References

IJMABHR

International Journal of Medical and All Body Health Research

IJMABHR

2582-8940

Anfo Publication House

377

10.54660/IJMBHR.2025.6.3.147-154

Evaluation of Different Pre-operative Bedside Airway Assessment Tests to Determine Ease of Insertion of ProSeal LMA: A Prospective Observational Study

Zubin Sharma

Shailja

Goel

Sharad

Jagar

Keshav Dev

Vaid

Nikhil

1Post Graduate Resident, Department of Anaesthesia and Critical Care, Saraswathi Institute of Medical Sciences, Pilkhuwa, Hapur, Uttar Pradesh, India 2Professor and HOD, Department of Anaesthesia and Critical Care, Saraswathi Institute of Medical Sciences, Pilkhuwa, Hapur, Uttar Pradesh, India 3Professor, Department of Anaesthesia and Critical Care, Saraswathi Institute of Medical Sciences, Pilkhuwa, Hapur, Uttar Pradesh, India 4Associate Professor, Department of Anaesthesia and Critical Care, Saraswathi Institute of Medical Sciences, Pilkhuwa, Hapur, Uttar Pradesh, India 5Assistant Professor, Department of Anaesthesia and Critical Care, Saraswathi Institute of Medical Sciences, Pilkhuwa, Hapur, Uttar Pradesh, India

28072025

6 3 147 154 20062025 22072025

CC BY-NC-SA 4.0

The ProSeal laryngeal mask airway (PLMA) has become an essential supraglottic airway device in modern anesthetic practice, yet predicting insertion difficulty remains a clinical challenge that can impact patient safety and operating room efficiency. This prospective observational study aimed to evaluate the predictive accuracy of various pre-operative bedside airway assessment tests for determining ease of PLMA insertion in adult patients undergoing elective surgery. A total of 280 patients aged 18-70 years, ASA physical status I-III, scheduled for elective procedures under general anesthesia with planned PLMA insertion were enrolled between January 2022 and December 2023. Pre-operative airway assessment included systematic evaluation of Mallampati classification, thyromental distance, sternomental distance, mouth opening, neck circumference, upper lip bite test, neck extension, and mandibular protrusion test. The primary outcome was ease of PLMA insertion categorized as easy (successful insertion within first 2 attempts), moderately difficult (3-4 attempts), or difficult (>4 attempts or failure requiring alternative airway). Secondary outcomes included insertion time, seal pressure, and complications. Easy insertion was achieved in 198 patients (70.7%), moderately difficult in 58 patients (20.7%), and difficult insertion in 24 patients (8.6%). Multivariate analysis identified Mallampati class III-IV (OR 5.2, 95% CI: 2.8-9.7, p

Proseal LMAAirway AssessmentPredictive TestsMallampati ClassificationThyromental DistanceSupraglottic AirwayInsertion DifficultyBedside Evaluation

References 1

Brain AI, Verghese C, Strube PJ. The LMA 'ProSeal'--a laryngeal mask with an oesophageal vent. Br J Anaesth. 2000;84(5):650-654.

Cook TM, Nolan JP, Verghese C, et al. Randomized crossover comparison of the ProSeal with the Classic laryngeal mask airway in unparalysed anaesthetized patients. Br J Anaesth. 2002;88(4):527-533.

Eschertzhuber S, Brimacombe J, Hohlrieder M, et al. The laryngeal mask airway Supreme versus the laryngeal mask airway ProSeal: a randomized controlled trial in paralyzed, anesthetized adult patients. Anesth Analg. 2009;109(6):1965-1971.

Ramachandran SK, Mathis MR, Tremper KK, et al. Predictors and clinical outcomes from failed Laryngeal Mask Airway Unique™: a study of 15,795 patients. Anesthesiology. 2012;116(6):1217-1226.

Mallampati SR, Gatt SP, Gugino LD, et al. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J. 1985;32(4):429-434.

Brimacombe J, Keller C, Berry A. Gastric insufflation with the ProSeal versus Classic laryngeal mask airway. Anesth Analg. 2002;94(6):1604-1606.

Samsoon GL, Young JR. Difficult tracheal intubation: a retrospective study. Anaesthesia. 1987;42(5):487-490.

Lee A, Fan LT, Gin T, et al. A systematic review (meta-analysis) of the accuracy of the Mallampati tests to predict the difficult airway. Anesth Analg. 2006;102(6):1867-1878.

Patil VU, Stehling LC, Zauder HL. Predicting the difficulty of intubation utilizing an intubation gauge. Anesthesiol Rev. 1983;10:32-33.

Schmitt HJ, Kirmse M, Radespiel-Troger M. Ratio of patient's height to thyromental distance improves prediction of difficult laryngoscopy. Anaesth Intensive Care. 2002;30(6):763-765.

Calder I, Calder J, Crockard HA. Difficult direct laryngoscopy in patients with cervical spine disease. Anaesthesia. 1995;50(9):756-763.

Cattano D, Panicucci E, Paolicchi A, et al. Risk factors assessment of the difficult airway: an italian survey of 1956 patients. Anesth Analg. 2004;99(6):1774-1779.

Brodsky JB, Lemmens HJ, Brock-Utne JG, et al. Morbid obesity and tracheal intubation. Anesth Analg. 2002;94(3):732-736.

Ezri T, Gewurtz G, Sessler DI, et al. Prediction of difficult laryngoscopy in obese patients by ultrasound quantification of anterior neck soft tissue. Anaesthesia. 2003;58(11):1111-1114.

Khan ZH, Kashfi A, Ebrahimkhani E. A comparison of the upper lip bite test (a simple new technique) with modified Mallampati classification in predicting difficulty in endotracheal intubation: a prospective blinded study. Anesth Analg. 2003;96(2):595-599.

Hester CE, Dietrich SA, White SW, et al. A comparison of preoperative airway assessment techniques: the modified Mallampati and the upper lip bite test. AANA J. 2007;75(3):177-182.

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(1):104-109.

Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2013;118(2):251-270.

Frerk C, Mitchell VS, McNarry AF, et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth. 2015;115(6):827-848.

Cook TM, Woodall N, Harper J, et al. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. Br J Anaesth. 2011;106(5):617-631.

Peterson GN, Domino KB, Caplan RA, et al. Management of the difficult airway: a closed claims analysis. Anesthesiology. 2005;103(1):33-39.

Cattano D, Killoran PV, Cai C, et al. Difficult mask ventilation in general surgical population: observation of risk factors and predictors. F1000Res. 2014;3:204.