An unusual cause of airway obstruction after guided insertion of the ProSeal LMA.

The ProSealTM laryngeal mask airway (PLMA) insertion using a gum-elastic bougie placed in the oesophagus as a guide has a high first-attempt success rate ( 99%) and a potential role in difficult airway management [1]. On those occasions when it fails, the aetiology is usually laryngospasm, severe epiglottic downfolding, glottic/supraglottic compression or cuff infolding [2]. Most of these problems can be identified and rectified by following an algorithm that we recently proposed [3]. We present a case illustrating another cause of failure. An obese 57-yr-old male (height 165 cm, weight 106 kg) with a history of failed laryngoscope-guided tracheal intubation but easy face mask ventilation presented for elective intra-abdominal surgery. He refused awake tracheal intubation. The airway management plan was to perform optimal laryngoscopy and to insert a tracheal tube if the vocal cords were seen, or a ProSeal LMA if not seen. The patient was pre-oxygenated until the end-tidal O2 was 90%. Induction was with midazolam 2 mg, alfentanil 1 mg and propofol 2.5 mg kg 1. Face mask ventilation was easy but required a Guedel airway. Muscle relaxation European Journal of Anaesthesiology 2005; 22: 887–894 © 2005 European Society of Anaesthesiology ISSN 0265-0215