Anaesthesia · Airway Management (Difficult Airway, Intubation, Airway Devices)

The ProSeal LMA (PLMA) differs from classic LMA in several design features. Which feature of the PLMA specifically reduces the risk of pulmonary aspiration?

  • A Its softer cuff provides a better perilaryngeal seal than classic LMA
  • B It can be used in controlled ventilation with pressures up to 40 cmH2O
  • C A dedicated drainage channel leading to the oesophagus allows passage of a gastric tube to decompress the stomach and reroutes regurgitated fluid away from the glottis
  • D PLMA has an in-built bite block preventing device compression and reducing leak
Correct answer: C. A dedicated drainage channel leading to the oesophagus allows passage of a gastric tube to decompress the stomach and reroutes regurgitated fluid away from the glottis

Explanation

The ProSeal LMA has a second posterior drainage tube aligned with the oesophagus (in addition to the airway tube), which serves two critical functions: (1) a gastric tube can be passed through it to actively decompress the stomach, reducing regurgitation risk; and (2) if regurgitation occurs, the fluid channels through this drainage tube away from the glottis, minimising aspiration. This anatomical design provides a higher seal pressure (≥25 cmH2O vs ~18 cmH2O for classic LMA) and the drainage channel makes it the preferred SGA when there is moderate aspiration risk in controlled ventilation cases.

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

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