• Mi-Hyun Kim, Jung-Won Hwang, Eun-Sung Kim, Sung-Hee Han, Young-Tae Jeon, and Sun-Mi Lee.
• Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, Catholic University of Korea, Seocho-Go, Seoul, South Korea.
• J Anesth. 2015 Apr 1; 29 (2): 256-62.

PurposeBased on experimental results, various authors have advocated a size 4 ProSeal™ laryngeal mask airway (PLMA) in preference to a size 3 PLMA for women given a neuromuscular blocking agent because the larger size provided a better airway seal. However, spontaneously breathing patients may be ventilated adequately with a lower seal pressure than that needed for mechanical ventilation. Therefore, a smaller size might be preferable as its reduced bulk possibly induces less mucosal damage in non-paralyzed patients.MethodsA total of 152 females undergoing general anesthesia for short outpatient gynecological surgeries were randomly allocated in equal numbers to insertion of a size 3 or 4 PLMA. The insertion time, success rate, seal pressure, hemodynamic variables, and complications, such as blood staining and sore throat, were evaluated.ResultsThe incidence of blood staining was lower with the size 3 PLMA compared to the size 4 PLMA (18 vs. 36 %; P = 0.028). Compared with the size 3 LMA, the size 4 PLMA resulted in higher fluctuations in both blood pressure (P = 0.003) and heart rate (P = 0.01). The insertion time was shorter with the size 3 PLMA (9 vs. 16 s; P < 0.001). The airway seal pressure with the size 3 PLMA, although lower than that of the size 4 PLMA (23 vs. 28 cmH2O; P = 0.001), was sufficient for spontaneous ventilation.ConclusionsDue to the reduced incidence of mucosal injury and greater hemodynamic stability, the size 3 PLMA may be preferable to the size 4 PLMA for non-paralyzed females.

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