Use of LMA-ProSealTM drain tube for oesophogastric instrumentation
Reading, UK
* E-mail: julianthompson{at}doctors.net.uk
Editor—The LMA-ProSealTM has extended the range of surgical procedures that may be undertaken without tracheal intubation.1 A recent case illustrated that this repertoire may be further extended to include investigative and potentially therapeutic procedures of the upper alimentary tract.
A 73-yr-old man, who had previously undergone radical radiotherapy and chemotherapy for invasive post-cricoid squamous cell carcinoma, re-presented with dysphagia caused by a cricopharyngeal stricture. Despite endoscopic dilatation of the stricture, insertion of a nasogastric tube was unsuccessful and a percutaneous endoscopic gastrostomy (PEG) was indicated for enteral feeding. The patient underwent a general anaesthetic and before commencing an open PEG procedure, the decision was taken to attempt a direct PEG procedure using the drainage tube of the LMA-ProSealTM, which is designed to lie at the upper oesophageal sphincter,2 as access for the endoscope. The internal diameter of the drain tube of size 3 and 4 LMA-ProsealTM is 6.5 (0.22) mm. Initially, a size 5 LMA-ProsealTM was inserted, using the recommended digital insertion technique, but was exchanged for a size 4 LMA-ProsealTM, as it was felt that the radiotherapy may have altered the dimensions of the oro-pharynx. Although ventilation continued through the airway tube, a lubricated fibre-optic laryngoscope (FOL) (11302BD1, Karl Storz Endoskope, Germany), with an outer diameter of 3.7 mm and length of 65 cm was inserted through the drain tube of the size 4 LMA-ProSealTM and successfully passed under direct vision through the cricopharyngeal stricture into the oesophagus and stomach. Unfortunately, the FOL used was of insufficient length to adequately transilluminate the stomach and ultimately the gastrostomy tube was inserted via a mini-laparotomy, with ongoing ventilation via the LMA-ProSealTM. A paediatric endoscope with a greater length than the FOL was not immediately available at this site but may have allowed successful completion of the PEG insertion.
This case illustrates that the drain tube of the LMA-ProsealTM may be used for oesophago-gastric instrumentation. The LMA-ProSealTM has already been demonstrated to be a safe alternative to nasal cannulae in a paediatric population undergoing gastroscopy.3 This technique allows the LMA-ProSealTM to be compatible with small diameter devices for oesophogastric endoscopy, transoesophageal echocardiography, and oesophageal Doppler cardiac output monitoring.
References
1 Lim Y, Goel S, Brimacombe JR. The ProSeal laryngeal mask airway is an effective alternative to laryngoscope-guided tracheal intubation for gynaecological laparoscopy. Anaesth Intensive Care (2007) 35:52–6.[Web of Science][Medline]
2 Brain AI, Verghese C, Strube PJ. The LMA ‘ProSeal’—a laryngeal mask with an oesophageal vent. Br J Anaesth (2000) 84:650–4.
3 Lopez-Gil M, Brimacombe J, Diaz-Reganon G. Anesthesia for pediatric gastroscopy: a study comparing the ProSeal laryngeal mask airway with nasal cannulae. Paediatr Anaesth (2006) 16:1032–5.[CrossRef][Medline]
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||