Gastric insufflation with the ProSeal laryngeal mask.

T he ProSeal laryngeal mask airway (PLMA) (Laryngeal Mask Company, Henley-on-Thames, UK) is a new airway device with a large double cuff that forms a better seal than the standard laryngeal mask airway; it also has a drainage tube designed to protect against regurgitation, facilitate passage of a gastric tube, reduce the risk of gastric insufflation, and facilitate the detection of malposition (1). The test for malposition involves placing a small volume of a water-based lubricating jelly in the proximal end of the drainage tube, applying positive pressure to the airway tube, and observing the meniscus of the jelly to determine whether there is an air leak up the drainage tube. The presence of an air leak suggests that the distal end of the drainage tube and the airway tube are not isolated and that the PLMA is malpositioned. We describe a patient undergoing laparoscopic cholecystectomy who developed gastric insufflation despite a negative malposition test and make recommendations for improving the reliability of the test for malposition.