ProSeal versus the Classic laryngeal mask airway for positive pressure ventilation during laparoscopic cholecystectomy

Lu, P.P., Brimacombe, J., Yang, C., and Shyr, M. (2002) ProSeal versus the Classic laryngeal mask airway for positive pressure ventilation during laparoscopic cholecystectomy. British Journal of Anaesthesia, 88 (6). pp. 824-827.

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Abstract

Background. We tested the hypothesis that the ProSeal laryngeal mask airway (PLMA) is a more effective ventilatory device than the Classic laryngeal mask airway (LMA‡) for laparoscopic cholecystectomy.

Methods. Eighty anaesthetized, paralysed patients (ASA 1–2, aged 18–80 yr) were randomly allocated for airway management with the PLMA or LMA. Ease of insertion and efficacy of seal were determined. Peak airway pressures were recorded immediately before and after carboperitoneum to 2.0 kPa. The inspired oxygen concentration and/or the ventilatory variable were adjusted according to a protocol to maintain SpO2 ≥95% and E′CO2 <6.0 kPa. Oxygenation was considered suboptimal if SpO2 fell to 94–90% and failed if SpO2 was <90%. Ventilation was considered suboptimal if E′CO2 was >6.0–7.3 kPa and failed if E′CO2 was >7.3 kPa.

Results. First‐time insertion success rates were higher for the LMA (40/40 vs 33/40; P=0.02). Seven patients required two attempts with the PLMA. Oropharyngeal leak pressure was higher for the PLMA [29 (sd 6) vs 19 (4) cm H2O; P<0.001]. There was a similar, significant increase in peak airway pressure after carboperitoneum for both devices (P<0.001). Before carboperitoneum, oxygenation and ventilation were optimal in all patients in both groups. After carboperitoneum, oxygenation was optimal in all patients in both groups, but ventilation was suboptimal more frequently with the LMA (8 vs 0; P=0.01). In three of these eight patients, ventilation failed but was subsequently optimal with the PLMA.

Conclusion. The PLMA is a more effective ventilatory device for laparoscopic cholecystectomy than the LMA. We do not recommend the use of the LMA for laparoscopic cholecystectomy.

Item ID: 27261
Item Type: Article (Research - C1)
ISSN: 1471-6771
Keywords: equipment, masks anaesthesia, surgery, laparoscopy, ventilation, positive end expiratory pressure
Date Deposited: 29 May 2013 04:36
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1103 Clinical Sciences > 110301 Anaesthesiology @ 100%
SEO Codes: 92 HEALTH > 9299 Other Health > 929999 Health not elsewhere classified @ 100%
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