An Evaluation of the Modified Airway Management Device

Comparison of the modified Airway Management Device with the Proseal laryngeal mask airway in patients undergoing gynaecological procedures

BACKGROUND AND OBJECTIVE

The modified Airway Management Device (AMD) and the Proseal laryngeal mask airway (PLMA) are both supraglottic airway devices designed to maintain airway patency and allow ventilation during anaesthesia. In this prospective, randomized trial, we compared the two devices in patients undergoing major gynaecological procedures.

METHODS

Eighty-two patients undergoing elective gynaecological surgery were randomized to two groups. Group A (n = 41) had the AMD and Group P (n = 41) the PLMA inserted after induction of anaesthesia. We compared the success of airway placement, time to achieve an airway, oropharyngeal leak pressure and complications associated during anaesthesia.

RESULTS

There were no differences in patient characteristic profile for both groups. First time insertion success rates were significantly higher in Group P than in Group A (100% vs. 83%, P < 0.012). Time taken to achieve airway was also significantly shorter in Group P than in Group A (mean 21.9 +/- 7.8 s vs. 40.2 +/- 48.0 s, P < 0.001). The oropharyngeal leak pressure was significantly higher for Group P than Group A (mean 31.2 +/- 5.7 cmH(2)O vs. 24.2 +/- 8.3 cmH(2)O, P < 0.001). Ten patients in Group A had transient loss of airway during anaesthesia and needed manipulation of the airway device and four patients needed to have the airway switched to PLMA for the rest of the procedure.

CONCLUSIONS

The modified AMD has a significant lower first time successful placement rate, required a longer insertion time and has a lower oropharyngeal leak pressure than the PLMA. It also demonstrated an increased loss of airway during anaesthesia. The modified AMD needs further evaluation on its efficacy and safety before its further use can be recommended.