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ProSeal Laryngeal Mask Airway versus Cuffed Endotracheal Tube for Laparoscopic Surgical Procedures under General Anesthesia: A Random Comparative Study

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Context The Proseal LMA(PLMA), which has been designed especially for positive pressure ventilation and protection against aspiration can act as an alternative to Endotracheal Tube (ETT) as an effective airway device for patients undergoing elective Laparoscopic surgeries. Aims To compare the efficacy and safety of PLMA with ETT in patients undergoing Laparoscopic surgeries under general anaesthesia. Settings and Design A prospective, randomized study was conducted in a tertiary care teaching hospital with 60 patients of ASA grade I/II undergoing elective Laparoscopic surgery under general anaesthesia. Ethical committee clearance and written consent taken. The patients were randomly divided into two equal groups to the PLMA group (Group S) and to the ETT group (Group C) Heart rate (HR), mean blood pressure (MAP), ETCO2 values, intraoperative complications such as regurgitation- aspiration, and Postoperative complications such as nausea or vomiting, throat soreness and oral injuries were monitored. Results There was no difference demographically. Insertion success rate was 100% for both the groups. The mean increase in HR was seen all throughout the duration of the surgery to 8 % above the baseline in Group C and to 3% above the baseline in Group S. On comparing the MAP in Group C, there was a increased by 2.5% to 78.300 ± 14.2615 mmHg as compared to an increase by 5% to 76.233 ± 6.2072 mmHg in Group S. EtCO2 showed a rise in both groups after pneumoperitoneum, which returned to baseline values after completion of surgery. Gastric aspirate values showed no difference in each group. Post op complications were seen mainly in Group C with statistical significance. Conclusions A properly positioned PLMA is a suitable and safe alternative to ETT for airway management in adequately fasted, adult patients undergoing elective Laparoscopic surgeries.
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958
Original Article
IntroductIon
The development of minimally invasive surgery has
revolutionized surgical procedures and has inuenced the
practice of anesthesiology. The success in healthy adult patients
has led to the introduction of more extensive endoscopic
procedures in older and sicker patients, as well as in pregnant
and pediatric patients. Despite the potential advantages,
Laparoscopic procedures are associated with physiological
hemodynamic changes and life-threatening complications
such as regurgitation of the gastric contents and potential
aspiration due to physiological changes associated with
pneumoperitoneum that are usually not encountered with the
conventional open procedure. As a result, anesthetic techniques
for Laparoscopic surgery have been rened to anticipate these
differences from open surgery.[1]
Maintenance of a patent airway remains an important concern
of an anesthesiologist.[2] Even though the time tested and
excellent airway securing device, i.e., the Endotracheal
Tube (ETT), is available at all times, it too has its demerits.
Morbidities such as trauma to the vocal cords and structures of
the oral cavity, pressor response, and sore throat are worrisome
to the anesthesiologist. This led to the use of supraglottic
devices such as ProSeal laryngeal mask airway (PLMA) for
Laparoscopic surgeries.[3]
Context: The Proseal LMA(PLMA), which has been designed especially for positive pressure ventilation and protection against aspiration
can act as an alternative to Endotracheal Tube (ETT) as an effective airway device for patients undergoing elective Laparoscopic surgeries.
Aims: To compare the efcacy and safety of PLMA with ETT in patients undergoing Laparoscopic surgeries under general anaesthesia.
Settings and Design: A prospective, randomized study was conducted in a tertiary care teaching hospital with 60 patients of ASA grade I/
II undergoing elective Laparoscopic surgery under general anaesthesia .Ethical committee clearance and written consent taken. The patients
were randomly divided into two equal groups to the PLMA group (Group S) and to the ETT group (Group C) Heart rate (HR), mean blood
pressure (MAP), ETCO2 values, intraoperative complications such as regurgitation- aspiration, and Postoperative complications such as nausea
or vomiting, throat soreness and oral injuries were monitored. Results: There was no difference demographically. Insertion success rate was
100% for both the groups. The mean increase in HR was seen all throughout the duration of the surgery to 8 % above the baseline in Group C
and to 3% above the baseline in Group S. On comparing the MAP in Group C, there was a increased by 2.5% to 78.300 ± 14.2615 mmHg as
compared to an increase by 5% to 76.233 ± 6.2072 mmHg in Group S. EtCO2 showed a rise in both groups after pneumoperitoneum, which
returned to baseline values after completion of surgery. Gastric aspirate values showed no difference in each group. Post op complications
were seen mainly in Group C with statistical signicance. Conclusions: A properly positioned PLMA is a suitable and safe alternative to ETT
for airway management in adequately fasted, adult patients undergoing elective Laparoscopic surgeries.
Keywords: Effective ventilation, Endotracheal Tube, Laparoscopic surgeries, ProSeal laryngeal mask airway
Address for correspondence: Dr. Suchita Shailesh Parikh,
E‑62, Grain Merchants CHS, Plot No. 26 and 35, Sector 17, Vashi,
Navi Mumbai ‑ 400 703, Maharashtra, India.
E‑mail: drsuchitaparikh@gmail.com
ProSeal Laryngeal Mask Airway versus Cuffed Endotracheal
Tube for Laparoscopic Surgical Procedures under General
Anesthesia: A Random Comparative Study
Suchita Shailesh Parikh, Shivam Bipin Parekh1, Chaula Doshi, Varsha Vyas
Department of Anaesthesia, Dr. D. Y. Patil Medical College and Research Center, Navi Mumbai, 1Department of Critical Care, P. D. Hinduja National Hospital and
Medical Research Center, Mumbai, Maharashtra, India
Abstract
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DOI:
10.4103/aer.AER_97_17
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How to cite this article: Parikh SS, Parekh SB, Doshi C, Vyas V. ProSeal
laryngeal mask airway versus cuffed endotracheal tube for laparoscopic
surgical procedures under general anesthesia: A random comparative study.
Anesth Essays Res 2017;11:958-63.
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Parikh, et al.: The ProSeal LMA versus Endotracheal Tube for Laparoscopic surgeries
Anesthesia: Essays and Researches ¦ Volume 11 ¦ Issue 4 ¦ October-December 2017 959
PLMA is a double-lumen, double-cuff LMA. The double-tube
design separated the respiratory and the alimentary tracks
providing a separate passage for the regurgitated fluids.
Furthermore, the double cuff provided a better seal around the
glottis, thus providing an option of administering intermittent
positive-pressure ventilation[4,5] These properties increase the
suitability to use PLMA in patients who are more prone to
aspiration of regurgitated uids.
The aim of our study is to compare the efcacy and safety of
PLMA with ETT in patients undergoing Laparoscopic surgeries
under general anesthesia.
subjects and methods
Patient selection
After obtaining approval from Ethical Committee, sixty
patients were chosen who were scheduled to undergo
elective Laparoscopic surgeries under general anesthesia. The
duration of this study was 1 year. Written informed consents
were obtained from the patients. The inclusion criteria were
patients with American Society of Anesthesiologists (ASA)
Physical Status I and II, aged 18–60 years. Patients were
excluded if they had a mouth opening <2 cm, anticipated
difcult airway, ASA Physical Status III or IV, body mass
index >30 kgm−2, upper respiratory tract infection, increased
risk of aspiration (gastroesophageal reux disorder, hiatus
hernia, and pregnancy), cervical spine fracture, or instability.
The patients were randomly divided into two groups
(according to a computer generated plan) – thirty patients to
the ProSeal group (Group S) and thirty patients to the ETT
group (Group C).
Study procedure
A thorough preanesthetic checkup was performed 1 day
before the day of the surgery. All patients were given tablet
alprazolam 0.5 mg orally at bedtime on the previous night of
surgery and kept nil per oral for 12 h before surgery. After the
patient was shifted to operation theater, standard monitors such
as pulse oximeter, noninvasive blood pressure, and three-lead
electrocardiogram were connected. Intravenous (IV) access
was gained with 18-gauge cannula and Ringer’s lactate
infusion was started. The patients were given injection
glycopyrrolate 0.2 mg IV, injection midazolam 0.05 mg/
kg IV, injection fentanyl 1 µg/kg IV, injection ondansetron
4 mg IV, and injection pantoprazole 40 mg IV and then
preoxygenated with 100% oxygen for 3 min. Anesthesia was
induced with injection propofol 2.5 mg/kg IV, and injection
atracurium 0.75 mg/kg IV was used to achieve neuromuscular
blockade. The patients were ventilated for 3 min with oxygen
and isourane 0.8%, and the device was inserted by trained
anesthesia providers with signicant experience and expertise
in insertion.
Group S (study group): PLMA (size 3 for females, size 4
for males) with introducer
Group C (control group): cuffed ETT (size 7–7.5 ID for
females, size 8–8.5 ID for males).
Correct placement of the device was conrmed by manual
ventilation, auscultation, and square wave capnography. Once
conrmed, positive-pressure ventilation was started with a
tidal volume of 8 ml/kg. Closed circuit breathing system with
soda lime was used. Maximum three attempts were allowed
while inserting the airway device. If more than three attempts
were required for device insertion, the patient was excluded
from the study as repeated laryngoscopic response may alter
the hemodynamic parameters under study.
Ease of insertion of the device was noted.
Ryle’s tube was inserted. Correct placement of the Ryle’s tube
was checked with air injection and epigastric auscultation.
Volume of gastric aspiration was measured just after insertion
of Ryle’s tube and intraoperatively.
Anesthesia was maintained by isoflurane 0.5%–1.2%,
air: O2 (60%: 40%) connected to Drager Fabius machine
and put on volume mode along with injection atracurium
0.25–0.4 mg/kg for the maintenance of blockade. IV crystalloids
were administered after calculating fluid requirements
according to Holliday-Segar formula. CO2 pressures and ow
rates were monitored and ranged between 10 and 15 mmHg
and 200 and 400 ml/min, respectively, in all cases.
Heart rate (HR) and mean blood pressure were recorded before
induction, at 1 and 5 min after the insertion of the device,
during CO2 insufation, every 15 min interval throughout
surgery, and then 5 min after removal of airway device.
ETCO2 values were monitored similarly.
Intraoperative complications such as regurgitation-aspiration,
hypoxia, hypercarbia, bronchospasm, airway obstruction,
gastric insufation, and pneumothorax were looked for.
At the completion of surgery, isoflurane was stopped.
Residual paralysis was reversed with injection neostigmine
0.05 mg/kg and injection glycopyrrolate 0.008 mg/kg.
Postoperative analgesia was administered with IV injection
diclofenac sodium 75 mg as infusion.
The device was removed after thorough Ryle’s tube and oral
suction. Any blood or secretions present on the device were
noted.
Postoperatively, patients were monitored for vital parameters,
nausea or vomiting, throat soreness, and oral injuries.
observatIon and results
In this prospective randomized study, sixty patients
aged 18–60 years of ASA Physical Status I and II
undergoing elective Laparoscopic surgery were studied
to evaluate hemodynamic response and postoperative
complications after securing the airway with either the
ETT or the PLMA.
The sample size was determined by power analysis. Patients
listed for surgery were enrolled and assessed for eligibility.
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Parikh, et al.: The ProSeal LMA versus Endotracheal Tube for Laparoscopic surgeries
Anesthesia: Essays and Researches ¦ Volume 11 ¦ Issue 4 ¦ October-December 2017
960
Those not meeting the inclusion criteria or those refusing to
participate were excluded from the study.
The data collection sheets were checked daily by the principal
investigator for correctness and consistency. Data collected
were coded and entered into the SPSS software. Data were
analyzed using  SPSS version 22.0 (SPSS Statistics for
Windows, Armonk, NY: IBM Corp); analysis between the
groups was done using the unpaired sample t-test while
within-group analysis was done using the paired sample t-test.
Chi-square test was used for qualitative data.
Continuous variables were described using mean ± standard
deviation. A P value of <0.05 was considered statistically
signicant.
Demographic profile
There were no statistical differences (P > 0.05) between the
groups regarding age, gender, weight, and height. All the
data were statistically insignicant and thus comparable.
Table 1 shows the comparison of demographic parameters of
all patients.
Insertion of device
Table 2 describes the insertion of device. Insertion success rate
was 100% for both the groups.
Comparison of pulse variation
Comparison of pulse variation is presented in Table 3.
Preoperatively, baseline mean pulse rate in Group S was
78.6 ± 6.27 per min and that in Group C was 79.76 ± 6.65,
with P = 0.23; thus, there was no statistical signicance in
both the groups.
During induction, there was a rise in mean pulse rate
in Group S to 81.80 ± 5.851 per min and in Group C to
82 ± 5.343 per min; however, the statistical analysis showed
no signicance.
After insertion of the device, in Group S, mean pulse rate
increased by 8% to 84.79 ± 7.497 per min, whereas in Group C,
the mean pulse rate increased by 10% to 87.5 ± 6.725 per min.
Even though there was a greater rise in mean pulse rate in
Group C as compared to Group S, there was no statistical
signicance seen as per P value.
As shown in Table 3, the mean increase in the pulse rate
was seen all throughout the duration of the surgery and
pneumoperitoneum to 8% above the baseline in Group C as
compared to 3% above the baseline in Group S. However,
there was no statistical signicance seen as per the P values.
The mean pulse rate thus showed better hemodynamic stability
in Group S as compared to Group C.
Comparison of mean arterial blood pressure variation
Comparison of mean arterial blood pressure variation is
presented in Table 4
Preoperatively, baseline mean arterial pressure (MAP) in
Group S was 74.133 ± 5.7938 mmHg and that in Group C was
75.233 ± 6.0554 mmHg, with P = 0.475; thus, there was no
statistical signicance in both the groups.
During induction, there was no signicant change in mean
MAP in both the groups.
After insertion of the device, in Group S, there was an
increase in mean MAP by 5% to 76.233 ± 6.2072 mmHg,
whereas in Group C, the mean MAP increased by 2.5% to
78.300 ± 14.2615 mmHg. Even though there was a greater
rise in mean MAP in Group C as compared to Group S, there
Table 1: Comparison of demographic parameters
Mean±SD P
Group S (n=30) Group C (n=30)
Age 34.27±11.44 34.57±9.107 0.72
Weight 53.9±9.211 53.83±8.663 0.54
Height 155.83±7.159 158.57±9.684 0.77
Male/female 8/22 5/25 0.69
Statistical test applied - Chi-square test. SD=Standard deviation
Table 2: Insertion of device
Group S (n=30) Group C (n=30)
Number of attempts
for insertion 1/2/3 (%)
100/0/0 100/0/0
Insertion
Easy 30 (with inserter) 30
Difcult Nil Nil
Table 3: Comparison of pulse variation
Time Mean±SD P
Group S
(n=30)
Group C
(n=30)
Baseline 78.60±6.278 79.76±6.659 0.23
After induction 81.80±5.851 82.00±5.343 0.32
Insertion of device 84.79±7.497 87.50±6.725 0.44
5 min after pneumoperitoneum 82.54±4.141 86.13±6.558 0.67
Removal of device 83.80±7.027 88.77±6.155 0.67
SD=Standard deviation
Table 4: Comparison of mean arterial blood pressure
variation
Time Mean±SD P
Group S
(n=30)
Group C
(n=30)
Baseline 74.133±5.7938 75.233±6.0554 0.475
After induction 75.767±6.8162 72.267±7.3669 0.061
Insertion of device 76.233±6.2072 78.300±14.2615 0.080
5 min after
pneumoperitoneum
70.333±11.7101 71.900±7.4387 0.539
Removal of device 69.967±12.6668 75.067±8.2166 0.069
5 min after removal 72.967±6.9901 72.967±6.9901 0.097
SD=Standard deviation
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Parikh, et al.: The ProSeal LMA versus Endotracheal Tube for Laparoscopic surgeries
Anesthesia: Essays and Researches ¦ Volume 11 ¦ Issue 4 ¦ October-December 2017 961
was no statistical signicance seen as per the P value. The
values of MAP gradually returned to the baseline values, with
no statistical signicance seen as per the P values. The mean
MAP thus showed better hemodynamic stability in Group S
as compared to Group C.
Comparison of end‑tidal carbon dioxide variation
Table 5 shows the comparison of end-tidal carbon dioxide
variation. On comparison, no statistical signicance was noted
in both the groups.
Comparison of gastric aspirate
Graph 1 shows the comparison of gastric aspirate variations.
On statistical analysis of the data with Chi-square test, there
was no statistical difference seen (P = 0.34) Thus, there was no
difference in the amount of gastric uid aspirated in each group.
Regurgitation of the gastric contents through the drain tube
was not seen in any of the patients. There was no case of
pulmonary aspiration.
There was no case of intraoperative displacement of the device.
Postoperative complications
Comparison of postoperative complications is presented in
Table 6. As shown in Table 6, postoperative complications such
as nausea, sore throat, and airway trauma were seen mainly
in patients with ETT (Group C) with statistical signicance
(P = 0.038, 0.002, 0.001, respectively); vomiting was not seen
in any group postoperatively.
dIscussIon
This study was carried out to compare the PLMA and the
ETT as an airway device during general anesthesia during
elective Laparoscopic surgeries in sixty ASA Grade I and
II patients who were randomly allotted into one of the two
groups containing thirty participants each, with respect to their
intraoperative hemodynamic parameters and postoperative
complications.
Both groups were given similar standardized anesthesia and
were compared for similar parameters including demographic
details, ease of insertion, volume of gastric aspirate,
hemodynamic alterations, and postoperative complications.
The two groups were comparable in terms of demographic data.
We compared the ease of insertion, attempts for insertion, and
the success rate of insertion in both groups and observed that
the insertion success rate was 100% in both.
Our ndings correlate well with Lim et al.,[6] who found that
the number of attempts for successful insertion was similar
between the both the groups and that both the devices were
successfully inserted within three attempts.
Oehler has compared different techniques of PLMA insertion.[7]
Their observation in terms of rst-time success rate at insertion
of PLMA by introducer technique and the number of attempts
for successful airway attainment coincide with our study.
On comparing the hemodynamic parameters, both the
groups were comparable in terms of baseline hemodynamic
parameters.
Our study demonstrated that there was a hemodynamic
response consisting of an increase in HR and MAP associated
with laryngoscopy and ETT insertion as well as with PLMA
insertion. The response caused by laryngoscopy with ETT
insertion was greater than that caused by PLMA insertion.
However, no statistical signicance was noted. Similar results
were seen by Güleç et al.,[8] who concluded that PLMA usage
is a suitable, effective, and safe alternative to ETT in patients
with lower metabolic stress.
The hemodynamic parameters were elevated to 10%–15% above
the baseline values after the insertion in patients of the ETT
group and gradually settled to 5%–8% above the baseline for the
remaining duration of the surgery. These results are comparable
16.7 16.7
3.3
23.3
20.0
3.3
0.0
5.0
10.0
15.0
20.0
25.0
<5 ml 5–10m
l>
10ml
Percentage
ProSeal LMA
ET Tube
Graph 1: Comparison of gastric aspirate variations
Table 5: Comparison of end‑tidal carbon dioxide variation
Time Mean ETCO2±SD P
Group S (n=30) Group C (n=30)
Insertion of device 32.033±1.4967 32.700±1.0554 0.051
After insertion 32.267±1.8742 32.933±1.1121 0.099
After
pneumoperitoneum
35.600±1.7140 36.000±1.8004 0.382
5 min after
pneumoperitoneum
32.217±1.5654 31.867±1.5976 0.507
SD=Standard deviation, ETCO2=End tidal carbon dioxide
Table 6: Comparison of postoperative complications
Group S (n=30) Group C (n=30) P
Incidence Percentage Incidence Percentage
Nausea 4 6.67 10 16.67 0.038
Sore throat 0 0 8 13.33 0.002
Airway
trauma
0 0 1 1.67 0.0001
Vomiting 0 0 0 0 -
Total 30 100 30 100
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Parikh, et al.: The ProSeal LMA versus Endotracheal Tube for Laparoscopic surgeries
Anesthesia: Essays and Researches ¦ Volume 11 ¦ Issue 4 ¦ October-December 2017
962
to those found by Kanchi et al.[9] and  Takahashi et al.,[10]
who found that in normotensive patients, laryngoscopy and
endotracheal intubation are immediately followed by an increase
in the sympathetic response and hemodynamic parameters.
The PLMA group in our study showed a 6%–8% increase in
hemodynamic parameters after insertion, which was lower than
that seen in patients with ETT. These parameters gradually
settled to 1%–3% above the baseline for the remaining duration
of the surgery.
These ndings are supported by Misra and Ramamurthy[11]
and Lim et al.,[6] who concluded that the PLMA is a similarly
effective airway device to conventional laryngoscope-guided
tracheal intubation but is more rapidly inserted and associated
with an attenuated hemodynamic response to insertion and
removal.
Idrees and Khan[12] noted that the hemodynamic response
to insertion was signicantly attenuated in LMA group as
compared to ETT group. They concluded that this attenuated
hemodynamic response to insertion of LMA as compared
to ETT will be beneficial in patients with compromised
cardiovascular prole, and hence, it has a safer hemodynamic
prole compared to ETT.
Laparoscopic surgery cause changes in respiratory mechanics
following carbon dioxide pneumoperitoneum. The pulmonary
compliance is decreased and the resistance is increased leading
to high airway pressure. Therefore, higher inspiratory pressures
are required to provide adequate tidal volume and minute
ventilation to maintain adequate airway pressures and end-tidal
carbon dioxide levels.[13,14]
On comparing the mean end-tidal carbon dioxide levels
in both the groups, the values of ETCO2 were comparable
in both the groups on insertion of the airway device;
however, there was a rise in both groups after laparoscopy
and pneumoperitoneum, which returned to baseline values
after completion of surgery. This variation was comparable
all throughout the duration of surgery with no statistically
signicant difference.
Ryle’s tube was inserted successfully in all our patients in
the rst attempt along with the insertion of either device.
In comparison, Cook et al.[15] were successful in 92%.
Sharma et al.[16] had a success rate of gastric tube placement
of 100%.
On comparing the mean values of gastric aspirate in both
groups, we noted minimal mean gastric aspirate in both the
groups with no statistical signicance. This could be attributed
to elective nature of the surgery where appropriate aspiration
prophylaxis was administered. Regurgitation of the gastric
contents through the drain tube was not seen in any of the
patients.
Cook et al.[17] observed that the drain tube enables early
diagnosis of mask misplacement, allows gastric drainage,
reduces gastric ination, and may vent regurgitated stomach
contents and also that the correctly placed PLMA reduces
aspiration risk Evans et al.[18] described a case of intraoperative
passive regurgitation where the PLMA successfully protected
the airway from the respiratory tract illustrates that passive
regurgitation can occur unexpectedly intraoperatively and
thus the PLMA can protect the airway during such an event
by allowing the regurgitated uid to pass up the drainage tube
without leaking into the glottis.
We compared postoperative complications such as nausea,
vomiting, airway trauma, and sore throat in both the groups.
16.67% patients in ETT group experienced nausea 6.67%
patients in PLMA group. These values were statistically
signicant. 13.33% patients in the ETT group had sore throat
postoperatively. No patient in the PLMA group experienced
this complication, which was statistically signicant.
Airway trauma was seen in 1.67% of all the cases. This was
highly statistically signicant.
Higgins et al.[19] showed that patients with ETT had the greatest
incidence of sore throat; 45.4%, followed by patients with
LMA.
Saraswat et al.[20] found that sore throat postoperatively was
seen in 10% patients with PLMA and in 20% patients with
ETT and noted airway trauma in 10% patients with PLMA
and in 16.67% patients with ETT.
No incidence of vomiting postoperatively in any groups. This
could be attributed to appropriate antacid prophylaxis and
Ryle’s tube suctioning, before extubation.
summary and conclusIon
We summarize that in the patients undergoing elective
Laparoscopic surgeries:
1. The PLMA has similar ease of insertion as the ETT
2. PLMA has better hemodynamic stability
3. PLMA is an equ ally good conduit for delive r y of positive
pressure ventilation and provides an effective airway
seal with minimal chances gastric distension and but no
regurgitation or aspiration in patients undergoing general
anesthesia during Laparoscopic surgeries
4. PLMA reduces the chances of postoperative complications
such as nausea, sore throat, and vomiting and airway
trauma and hence is desirable especially for day care
procedures.
Hence, we conclude that a properly positioned PLMA is a suitable
and safe alternative to ETT for airway management in adequately
fasted, adult patients undergoing elective Laparoscopic surgeries.
It provides equally effective pulmonary ventilation without
gastric distention, regurgitation, and aspiration.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conicts of interest.
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Parikh, et al.: The ProSeal LMA versus Endotracheal Tube for Laparoscopic surgeries
Anesthesia: Essays and Researches ¦ Volume 11 ¦ Issue 4 ¦ October-December 2017 963
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... Patients reported the incidence in the form of yes or no for vomiting. Nausea was reported by patients as nominal data in some studies, [4,[7][8][9][10] while in others, the event was measured as per visual analogue scale. [11,12] The data were collected from those studies who reported these events independently. ...
... This review includes a total of 2213 patients who met our inclusion criteria [ Table 2]. [4,[7][8][9][10][11][12][15][16][17][18][19][20][21][22][23][24][25][26][27][28] Risk of bias assessment Risk of bias was assessed as per authors' judgement. Among 21 RCTs, 12 studies demonstrated an overall low risk of bias in most of the categories [ Figure 2]. ...
... The incidence of sore throat was studied in 18 studies. [4,[7][8][9][10][11][12][18][19][20][21][22][23][24][25][26][27][28] Pooled analysis showed 44% reduction in incidence of sore throat in SAD group as compared to ET intubation group (RR 0.44, P < 0.00001 [0.30, 0.65], i 2 = 72%) [ Figure 3a]. However, there was detection bias noted in few studies. ...
Article
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Background and aims: Laparoscopic surgeries are among the most frequent procedures done worldwide. There is a gradual shift in the method of airway securement from endotracheal intubation to supraglottic airway devices (SAD). The objective of the current work was to perform a systematic review and meta-analysis of published RCTs on airway complications in laparoscopic surgery performed with a SAD or endotracheal intubation (ETT). Methods: The research was registered in PROSPERO, and a literature search was conducted in Google Scholar and PubMed until August 2022. Out of 78 studies, 31 studies were screened and 21 were included for analysis. RevMan 5.4 was used to analyse data on sore throat, hoarseness, nausea, vomiting, stridor and cough. Results: Twenty-one randomised controlled trials, enrolling a total of 2213 adult patients, were included in the quantitative analysis. A significant incidence of sore throat and hoarseness was seen at post-operative period in ETT group with risk ratio (RR) 0.44, P < 0.00001 [0.30, 0.65], i2 = 72% and RR 0.38, P < 0.001 [0.21, 0.69], i2 = 72%, respectively. However, incidence of nausea, vomiting and stridor was not significant with RR 0.83, P = 0.26 [0.60, 1.15], i2 = 52% for nausea and RR 0.55, P = 0.03 [ 0.33, 0.93], i2 = 14% for vomiting. Incidence of cough was more in ETT group with RR 0.11, P < 0.00001 [ 0.06, 0.20], i2 = 42%, as compared to SAD group. Conclusion: There was a substantial variation between SADs and ETTs with respect to the incidence of hoarseness, sore throat, nausea and cough. The existing literature is reinforced by the evidence uncovered in this updated systematic review.
... Surgical site infection (SSI) is one of the most common complications following cesarean section (CS) with a reported incidence of 3-20%. SSI causes massive burdens on both the mother and the healthcare system [3,4]. Cesarean section (CS) is the most common obstetric surgical Procedure, and its global rates (including both emergency and elective) range from 5 to 20% and the rates continue to rise in both developed and developing countries [5,6,7]. ...
Article
Full-text available
The global incidence of cesarean section deliveries has significantly increased, resulting in a rise in post-cesarean surgical site infections (SSIs). These infections pose a notable threat to maternal health, often leading to prolonged hospital stays, elevated costs, and direct health consequences, particularly in populations facing low socioeconomic status, limited resources, and conditions involving forced internal displacement due to conflict. Fort Portal Regional Referral Hospital lacked prior studies on SSIs, prompting the initiation of this research to ascertain the prevalence and specific factors linked to post-caesarean SSIs within the Maternity Ward at FPRRH. The study adopted a retrospective cross-sectional approach, utilizing a pretested checklist to gather information from 110 patient files admitted and operated on in Maternity Ward during the six months preceding the investigation. The collected data underwent entry and analysis using IBM SPSS version 25, incorporating the chi-square test to establish relationships between SSIs and associated risk factors. Results were presented through tables and charts. The mean age of study participants was 27.67 years, with a standard deviation of 6 and an age range of 16 to 45 years. A majority (64.3%) were over 30 years old, over 50% hailed from rural areas, and the majority identified as Christians and were married. The overall prevalence of post-caesarean SSIs stood at 12.7%. Statistically significant factors influencing SSIs included gestational age, diabetes mellitus, duration of membrane rupture, chorioamnionitis, preoperative hematocrit levels, and referral to FPRRH. In conclusion, this study revealed a 12.7% prevalence of post-caesarean SSIs, with gestational age, diabetes mellitus, duration of membrane rupture, chorioamnionitis, preoperative hematocrit levels, and referral to FPRRH identified as significant contributing factors. Recognizing and addressing these factors early on could guide obstetricians in enhancing their daily practices, ultimately improving the outcomes of cesarean sections and diminishing the risk of post-caesarean SSIs.
... They include patient related factors and surgery related factors [3]. Antibiotic therapy plays a crucial role in prevention of surgical [24,25,26,27]. Therefore, the choice of antibiotics in both prevention and treatment of surgical site infection should consider the common pathogens responsible for surgical site infection [28]. ...
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Surgical wound infection is defined as infections that occur at or near surgical incision within 30 days of operation or after 1 year if an implant is placed. This study determined factors associated with Surgical wound infection among patients operated in Surgical ward at Kiryandongo general Hospital. This was a descriptive cross-sectional study design which employed both quantitative and qualitative methods in data collection. The study found out that of the 100 patients who underwent major surgical procedures in Kiryandongo General Hospital, 15 (15.0%) had surgical site infection. Host factors associated with Surgical Site Infection among participants were Age(P-value,0.001), Sex(P-value,0.032), Level of education (P-value,0.002), weight (P-value,0.027), BMI(P-value,0.006), Level of blood sugar (P-value,0.001), erythrocyte sedimentation rate (P-value,0.041) and temperature (P-value,0.005). The study also revealed that surgical site infection was associated with duration of hospital stay (P-value,0.004), Cadre of the operating surgeon(P-value,0.000), Duration of the operation(P-value,0.003), type of antibiotic used pre-operatively(P-value,0.041), type of sutures used(P-value,0.023) and cleanliness of wounds(P-value,0.007). Surgical site infections continue to be a major public health problem. The risk factors associated with Surgical wound infection were age, male gender, level of education, height, weight, BMI, blood sugar, nutrition, erythrocyte sedimentation rate, fever, duration of hospital stay, type of incision, cadre of surgeon, duration of the procedure, type of the operation, antibiotics, type of the sutures used and type of wound.
... Common airway complications were observed less in using LMA. 11,17,[21][22][23][24] A laryngeal mask may also provide an advantage in patients with an upper respiratory tract infection (URTI) and who require emergency surgery because of an incarcerated or strangulated inguinal hernia. Also, some children have a frequency of URTI of 6-8 episodes per year, so it may be challenging to schedule the child during a symptom-free interval for elective surgery; LMA will be a better alternative for appropriate surgical procedures in children who are at high risk of airway complications. ...
... PLMA has been found to be a suitable alternative to endotracheal tube (ETT) for airway management in laparoscopic surgeries. [4,5] Despite introduction of new SGDs, none of them has fared better than PLMA in terms of oropharyngeal seal pressures (OLP). [6][7][8][9] However, PLMA has certain limitations like over inflation of its cuff can displace it and diffusion of nitrous oxide into the cuff during anesthesia can increase the intracuff pressure that may increase laryngo-pharyngeal morbidity. ...
Article
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Background and aims: Several supraglottic airway devices (SGD) are available nowadays. But none has been found to be better than Proseal laryngeal mask (PLMA) in terms of oropharyngeal leak pressure (OLP). We aimed to compare OLP of newly introduced Baska® Mask with PLMA in patients undergoing elective surgical procedures under general anesthesia. Material and methods: Totally, 80 consecutive adult patients of either sex requiring general anesthesia were randomized into two groups Group B (Baska mask, n = 40) or Group P (PLMA. n = 40). After standardized induction with propofol 2 - 2.5 mg/kg-1 and fentanyl 2 mgkg-1, and muscle relaxation with vecuronium 0.1 mgkg-1 one of the two devices was placed. OLP (primary outcome) was measured 5 minutes and 30 minutes post induction. The time needed to achieve effective airway, anatomical alignment of the device, number of attempts, leak fraction, and postoperative laryngopharyngeal morbidity were noted. Results: Both the devices could be inserted in first attempt in all the patients, but the time needed to achieve effective airway was significantly less in Group B (12.58 ± 1.81 sec vs 17.92 ± 2.45 sec, P < 0.001). The mean OLP was better in Group B at 5 min (37.6 ± 2.43 cm H2O vs 30.82 ± 3.96 cm H2O) and at 30 min (38.83 ± 1.72 cm H2O vs 30.82 ± 3.96 cm H2O; P < 0.001). Anatomical alignment of SGD with glottis (FOB grade 3 or 4 view) was significantly better in group B (34/40) as compared to group P (25/40) (p = 0.009). There was no difference in laryngopharyngeal morbidity in the two groups. Conclusion: Baska mask provided higher OLP, better alignment to the glottis and faster placement time as compared to PLMA.
... There were initial concerns over the risk of aspiration associated with the use of SADs during laparoscopic surgeries, as the rise in intra-abdominal pressure may cause difficulties with ventilation and an increased risk of gastric regurgitation [2]. Numerous studies have demonstrated that second-generation SADs with esophageal drainage tubes can be safely used in patients undergoing elective laparoscopic surgeries without an elevated risk of aspiration [3][4][5][6][7]. ...
Article
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Background The third-generation streamlined liner of the pharynx airway (SLIPA-3G) is a new-generation supraglottic airway device (SAD) that is non-cuffed and disposable, with a sealing pressure that varies dynamically with the airway pressure. This study compared the SLIPA-3G with the laryngeal mask airway supreme (LMAS) in patients undergoing laparoscopic cholecystectomy. Methods Two hundred and twenty patients scheduled for laparoscopic cholecystectomy were randomly allocated to either the SLIPA-3G group or the LMAS group. Data were collected on the patients’ hemodynamic parameters at different time points, ease of insertion, fiberoptic view, oropharyngeal leak pressure (OLP) at different time points and SAD-related complications. Results The mean OLP immediately after device placement in the LMAS group was significantly higher than that of the SLIPA-3G group (31.34 ± 6.99 cmH 2 O vs.28.94 ± 6.01 cmH 2 O, P = 0.008, 95% CI 0.62–4.17). The OLPs of the two groups were not significantly different after the induction of a pneumoperitoneum until the end of surgery. The OLP increased gradually through the course of the operation in the SLIPA-3G group ( P value = 0.035) but not in the LMAS group ( P value = 0.945). There was no significant difference between the two groups in hemodynamic parameters, insertion time and success rate, fiberoptic view and complication rate. Conclusions The SLIPA-3G and LMAS were associated with comparable OLPs, hemodynamic parameters, ease of insertion, fiberoptic views and complication rates when used during laparoscopic cholecystectomy. The SLIPA-3G can be used as an effective alternative to the LMAS in patients undergoing laparoscopic surgeries.
Article
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Objective: This study aimed to evaluate respiratory parameters during percutaneous internal ring suturing (PIRS) for inguinal hernia repair in two different-aged pediatric patients in whom the airway is provided with a laryngeal mask or endotracheal tube for general anaesthesia. Methods: After local ethics committee and parental consent, 180 ASAI-II children were randomly allocated to 4 groups; according to their age (0-24 months / 25-144 months) and airway device laryngeal mask (LMA) / endotracheal tube (ETT) used for general anaesthesia (45 children each) for laparoscopic inguinal hernia repair. Standard anaesthesia induction was done with lidocaine, propofol, and fentanyl, and 0.6 mg kg-1 rocuronium was added to the ETT groups. Sevoflurane is used for maintenance. Hemodynamic parameters, peak airway pressure, end-tidal carbon dioxide (EtCO2), and peripheric oxygen saturation (SpO2) values were recorded after induction, before, and during pneumoperitoneum. The duration of anaesthesia, surgery, recovery time, and surgical satisfaction was recorded. Airway complications (cough, laryngospasm, bronchospasm, desaturation, and aspiration) were recorded. Results: Hundred and eighty patients (45 in each group) were analyzed. Duration of surgery and surgical satisfaction were similar in all groups. Duration of anaesthesia and recovery times were significantly shorter in the LMA groups. Peak airway pressure and EtCO2 levels were significantly lower in the LMA groups. Rare airway complications were observed without significance. Conclusion: In laparoscopic inguinal hernia repair with the PIRS technique, LMA offered comparable operating conditions and surgical satisfaction.
Article
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Introduction: Recent advances in airway management have led to supraglottic airway devices (SAD) being increasingly often chosen instead of tracheal intubation for laparoscopic surgery. However, there are ongoing arguments regarding the use of SAD due to worries about the risks of insufficient ventilation and pulmonary aspiration. The LMA Protector is a second generation SAD which was put into use recently. This prospective randomised trial investigated whether the LMA Protector was comparable to the tracheal tube regarding respiratory parameters, perioperative complications and haemodynamic parameters in patients undergoing laparoscopic surgery. Material and methods: A total of 154 adult patients were randomised to two groups: Group 1 (tracheal intubation) and Group 2 (LMA Protector). Achieving adequate depth of anaesthesia, the patients were either intubated or the LMA Protector was placed. The initial baseline measurements were recorded including tidal volume, peak inspiratory pressure (PIP), oropharyngeal leak pressure (OLP) and haemodynamic parameters. These measurements were repeated and recorded again following pneumoperitoneum and recovery from anaesthesia. Results: At the mean age of 52.22 ± 13.90 years 77 patients were intubated and in 77 patients the LMA Protector was applied. Following insertion of the airway device and pneumoperitoneum, the heart rate was higher in the intubation group. In the LMA Protector group OLP measures were found to be statistically similar. The mean Brimacombe fibreoptic visualisation score was 2.12 ± 0.58 and the rate of requirement of optimisation was 15% in the LMA Protector group. Conclusions: With high OLP, better haemodynamic parameters and low laryngeal view scores, we concluded that the LMA Protector can be used safely in patients undergoing laparoscopic surgery.
Article
The Ambu® AuraGain™ (Ambu A/S, Ballerup, Denmark) is a newer phthalate-free, single-use supraglottic device with the advantage of a facility for tracheal intubation if necessary intraoperatively. We compared the oropharyngeal leak pressures and other performance variables between the AMBU AuraGain and the LMA® Supreme™ (Teleflex Medical, Athlone, Co. Westmeath, Ireland) in patients undergoing laparoscopic cholecystectomy and preperitoneoscopic inguinal herniorrhaphy with carbon dioxide insufflation under controlled ventilation. We recruited 120 American Society of Anesthesiologists physical status class I–3 patients between the ages of 21 and 80 years undergoing laparoscopic cholecystectomy or preperitoneoscopic inguinal herniorrhaphy into this single-centre randomised controlled trial. The primary outcome measure was the oropharyngeal leak pressures. Secondary outcomes included insertion parameters, ventilatory characteristics and postoperative sequelae. The AuraGain had slightly but significantly higher oropharyngeal leak pressures than the LMA Supreme (mean (standard deviation) 26.1 (6.9) versus 21.4 (4.7) cmH 2 O, P < 0.010). The overall insertion success of the AuraGain was comparable to the LMA Supreme (AuraGain 58/60 (96.7%); LMA Supreme 56/59 (94.9%), P = 0.679). The AuraGain was deemed more difficult to insert than the LMA Supreme, with 26/60 (43.3%) of AuraGain insertions graded easy versus 48/59 (81.4%) of LMA Supreme, P < 0.001. The mean time to insertion of the AuraGain was slightly longer than the LMA Supreme, 32.2 (10.5) versus 28.3 (12.0) s, P < 0.001. Intraoperative device failure occurred following carbon dioxide insufflation in one AuraGain and three LMA Supremes, bringing the perioperative success rate of AuraGain and LMA Supreme to 95% and 89.8%, respectively, P = 0.322. No cases of regurgitation and aspiration occurred, and minor postoperative complications were similar. The AuraGain exhibited higher oropharyngeal leak pressures than the LMA Supreme, but was slightly more difficult to insert. The higher oropharyngeal leak pressures suggest that ventilation might be less affected by high peak inspiratory pressures when using the AuraGain than the LMA Supreme.
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Background Although endotracheal tube is preferred for airway management during laparoscopic percutaneous extraperitoneal closure for inguinal hernias, laryngeal mask airway may also be used. However, few studies have reported the usefulness of laryngeal mask airway during laparoscopic percutaneous extraperitoneal closure. Our study aims to report the advantages of laryngeal mask airway versus endotracheal tube during laparoscopic percutaneous extraperitoneal closure for inguinal hernia in pediatric day surgery.Methods The records of 56 patients (Group I, endotracheal tube; Group II, laryngeal mask airway) treated for inguinal hernia using laparoscopic percutaneous extraperitoneal closure between November 2018 and December 2019 were retrospectively reviewed. The duration of anesthesia; changes in hemodynamics (heart rate and systolic/diastolic blood pressure), end-tidal carbon dioxide, and bispectral index; and postoperative complications were analyzed.ResultsGroups I and II had 39 and 17 patients, respectively. The duration of anesthesia and surgery and changes in hemodynamics and bispectral index were similar between the two groups. Induction and recovery times were significantly shorter and changes in end-tidal carbon dioxide were more significant in Group II ( p < 0.05). The incidence of sore throat and nausea was higher in Group I ( p < 0.05).Conclusions Laryngeal mask airway was equivalent to endotracheal tube in terms of performance during laparoscopic percutaneous extraperitoneal closure, although induction and recovery were achieved sooner in laryngeal mask airway, with a lower incidence of sore throat and nausea.Trial RegistrationNot applicable
Article
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We aimed to compare hemodynamic and endocrine alterations caused by stress response due to Proseal laryngeal mask airway and endotracheal tube usage in laparoscopic cholecystectomy. Sixty-three ASA I-II patients scheduled for elective laparoscopic cholecystectomy were included in the study. Patients were randomly allocated into two groups of endotracheal tube and Proseal laryngeal mask airway. Standard general anaesthesia was performed in both groups with the same drugs in induction and maintenance of anaesthesia. After anaesthesia induction and 20 minutes after CO(2) insufflations, venous blood samples were obtained for measuring adrenalin, noradrenalin, dopamine and cortisol levels. Hemodynamic and respiratory parameters were recorded at the 1(st), 5(th), 15(th), 30(th) and 45(th) minutes after the insertion of airway devices. No statistically significant differences in age, body mass index, gender, ASA physical status, and operation time were found between the groups (p > 0.05). Changes in hemodynamic and respiratory parameters were not statistically significant when compared between and within groups (p > 0.05). Although no statistically significant differences were observed between and within groups when adrenalin, noradrenalin and dopamine values were compared, serum cortisol levels after CO(2) insufflation in PLMA group were significantly lower than the ETT group (p = 0.024). When serum cortisol levels were compared within groups, cortisol levels 20 minutes after CO(2) insufflation were significantly higher (46.1 (9.5-175.7) and 27.0 (8.3-119.4) in the ETT and PLMA groups, respectively) than cortisol levels after anaesthesia induction (11.3 (2.8-92.5) and 16.6 (4.4-45.4) in the ETT and PLMA groups, respectively) in both groups (p = 0.001). PLMA usage is a suitable, effective and safe alternative to ETT in laparoscopic cholecystectomy patients with lower metabolic stress.
Article
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Endotracheal intubation involving conventional laryngoscopy elicits a haemodynamic response associated with increased heart and blood pressure. The study was aimed to see if video laryngoscopy and endotracheal intubation has any advantages over conventional laryngoscopy and endotracheal intubation in patients with coronary artery disease. Thirty patients suffering from coronary artery disease scheduled for elective coronary artery bypass grafting (CABG) were studied. The patients were randomly allocated to undergo either conventional laryngoscopy (group A) or video laryngoscopy (group B). The time taken to perform endotracheal intubation and haemodynamic changes associated with intubation were noted in both the groups at different time points. The duration of laryngoscopy and intubation was significantly longer in group B (video laryngoscopy) when compared to group A patients. However, haemodynamic changes were no different between the groups. There were no events of myocardial ischaemia as monitored by surface electrocardiography during the study period in either of the groups. In conclusion, video laryngoscopy did not provide any benefit in terms of haemodynamic response to laryngoscopy and intubation in patients undergoing primary CABG with a Mallampatti grade of <2.
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Aims to compare the efficacy of Proseal laryngeal mask airway(PLMA) and endotracheal tube (ETT) in patients undergoing laparoscopic surgeries under general anaesthesia. This prospective randomised study was conducted on 60 adult patients, 30 each in two groups, of ASA I-II who were posted for laparoscopic procedures under general anaesthesia. After preoxygenation, anaesthesia was induced with propofol, fentanyl and vecuronium. PLMA or ETT was inserted and cuff inflated. Nasogastric tube (NGT) was passed in all patients. Anaesthesia was maintained with N(2) O, O(2), halothane and vecuronium. Ventilation was set at 8 ml/kg and respiratory rate of 12/min. The attempts and time taken for insertion of devices, haemodynamic changes, oxygenation, ventilation and intraoperative and postoperative laryngopharyngeal morbidity (LPM) were noted. There was no failed insertion of devices. Time taken for successful passage of NGT was 9.77 s (6-16 s) and 11.5 s (8-17 s) for groups P and E, respectively. There were no statistically significant differences in oxygen saturation (SpO(2)) or end-tidal carbon dioxide (EtCO(2)) between the two groups before or during peritoneal insufflation. Median (range) airway pressure at which oropharyngeal leak occurred during the leak test with PLMA was 35 (24-40) cm of H(2)O. There was no case of inadequate ventilation, regurgitation, or aspiration recorded. No significant difference in laryngopharyngeal morbidity was noted. A properly positionedPLMA proved to be a suitable and safe alternative to ETT for airway management in elective fasted, adult patients undergoing laparoscopic surgeries. It provided equally effective pulmonary ventilation despite high airway pressures without gastric distention, regurgitation, and aspiration.
Article
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We describe a new laryngeal mask airway (LMA) that incorporates a second tube placed lateral to the airway tube and ending at the tip of the mask. The second tube is intended to separate the alimentary and respiratory tracts. It should permit access to or escape of fluids from the stomach and reduce the risks of gastric insufflation and pulmonary aspiration. It can also determine the correct positioning of the mask. A second posterior cuff is fitted to improve the seal. A preliminary crossover comparison with the standard mask in 30 adult female patients showed no differences in insertion, trauma or quality of airway. At 60 cm H2O intracuff pressure, the new LMA gave twice the seal pressure of the standard device (P<0.0001) and permitted blind insertion of a gastric tube in all cases. It is concluded that the new device merits further study.
Article
Lightwand devices are effective and safe as an aid to tracheal intubation. Theoretically, avoiding direct-vision laryngoscopy could allow for less stimulation by intubation than the conventional laryngoscopic procedure. We designed this prospective randomized study to assess the cardiovascular changes after either lightwand or direct laryngoscopic tracheal intubation in adult patients anesthetized with sevoflurane. Sixty healthy adult patients with normal airways were randomly assigned to one of three groups according to intubating procedure under sevoflurane/nitrous oxide anesthesia (fraction of inspired oxygen = 0.33) (n = 20 each). The lightwand group received tracheal intubation with Trachlight®, the laryngoscope-intubation group received tracheal intubation with a direct-vision laryngoscope (Macintosh blade), and the laryngoscopy-alone group received the laryngoscope alone. Heart rate and systolic blood pressure were recorded continuously for 5 min after tracheal intubation or laryngoscopy with enough time to intubate. All procedures were successful on the first attempt. The maximum heart rate and systolic blood pressure values obtained after intubation with Trachlight (114 ± 20 bpm and 143 ± 30 mm Hg, respectively) did not differ from those with the Macintosh laryngoscope (114 ± 20 bpm and 138 ± 23 mm Hg), but they were significantly larger than those in the laryngoscopy-alone group (94 ± 19 bpm and 112 ± 21 mm Hg) (P < 0.05). Direct stimulation of the trachea appears to be a major cause of the hemodynamic changes associated with tracheal intubation.
Article
Robotic surgery is the latest development in minimal invasive surgery. It provides superior visualisation and dexterity and therefore allows the surgeon to perform complex tasks that would exceed his/her abilities with conventional laparoscopy and would be associated with an increased morbidity if performed by laparotomy. Current evidence demonstrates the feasibility and safety of this technology in gynaecology. The costs of robotic surgery remain one of the main sources of controversy but are expected to come down with further developments of the technology. If evidence-based long-term outcome evaluations show the superiority of robotic surgery in comparison to conventional laparoscopic and open surgery, this technology will have a major impact on gynaecological surgery.
Article
The changes occurring in total respiratory system, lung and chest wall mechanics, lung volume and gas-exchange during abdominal insufflation with carbon dioxide for laparoscopic cholecystectomy were studied. Using the technique of rapid airway occlusion during constant flow inflation together with an oesophageal balloon, we computed compliance and maximum resistance of the respiratory system, subsequently apportioning it into its lung and chest wall components. Maximum resistance of the respiratory system was further divided into airway resistance and the viscoelastic properties of the lung and the chest wall. In 10 patients (group 1), we measured respiratory system, lung and chest wall mechanics (compliance and resistance), functional residual capacity, end-tidal carbon dioxide tension and oxygen saturation. In addition, arterial blood gas analysis and end-tidal carbon dioxide tension were measured in a second group of 10 patients (group 2). Measurements, in both groups, were obtained in the reverse Trendelenburg position, at 15 min after the induction of anaesthesia, 5 min and 45 min after abdominal insufflation and at 15 min after abdominal deflation. Tidal volume, respiratory rate, inspiratory flow and the fraction of inspired oxygen were similar in both groups and maintained constant during the procedure. We found that abdominal carbon dioxide insufflation caused: a reduction in compliance of the respiratory system (both lung and chest wall components) and of functional residual capacity; a marked increase in the maximum resistance of the respiratory system (mainly due to increases in the viscoelastic properties of the lung and chest wall); no change in oxygenation, but an increase in the end-tidal carbon dioxide tension (which was correlated closely with the arterial carbon dioxide tension). These changes were not affected by the duration of anaesthesia.
Article
The ProSeal laryngeal mask airway (PLMA) is a new laryngeal mask device with a larger, wedge‐shaped cuff and a drainage tube. We tested the hypothesis that directly measured mucosal pressure and oropharyngeal leak pressure (OLP) are higher for the PLMA compared with the laryngeal mask airway (LMA†). We also assess the mechanism of seal, and the reliability of cuff volume, in vivo intracuff pressure and calculated mucosal pressure (in vivo minus in vitro intracuff pressure) to predict directly measured mucosal pressure. Thirty‐two anaesthetized, paralysed adult patients were randomly allocated to receive either a size 4 LMA or PLMA. Microchip sensors were attached at locations corresponding to: (a) base of tongue; (b) distal oropharynx; (c) hypopharynx; (d) lateral pharynx; (e) posterior pharynx; and (f) pyriform fossa. In vitro and in vivo intracuff pressures, OLP and directly measured mucosal pressure were documented at zero volume and after each 10 ml up to 40 ml. Directly measured mucosal pressure was similar between devices for a given cuff volume, but was lower for the PLMA for a given OLP. Directly measured mucosal pressure was highest in the distal oropharynx for both devices, but rarely (<5%) exceeded 35 cm H2O. OLP was higher for the PLMA at all cuff volumes. Directly measured mucosal pressure was usually lower than OLP for both devices, and there was a positive correlation between directly measured mucosal pressure and OLP. Cuff volume, in vivo intracuff pressure and calculated mucosal pressure were poor to moderate predictors of directly measured mucosal pressure for the LMA and PLMA. We conclude that the PLMA forms a better seal than the LMA without an increase in directly measured mucosal pressure. Br J Anaesth 2000; 85: 262–6
Article
To investigate the use of Laryngeal Mask Airway (LMA) and its comparison with the endotracheal tube for positive pressure ventilation. A tertiary care teaching hospital. Fifty adult ASA I and II patients undergoing peripheral limb surgery were randomly allocated to 2 groups for LMA or endotracheal tube insertion. A standardized anaesthetic technique was used. The groups were then compared regarding haemodynamic changes on insertion as well as removal of LMA and ETT and any complications that occurred were noted. The haemodynamic response to insertion was significantly attenuated (p < 0.05) in LMA group as compared to ETT group. The cardiovascular response to extubation was not significantly different between the groups. A higher incidence of coughing and mild hypoxaemia at extubation was noted in ETT group as compared to LMA group (p < 0.05) and blood was detected in 4 cases after LMA removal. It is concluded that the use of LMA during positive pressure ventilation is safe in selected cases. There is an attenuated haemodynamic response to insertion of LMA as compared to endotracheal tube which will be beneficial in certain patients e.g., those with ischaemic heart disease, vascular disease and hypertensives.