The Pro‐seal laryngeal mask airway

We were extremely interested to read the flurry of correspondence regarding reflux through the drain tube of the Pro-seal laryngeal mask airway. One letter (Cook & Nolan Anaesthesia 2002; 57: 288–9) describes very eloquently matters relating to the Pro-seal laryngeal mask airway, standard laryngeal mask airway, ventilation and regurgitation which needs no repeating here. They state that they know of four cases where gastric contents have come up the drain tube without laryngeal soiling. We have been using the Pro-seal laryngeal mask airway in Worthing Hospital as the airway of choice for laparoscopic cholecystectomy for some time in patients without symptomatic reflux. We can report three patients in whom gastric contents were regurgitated through the drain tube without any clinical signs of laryngeal contamination or soiling of the interior of the mask following removal. Interestingly, in all three cases, this occurred in the early recovery phase and a nasogastric tube was passed in each case through the drain tube to reduce the volume of gastric secretions without difficulty. Although a small number, the absence of laryngeal soiling gives an indication that the drain tube ‘does what it says in the manual’[1]. It will be interesting to see how quickly confidence increases with this device and to what extent it replaces the tracheal tube for routine patient ventilation.