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International Journal of Research in Medical Sciences | December 2016 | Vol 4 | Issue 12 Page 5334
International Journal of Research in Medical Sciences
Patodi V et al. Int J Res Med Sci. 2016 Dec;4(12):5334-5340
www.msjonline.org
pISSN 2320-6071 | eISSN 2320-6012
Original Research Article
A comparative study between ProSeal laryngeal mask airway and
endotracheal tube for ease of insertion and haemodynamic changes
in patients undergoing laparoscopic cholecystectomy
under general anaesthesia
Veena Patodi*, Maina Singh, Surendra K. Sethi, Vini N. Depal, Neena Jain, Vijay Kumar
INTRODUCTION
Airway management is very crucial for an
anaesthesiologist despite significant advances in the
anaesthetic practice from time to time. The cuffed
endotracheal tube was considered as the gold standard for
providing an adequate and effective glottic seal for
positive pressure ventilation, prevents gastric insufflation
and aspiration particularly for laparoscopic procedures
under general anaesthesia where pneumoperitoneum
decreases the pulmonary compliance, reduces functional
residual capacity and increases airway pressures.
However, the use of endotracheal tube may be associated
with various problems like haemodynamic pressor
response, dental trauma, cough and sore throat. So this
warrants searching for a newer alternative device which
ABSTRACT
Background:
The endotracheal tube is considered a gold standard for providing a safe and effective glottic seal,
especially for laparoscopic procedures under general anaesthesia. However, haemodynamic pressor responses
associated with its use might be detrimental. The ProSeal LMA minimizes this response without compromising the
airway with lesser incidence of complications. The aim of this study was to compare ProSeal LMA and Endotracheal
tube with respect to intra-operative haemodynamic responses and ease of insertion of device and nasogastric tube in
patients undergoing laparoscopic surgeries under general anaesthesia.
Methods:
This prospective randomized study was conducted on sixty patients, aged 20-60 years; of ASA grade 1 or
2, 30 in each group, posted for laparoscopic cholecystectomy under general anaesthesia. After induction with propofol
and neuromuscular blockade with rocuronium, PLMA or ETT was inserted. The haemodynamic responses and
insertion time of device and nasogastric tube were noted. Postoperative complications, if any were also noted.
Results:
The mean time of insertion of PLMA was 37.40±16.09 seconds and for intubation (ETT) was 31.17±20.89
seconds which was statistically not significant (P >0.05). The mean time of insertion of nasogastric tube was
18.84±6.84 seconds in PLMA group and 73.00±71.06 seconds in the ETT group which was highly significant, (P
<0.001). There was a statistically significant increase in the heart rate(HR),systolic blood pressure (SBP),diastolic
blood pressure (DBP) and mean arterial pressure (MAP) at intubation that persisted till 5 minutes of intubation and
also at the time of extubation in ETT group, (P <0.05). However, the haemodynamic parameters remained comparable
to baseline values, after insertion of ProSeal and at its removal in PLMA group (P>0.05).
Conclusions:
ProSeal LMA proved to be a suitable alternative to endotracheal tube for airway management with
stable haemodynamics in patients undergoing laparoscopic cholecystectomy under general anaesthesia.
Keywords: Ease of insertion, Endotracheal tube, Haemodynamics, Laparoscopic surgeries, ProSeal LMA
Department of Anaesthesiology, JLN Medical College and Hospital, Ajmer, Rajasthan, India
Received: 04 October 2016
Accepted: 04 November 2016
*Correspondence:
Dr. Veena Patodi,
E-mail: veenapatodi@gmail.com
Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.
DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20164205
Patodi V et al. Int J Res Med Sci. 2016 Dec;4(12):5334-5340
International Journal of Research in Medical Sciences | December 2016 | Vol 4 | Issue 12 Page 5335
reduces haemodynamic variations along with other
complications.1-4
In 2000, Dr. Brain invented the ProSeal laryngeal mask
airway with a double cuff and a double lumen which
seperates the respiratory and gastrointestinal tract along
with providing an effective seal, improved and adequate
controlled ventilation which was a useful advancement in
the field of anaesthesia.5 So we hypothesized that ProSeal
LMA can be used as an effective alternative to ETT in
laparoscopic surgeries as it provides stable
haemodynamics with adequate ventilation and minimal
postoperative complications.
This study was conducted to compare the ProSeal LMA
and the endotracheal tube in laparoscopic
cholecystectomy under general anaesthesia with regards
to intra-operative haemodynamic responses, the ease of
insertion of device and nasogastric tube, adequacy of
ventilation and also occurrence of any post-operative
complications like cough, sore throat, laryngospasm and
tracheal aspiration.
METHODS
This prospective randomized comparative study was
conducted in the Department of Anesthesiology at our
medical college’s attached hospital after obtaining
approval from the institutional ethical committee and
patient’s written and informed consent. Sixty adult
patients were included of either sex belonging to
(American Society of Anesthesiologists) ASA grade 1 or
2, aged 20-60 years, posted for elective laparoscopic
cholecystectomies under general anaesthesia. Patients
with anticipated difficult airway, obesity (body mass
index>35kg/m2), oropharyngeal pathology, cardio-
pulmonary disease, cervical spine fracture or instability
or patients at increased risk of aspiration (gastro-
oesophageal reflux disease, hiatus hernia, and pregnant
patients) were excluded from the study.
All the patients were allocated randomly into two groups
of 30 each; using computer generated random number
table and sequentially numbered opaque sealed
envelopes; PLMA Group who underwent insertion of a
ProSeal LMA (n=30) and ETT Group who underwent
insertion of an Endotracheal tube (n=30).
All the patients were undergone routine preanaesthetic
evaluation before the surgery and explained about the
anaesthetic technique and perioperative course. They
were kept nil per oral overnight. After arrival in the
operation theatre, 18G intravenous (IV) cannula was
secured and Ringer lactate solution started through it.
All standard monitors noninvasive blood pressure
(NIBP), pulse oximeter (SpO2), electrocardiogram
(ECG), Capnography (EtCO2) were attached and baseline
parameters were recorded. Intravenous midazolam 0.02
mg/kg, glycopyrrolate 0.005 mg/kg, and fentanyl 1-2
μg/kg were administered 1-2 min before induction. After
pre-oxygenation with 100% O2 for 3-5 minutes,
anaesthesia was induced with propofol 2-2.5 mg/kg till
the loss of verbal commands.
Neuromuscular blockade to facilitate placement of device
was achieved by rocuronium 0.8 mg/kg intravenously.
The patient was manually ventilated by facemask using
intermittent positive pressure ventilation (IPPV) with
100% oxygen for 90 seconds. Following adequate
paralysis, the corresponding airway was inserted in each
group.
In PLMA group, size 3 or 4 ProSeal LMA (according to
weight) was inserted and cuff inflated with 20-30 ml of
air with standard technique. In ETT group, endotracheal
intubation (with appropriate size endotracheal tube) was
performed using direct laryngoscopy. The time interval
between holding the airway device to confirmation of
correct placement by bilateral air entry on chest
auscultation was noted. Correct placement of the devices
was confirmed by adequate bilateral chest movement on
manual ventilation, bilateral equal air entry on chest
auscultation, normal capnography waveforms and oxygen
saturation more than 95%. Also nasogastric tube of
appropriate size was inserted in all patients using
lubricated jelly.
Anaesthesia was maintained with oxygen, nitrous oxide,
halothane and rocuronium. A tidal volume of 8 ml/kg,
respiratory rate of 12/min and I/E ratio of 1:2, EtCO2
between 35 to 45 mmHg was maintained for adequate
ventilation.
At the end of the procedure, anaesthetic agents were
discontinued and patients were kept on 100% oxygen
with PLMA or ETT in situ. Patients were reversed with
intravenous neostigmine 0.05 mg/kg and glycopyrrolate
0.01 mg/kg. The patient was extubated or the device
removed once the patient became fully awake and met all
the criteria of recovery from neuromuscular blockade.
The patients were monitored in the post-anaesthesia care
unit. Any incidences of sore throat, cough or any other
complications were noted.
The patients were observed for various parameters;
Insertion characteristics (attempts or ease of insertion and
time taken for insertion) of the PLMA or ETT and the
nasogastric tube (NGT). The ease of insertion and
attempt were graded as: Easy insertion -insertion at first
attempt with no resistance; difficult insertion -insertion
with resistance or at second attempt; failed insertion -
insertion not possible.
Haemodynamic parameters (HR,SBP,DBP,MAP) were
recorded: Preoperatively (baseline), at the time of
insertion, at 1,2 and 5 mins after insertion of device, after
achieving pneumoperitoneum, at 30 mins and during
removal of devices. Oxygen saturation (SpO2) and end-
tidal carbon dioxide (EtCO2) were also recorded.
Patodi V et al. Int J Res Med Sci. 2016 Dec;4(12):5334-5340
International Journal of Research in Medical Sciences | December 2016 | Vol 4 | Issue 12 Page 5336
Statistical analysis
The sample size was calculated to be 30 patients in each
group showing a significant difference between the two
groups with regard to different study parameters and
based on previous studies, with type 1 error of 0.05 and a
power of 0.9. Statistical analysis was done using Chi-
Square test, Fisher’s Exact test and Student’s paired and
unpaired t-test. Null hypothesis was assumed. Data were
analyzed using the statistical software (SPSS version
17.0, Chicago, IL, USA). Data were expressed as
Mean±SD and percentage. P value of >0.05 was
considered to be statistically not significant, a P value of
<0.05 was statistically significant and a P value of <0.001
was highly significant.
RESULTS
In present study, both the groups were comparable with
respect to demographic profile i.e. age, weight and sex,
(P>0.05). ASA grade and Mallampati grade were also
comparable, (P>0.05) (Figure 1).
The ProSeal LMA was inserted easily in the first attempt
in 66.67% patients whereas 33.33% patients required a
second attempt and the mean time of insertion of PLMA
was 37.40±16.09 seconds however, in ETT group,
intubation was successful in first attempt in 96.7%
patients and 18.3% patients required a second attempt
with mean time of intubation was 31.17±20.89 seconds.
Figure 1: Demographic data.
The mean time of device insertion was statistically not
significant (P>0.05). However the mean time of insertion
in ETT group was shorter as compared to PLMA group
(Table 1).
Table 1: Comparison of characteristics of two airway devices in both groups.
Airway parameters
PLMA (n=30)
ETT (n=30)
P value
Attempts of device insertion (1/2/3/failed)
20/10/0/0
29/1/0/0
-
Time taken for insertion of device(seconds)
37.40±16.09
31.17±20.89
>0.05
Attempts of NGT insertion (1/2/3/failed)
30/0/0/0
15/13/2/0
Time taken for insertion of NGT(seconds)
18.80±6.84
73.00±71.06
<0.05
Data expressed as number and Mean±SD, P<0.05 considered as significant.
Table 2: Comparison of mean HR (bpm) at various time intervals.
Time Interval
PLMA group
(bpm)
Intra group P
value
ETT group
(bpm)
Intra group P
value
inter group P
value
Mean
SD
Mean
SD
Preop
86.20
13.57
86.20
8.14
1.000
Insertion
84.13
15.40
0.140
98.40
13.90
0.000
0.000
1 min
85.13
13.66
0.502
103.83
11.70
0.000
0.000
3 min
85.67
14.20
0.766
101.90
13.77
0.000
0.000
5 min
85.47
11.55
0.703
94.47
20.00
0.020
0.037
Pneumo
86.60
10.77
0.831
91.00
13.59
0.081
0.170
30 min
85.33
9.79
0.674
86.13
16.61
0.983
0.821
Removal
88.93
10.80
0.169
99.33
13.13
0.000
0.001
PLMA- Proseal Laryngeal Mask Airway; ETT- Endotracheal Tube; P>0.05, not significant; P<0.05, significant.
Nasogastric tube was inserted in all patients in the first
attempt in the PLMA group with mean time of insertion
was 18.84±6.84 seconds, whereas nasogastric tube was
inserted in first attempt in 50% patients and 6.7% patients
required 3 attempts in the ETT group with a mean
insertion time of 73.00±71.06 seconds which was
significantly higher than the PLMA group, (P<0.05)
(Table 1). The mean heart rate (HR) increased
significantly from 86.20±13.57 bpm to 98.40±13.90 at
insertion, 103.83±11.70 bpm at 1 min and 101.90±13.77
0
20
40
60
80
100
Male Female Age Weight MP Ι MP ΙΙ ASA I ASA II
Demograhics
PLMA ETT
Patodi V et al. Int J Res Med Sci. 2016 Dec;4(12):5334-5340
International Journal of Research in Medical Sciences | December 2016 | Vol 4 | Issue 12 Page 5337
bpm at 3 min and 94.47±20.00 bpm at 5 min in the ETT
group , (P<0.05), (Table 2). The mean SBP increased
from its baseline value, 133.07±10.75 to 148.27±16.47
mm Hg at 1 min,142.80±20.04 mmHg at 3 min and
141.67±9.53 at 5 min, after intubation in ETT group
which was statistically significant, (P<0.05), (Table 3).
Table 3: Comparison of systolic blood pressure (mmHg) at various time intervals.
Time interval
PLMA group
(mmHg)
Intra group P
value
ETT group
(mmHg)
Intra group P
value
Inter group
P value
Mean
SD
Mean
SD
Preop
152.20
113.44
133.07
10.75
0.362
Insertion
125.67
9.87
0.194
139.73
20.33
0.126
0.001
1 min
123.07
9.67
0.156
148.27
16.47
0.000
0.000
3 min
117.43
21.85
0.100
142.80
20.04
0.011
0.000
5 min
122.03
8.90
0.147
141.67
19.53
0.022
0.000
Pneumo
123.13
8.10
0.165
124.53
15.30
0.014
0.659
30 min
128.07
7.64
0.247
128.80
10.42
0.164
0.757
Removal
131.87
6.66
0.334
141.40
7.19
0.000
0.000
PLMA- ProSeal Laryngeal Mask Airway; ETT- Endotracheal Tube; P>0.05, not significant; P<0.05, significant.
Table 4: Comparison of diastolic blood pressure (mmHg) at various time intervals.
Time interval
PLMA group
(mmHg)
Intra group
P Value
ETT group (mmHg)
Intra group P
value
Inter group P
value
Mean
SD
Mean
SD
Preop
83.53
6.60
85.93
10.04
0.278
Insertion
79.60
7.60
0.002
88.77
20.31
0.397
0.024
1 min
77.80
8.16
0.000
94.87
7.66
0.000
0.000
3 min
78.47
7.42
0.000
93.87
10.40
0.000
0.000
5 min
81.53
7.44
0.075
89.07
12.88
0.159
0.007
Pneumo
81.13
6.12
0.071
82.27
8.82
0.132
0.565
30 min
82.00
5.25
0.201
87.93
7.31
0.288
0.001
Removal
83.33
4.88
0.851
90.40
6.59
0.011
0.000
PLMA- ProSeal Laryngeal Mask Airway; ETT- Endotracheal Tube; P>0.05, not significant; P<0.05, significant.
Table 5: Comparison of mean arterial pressure (mmHg) at various time intervals.
Time interval
PLMA group
(mmHg)
Intra group
P value
ETT group (mmHg)
Intra group P
value
Inter group P
value
Mean
SD
Mean
SD
Preop
106.42
39.13
101.64
8.76
0.517
Insertion
94.96
7.23
0.094
105.76
17.49
0.179
0.003
1 min
92.89
8.27
0.047
112.67
8.89
0.000
0.000
3 min
91.46
9.88
0.033
110.18
10.99
0.000
0.000
5 min
95.03
6.84
0.099
106.60
12.65
0.039
0.000
Pneumo
95.13
6.21
0.115
96.36
9.98
0.042
0.571
30 min
97.36
5.46
0.205
101.56
7.19
0.965
0.013
Removal
99.51
4.69
0.344
107.40
4.51
0.000
0.000
PLMA- Proseal Laryngeal Mask Airway; ETT- Endotracheal Tube; P>0.05, not significant; P<0.05, significant
The mean DBP was also increased significantly at 1 and
3 min after intubation, (P<0.05), (Table 4).
Similarly, the mean arterial pressure increased from
baseline 101.64±8.76 mmHg to 112.6±8.89 mmHg at 1
min, 110.18 ±10.99 mmHg at 3 min and 106.60±12.65
mmHg at 5 min in the ETT group,(P<0.05) whereas no
statistically significant haemodynamic changes were
observed from their baseline values in the PLMA group,
(P>0.05).
Patodi V et al. Int J Res Med Sci. 2016 Dec;4(12):5334-5340
International Journal of Research in Medical Sciences | December 2016 | Vol 4 | Issue 12 Page 5338
Similarly, at removal and extubation, the heart rate and
mean arterial pressure also increased significantly,
P<0.05 whereas in the ETT group as compared to the
PLMA group, whereas in PLMA group, these parameters
remained comparable to baseline values, (P>0.05) (Table
5).
Figure 6: Comparison of complications.
The incidence of cough was 6.7% and 10% while that of
sore throat was 10% and 20% in group PLMA and ETT
respectively. (Figure 2) The mean oxygen saturation
(SpO2) was also comparable in both the groups, (P>0.05).
Figure 3: Consort flow diagram showing the flow of
participants through each stage of a randomized trial.
DISCUSSION
The achievement of smooth induction and recovery with
stable intraoperative haemodynamics and minimal
postoperative complications remains an important
anaesthetic goal during general anaesthesia in
laparoscopic surgeries. The laryngoscopy and tracheal
intubation leads to haemodynamic pressor response due
to oropharyngeal stimulation and may prove to be
detrimental for the patients with low cardiac reserve.1 The
ProSeal LMA, a supraglottic airway device with its
additional features has proven to be favourable
particularly in these situations.
PLMA has an added advantage of reduced risk of gastric
insufflation, regurgitation and aspiration of gastric
contents and proved to be efficient in laparoscopic
surgeries where increased intra-abdominal pressure
created by pnemoperitoneum required higher peak airway
pressures for adequate pulmonary ventilation.1,2,6 So with
above hypothesis, we conducted a prospective
randomized study in 60 adult patients undergone
laparoscopic cholecystectomies and compared the
haemodynamic responses, the ease of insertion of device
and nasogastric tube and any complications in both
groups.
The 66.67% of patients had easy insertion of ProSeal
LMA while 33.3% patients required a second attempt
with mean time of insertion being 37.40±16.09 seconds
while, in the ETT group, intubation was successful in
first attempt in 96.7% patients and 18.3% patients
required a second attempt and the mean time of
intubation was 31.17±20.89 seconds. The duration of
insertion of ProSeal and endotracheal tube was
statistically not significant, (P>0.05) however the mean
time of insertion in ETT group was shorter. Saraswat et al
and Kannan et al also reported no significant difference
between the insertion time of ProSeal and endotracheal
tube which concurs with present study.9,10 Usually
anesthesiologist’s have more experience and confidence
in traditional direct laryngoscopy and endotracheal
intubation as compared to other alternative devices and
PLMA is not used so frequently even in routine practice
in all institutions. So it needs expertise for successful
placement of PLMA in first attempt and with lesser time.
It is always hesitating to use an alternative device unless
it is indicated in some particular situation. This may be
the cause of longer mean insertion time of device in
PLMA group as compared to ETT group in our study
however this was statistically not significant.
In the PLMA group, nasogastric tube was inserted in all
patients in the first attempt with mean time of insertion of
18.84±6.84 seconds. This was comparable with study
done by Shroff et al who reported a mean insertion time
of 14 seconds in the PLMA group.7 Sharma et al also had
a 100% first attempt success rate of nasogastric insertion
with Proseal LMA however 50% patients had first
attempt success rate, while 43.3% and 6.7% required
second and third attempt respectively in the ETT group
with a mean insertion time of 73.00±71.06 seconds which
was significantly higher than the PLMA group (P value <
0.001).8 This may be due to presence of additional gastric
0.00%
2.00%
4.00%
6.00%
8.00%
10.00%
12.00%
14.00%
16.00%
18.00%
20.00%
PLMA ETT
6.7%
10.0%
10.0%
20.0%
Percentage
Study Group
Cough Sore throat
Patodi V et al. Int J Res Med Sci. 2016 Dec;4(12):5334-5340
International Journal of Research in Medical Sciences | December 2016 | Vol 4 | Issue 12 Page 5339
channel along with the length of ProSeal which may be
helpful for insertion of nasogastric tube as endotracheal
tube obliterates the passage of nasogastric tube while
insertion.
The HR, SBP, DBP and MAP significantly increased
from the baseline value at intubation that persisted till 5
minutes in the ETT group (P < 0.05). Similarly the rise in
HR, SBP, DBP and MAP was observed at extubation,
(P<0.05). However, the haemodynamic parameters
remained comparable to the baseline values (P>0.05)
after insertion of ProSeal and at its removal. Saraswat et
al reported significant increase in heart rate and the mean
arterial pressure 10 seconds after intubation that lasted till
3 minutes after intubation and also during the time of
extubation in the ETT group.9
Sharma B et al reported that there were no significant
haemodynamic changes at 1 and 5 min after insertion of
PLMA, (P<0.05).3 Similarly Kannan S et al concluded in
their study that SBP, DBP and MAP were lower in group
PLMA at 1 and 2 min after insertion and its removal,
(P<0.05).10 Piper et al also reported higher mean arterial
blood pressures after intubation than after insertion of
PLMA, which was significant, (P<0.01).11 Similarly,
Patel et al reported that there was rise in heart rate both
during insertion and extubation in ETT group as compare
to ProSeal LMA group and this change was highly
significant,(P<0.01) The findings of Shroff et al, Carron
et al and Kannan et al also concurred with present
findings.7,10,12,13
However, Lalwani et al and Dave et al found that heart
rate was increased significantly in both ETT and PLMA
group whereas in our study, HR is increased significantly
in ETT group only.14,15 This haemodynamic pressor
response may be attributed to the sympathetic stimulation
during laryngoscopy and intubation and this is due to
sympathoadrenal response to tracheal intubation arises
from stimulation of the pharyngeal wall and supraglottic
region by tissue tension induced by laryngoscopy. This is
mediated via vagal and glossopharyngeal afferents. The
reflex circulatory response is seen with an increase in the
plasma catecholamine levels after laryngoscopy.13
Among the catecholamine’s, noradrenaline levels show a
greater surge after laryngoscopy and intubation.
This transient pressor response to laryngoscopy and
tracheal intubation like hypertension and tachycardia is of
not much significance in healthy patients but it may
prove to be detrimental in patients with low cardiac
reserve like myocardial insufficiency, hypertension or
cerebrovascular disease.2 The catecholamine’s secreted
due to stress response may increase heart rate and
myocardial oxygen demand or consumption significantly
which may lead to cardiac arrhythmias and myocardial
ischemia.
The ProSeal LMA is a supraglottic airway device which
does not require laryngoscopy and visualization of vocal
cords for insertion so this makes the placement of
ProSeal LMA less stimulating and easier than
endotracheal intubation and therefore it provokes a lesser
sympathetic response while its insertion as compared to
ETT. The attenuation of the pressor response is due to
diminished catecholamine release and lower cortisol
levels after insertion of the ProSeal LMA.2,13,16 The
PLMA forms effective seal around the glottis opening
which provides adequate ventilation and oxygenation
along with CO2 insufflation and pnemoperitoneum in
reverse trendelenburg position without any significant
gastric distension and pulmonary aspiration. Maltby et al
also reported that both of the devices have equal
effectiveness in terms of adequate ventilation and
oxygenation in their study groups.6 The PLMA has an
additional feature of gastric drainage channel and higher
sealing pressures which may protect against regurgitation
and gastric aspiration.16
The incidence of cough and sore throat was
comparatively more in the ETT group than in the PLMA
group. Saraswat et al and Maltby et al also reported a
higher incidence of cough and sore throat after intubation
in ETT group.6,9 Lim et al and Carron et al also reported
that there was a significant incidence of cough after
extubation as compared after removal of PLMA.13 The
lower incidence of cough and sore throat with ProSeal
LMA could be due to the fact that it exerts less mucosal
pressure and does not hamper the pharyngeal perfusion
pressures.5 The cuff of PLMA is less stimulating to
pharyngeal mucosa as compared to ETT cuff in trachea
which may be the cause of reduced incidence of
postoperative nausea and vomiting also in these
patients.16
Limitations
We were not able to make significant differences between
two devices to secure an airway particularly in
laparoscopic surgeries as we could not reveal that one
device is far superior to the other device in terms of
different parameters we have studied, this may be due to
smaller sample size of our study. So it might be possible
that further studies with larger sample size would make
significant differences between the two techniques and
the results could be better appreciated.
CONCLUSION
Present study concluded that the ProSeal LMA provides a
reliable and secured airway with stable intraoperative
haemodynamics and lesser postoperative complications
so can be effectively used as an alternative to
endotracheal tube in elective laparoscopic surgeries under
general anaesthesia. However, PLMA requires expertise
for its easier insertion and placement.
Funding: No funding sources
Conflict of interest: None declared
Patodi V et al. Int J Res Med Sci. 2016 Dec;4(12):5334-5340
International Journal of Research in Medical Sciences | December 2016 | Vol 4 | Issue 12 Page 5340
Ethical approval: The study was approved by the
Institutional Ethics Committee
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Jr, Dripps RD. Reflex circulatory responses to
tracheal intubation performed during general
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2. Prys-Robert C, Green LT, Meloche R, Foëx P.
Studies of anaesthesia in relation to hypertension. ΙІ.
Haemodynamic consequences of induction and
endotracheal intubation. Br J Anaesth. 1971;43:122-
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Cite this article as: Patodi V, Singh M, Sethi SK,
Depal VN, Jain N, Kumar V. A comparative study
between ProSeal laryngeal mask airway and
endotracheal tube for ease of insertion and
haemodynamic changes in patients undergoing
laparoscopic cholecystectomy under general
anaesthesia. Int J Res Med Sci 2016;4:5334-40.
