a tidal volume of 8ml/kg in both the groups by using a Penlon Anaesthesia ventilator. The cuff pressure was kept constant at 60 cm of H2O by using a Portex aneroid gauge. The Propofol infusion was continued till just before the extubation at 2mg/kg/hr. Auscultation of the chest was done after the removal of the device for any evidence of aspiration. Secretions if present, were noted and the pH was tested with a litmus paper which was sensitive to changes of 0.5 unit pH from pH 2.5 -8.5. Post operatively, the patients were monitored for heart rate (HR), blood pressure (BP), SPO2 and the incidence of nausea and vomiting. The patients were questioned directly about the sore throat half an hour after their admission to the recovery room. The sore throat incidence was evaluated by using a 3 point scale as follows:

• 2- Continuous throat pain. • 1- Throat discomfort. • 0- no complaints at all. An enquiry about the same was made 24 hrs later.

Results

OBSERVATION AND RESULTS
The observation and the results of the two groups, the LMA group and the PLMA group are mentioned below. Statistical analysis was performed with the paired t test and the Levene’s test for the equality of variances. The groups were comparable with regard to all the demographic data like age, weight and sex. The mean ages were 30.8 and 33.6 for the LMA and the PLMA groups respectively. The mean weights were 53.6 and 55.8 Kgs for the LMA and the PLMA groups respectively. The male to female ratio was 16:34. The mean duration of anaesthesia in the LMA group was 67.8 mins and that in the PLMA group was 66.8 mins and there was no statistically significant difference between the two groups (Table/Fig 1).

Size 3 and size 4 devices were used for the male and female patients respectively. In the LMA group, the size 3 device was used in 16 patients and the size 4 device in 9 patients. The first time success- rates for LMA were slightly higher (23 of 25 vs 21 of 25; 92%), as compared to those of the PLMA group, which was statistically insignificant. With LMA, 2 patients and with PLMA, 4 patients required two attempts. The time which was required for achieving an effective airway was longer with the Proseal LMA than with the Classic LMA. The airway seal pressure was 3-27 cm of H2O, which was higher for PLMA than for LMA (27 +16 vs 14 + 2cm H2O), which was statistically significant, as shown in (Table/Fig 2).

Intra operatively, the HR increased significantly 5 min after the insertion of LMA. The systolic BP was significantly lower in the LMA group 15 and 30 min after the insertion of the device. There were no episodes of desaturation, laryngospasm or bronchospasm with either device.

In the PLMA group, the gastric tube placement was successful in 24 of the 25 patients and it took an average of 11 sec. In one case, the gastric tube could not be passed, even though an effective ventilation could be achieved. Regurgitation of the gastric contents through the drain tube was noticed in two of the PLMA cases. There were no cases of regurgitation into the mask with either device, as was detected by the litmus paper. After the removal of either device, blood stained secretions were noted in 1 and 2 cases of LMA and PLMA respectively. Post- operatively, mild sore throat (grade -1) was noted in 1and 2 cases of LMA and PLMA respectively.

Discussion

The inception of the LMA was a result of the application of the bio-engineering and post mortem examinations of the adult larynx. A potential risk of LMA is an incomplete mask seal which causes gastric insufflation or oropharyngeal air leakage. A new variant of LMA, “LMA -Proseal” is a laryngeal mask with an oesophageal vent, which is intended to separate the alimentary and the respiratory tracts. It can also determine the correct positioning of the mask (1).

There is no conclusive evidence in the literature regarding the size selection in the Asian population. Tan SM et al also showed that the size 5 PLMA in men in the Asian population resulted in increasedmucosal injury and that size 3 and 4 in the Asian women resulted in an effective glottic seal (2). Hence, in our study, we chose a fixed size LMA/PLMA for men and women (size 4 and 3 respectively).

Brimacombe et al showed that the first-time success rates were higher and that the effective airway time was shorter with the introducer (3). The insertion is easier with the introducer, because it occupies lesser space than the finger and avoids the insertion of the finger inside the oral cavity, directs the cuff around the oropharyngeal inlet and facilitates a full depth of insertion. In our study, the first time success- rates were slightly higher for LMA and the time which was required for achieving an effective airway was longer with the Proseal LMA than with the Classic LMA. This was in conformity with the reports of earlier studies (3),(4), (5). The common reason which was stated was that when deflated, the semi rigid distal end of the drain tube formed the leading edge of the Proseal, which was more rigid than the leading edge of the classic LMA. These factors could contribute to a difficult insertion of the PLMA (4). This time difference may not be significant for the routine cases, but it is important in emergency situations where securing the airway is of prime importance.

The use of LMA for positive pressure ventilation is not new, but it is regarded by some as controversial. The lungs of most of the healthy patients can be ventilated if the seal pressure exceeds 20 cm H2O (4). An airway sealing pressure or a ‘leak’ test is commonly performed with the LMA to quantify the efficacy of the seal with the airway (6). This value is important as it indicates the feasibility of the positive pressure ventilation and the degree of airway protection from supracuff soiling. The most common airway sealing pressure test involves listening over the mouth and noting the airway pressure at which the gas escapes. Keller et al concluded that for clinical purposes, the manometry stability test may be the appropriate test for comparing the airway seal pressures (6). If the peak inflation pressure exceeded the leak pressure, the likelihood of the gastric insufflation was increased (4). Our study results suggested that if a Classic LMA was selected for positive pressure ventilation, the chances of the leakage were higher. However, we could effectively ventilate in all the LMA cases.

The optimal positioning of the drain tube determines the correct positioning of the mask (1). The drain tube appeared to be placed optimally in all except one case. In one case, we could not pass the drain tube but however, an effective ventilation was achieved. Regurgitation of the gastric contents through the drain tube was noticed in two of the PLMA cases. The use of a prokinetic agent pre operatively could explain the absence of regurgitation of the gastric contents in a majority of the cases. Brimacombe et al concluded in their cadaver model, that a correctly placed PLMA allows the fluid in the oesophagus to bypass the pharynx and mouth when the drainage tube is open (7). These findings have led to the use of PLMA in adult as well as in paediatric laparoscopic procedures (8), (9).

We noticed in our study that, the bite block of the PLMA lay slightly above the margin of the teeth. This could be due to the anatomical factors which were related to the racial differences in the population. Some studies have described the position of theLMA/PLMA based on fibre optic grading (3),(4). We did not use a fibre optic scope as the requisite sized bronchoscope was not available during the study.

Evans and colleagues demonstrated that PLMA causes a minimal haemodynamic response to the insertion (10). Though in our study, the haemodynamic changes after the insertion of either device were statistically significant, they were found to be insignificant clinically. For most of the patients and the operations, these considerations were not critical. However, the patients who emerge from anaesthesia for neurosurgery, cardiac surgery and open eye surgery can benefit from a smooth recovery. The PLMA may find a role during such procedures. There were no episodes of desaturation, laryngospasm or bronchospasm.

Postoperatively, mild sore throat (grade-1) was noted in 1and 2 cases of LMA and PLMA respectively. The incidence of the sore throat varies in different studies due to the variation in size of the LMA and the endotracheal tube which is used in different studies, the design and the type of ETT which is used and the lubricating material which is used. The sore throat and dysphagia that occurs in the postoperative period is usually present for a short period only.

We conclude that the Proseal LMA is capable of achieving a better seal than the LMA and that it facilitates gastric placement, but it is more difficult to insert. Further research is required to determine the role of the Proseal LMA in airway management, but the better seal suggests its role as an alternative to LMA for positive pressure ventilation, either as backup or as a replacement device.

References

1.
Brain Al, Verghese C, Strube PJ. The LMA ‘ProSeal’--a laryngeal mask with an oesophageal vent. Br J Anaesth 2000; 84:650-4.
2.
Tan SM, Sim YY, Koay CK. The ProSeal laryngeal mask airway size selection in male and female patients in an Asian population. Anaesth Intensive Care 2005; 33:239-42.
3.
Brimacombe J, Keller C. The ProSeal laryngeal mask airway: A randomized, crossover study with the standard laryngeal mask airway in paralyzed, anesthetized patients. Anesthesiology 2000; 93: 104-9.
4.
Cook TM., Nolan JP., Verghese C., Strube PJ, Lees M, Millar JM, Fet PJ et al. A randomized crossover comparison of the ProSeal with the classic laryngeal mask airway in unparalysed anaesthetized patients. Br J Anaesth 2002; 4: 527-33.
5.
Lu PP, Brimacombe J, Yang C, Shyr M. ProSeal versus the Classic laryngeal mask airway for positive pressure ventilation during laparoscopic cholecystectomy. Br J Anaesth 2002; 88:824-7.
6.
Brimacombe J, Brain AIJ: The laryngeal mask airway: Review and practical guide. London: WB Saunders, 1997
7.
Keller C, Brimacombe J, Kleinsasser A, Loeckinger A. Does the ProSeal laryngeal mask airway prevent the aspiration of regurgitated fluid? Anesth Analg 2000; 91: 1017-20.
8.
Roth H, Genzwuerker HV, Rothhaas A, Finteis T, Schmeck J. The ProSeal laryngeal mask airway and the laryngeal tube suction for ventilation in gynaecological patients undergoing laparoscopic surgery. Eur J Anaesthesiol 2005; 22: 117-22.
9.
Sinha A, Sharma B, Sood J. ProSeal as an alternative to endotracheal intubation in pediatric laparoscopy. Paediatr Anaesth 2007; 17:327-32.
10.
Evans NR, Gardner SV, James MF, King JA, Roux P, Bennett P et al. The proseal laryngeal mask: results of a descriptive trial with an experience of 300 cases. Br J Anaesth 2002; 88:534-9.

DOI and Others

JCDR/2011/1516

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com