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The comparison of ProSeal laryngeal mask airway and endotracheal tube in patients undergoing laparoscopic surgeries under general anaesthesia

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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.
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129
Indian Journal of Anaesthesia | Vol. 55| Issue 2 | Mar-Apr 2011
The comparison of Proseal laryngeal mask airway
and endotracheal tube in patients undergoing
laparoscopic surgeries under general anaesthesia
Namita Saraswat, Aditya Kumar1, Abhijeet Mishra2, Amrita Gupta1, Gyan Saurabh3,
Uma Srivastava1
Departments of Anaesthesia and 3Surgery, Lady Hardinge Medical College, New Delhi, 1Department of
Anaesthesia, S.N. Medical College, Agra and 2RML Hospital, New Delhi, India
How to cite this article: Saraswat N, Kumar A, Mishra A, Gupta A, Saurabh G, Srivastava U. The comparison of Proseal laryngeal mask
airway and endotracheal tube in patients undergoing laparoscopic surgeries under general anaesthesia. Indian J Anaesth 2011;55:129-34.
ABSTRACT
Aims to compare the efcacy 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 inated.
Nasogastric tube (NGT) was passed in all patients. Anaesthesia was maintained with N2O, O2,
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 signicant differences
in oxygen saturation (SpO2) or end-tidal carbon dioxide (EtCO2) between the two groups before or
during peritoneal insufation. Median (range) airway pressure at which oropharyngeal leak occurred
during the leak test with PLMA was 35 (24-40) cm of H2O. There was no case of inadequate
ventilation, regurgitation, or aspiration recorded. No signicant difference in laryngopharyngeal
morbidity was noted. A properly positioned PLMA 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.
Key words: Endotracheal tube, IPPV, laparoscopy, oropharyngeal seal pressure, Proseal LMA
Address for correspondence:
Dr. Namita Saraswat,
Department of Anaesthesia,
Lady Hardinge Medical
College, New Delhi, India.
E-mail: namita_saraswat@
yahoo.com
INTRODUCTION
In spite of tremendous advances in contemporary
anaesthetic practice, advances, airway management
continues to be of paramount importance to
anaesthesiologists. Till date, the cuffed tracheal tube
was considered as the gold standard for providing a
safe glottic seal, especially for laparoscopic procedures
under general anaesthesia.[1] The disadvantages of
tracheal intubation, which involves rigid laryngoscopy,
are in terms of concomitant haemodynamic responses
and damage to the oropharyngeal structures at
insertion. Postoperative sore throat is also a serious
concern. This precludes the global utility of the
tracheal tube and requires a better alternative.[2] Over
a period of time, new airway devices have been added
to the anaesthesiologist’s armamentarium.
Proseal laryngeal mask airway (PLMA) has a dorsal
cuff, in addition to the peripheral cuff of LMA, which
pushes the mask anterior to provide a better seal
around the glottic aperture and permits high airway
Access this article online
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DOI: 10.4103/0019-5049.79891
Quick response code
Clinical
Investigation
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Saraswat, et al.: Proseal LMA vs endotracheal tube in laparoscopic surgeries
pressures without leak. The drain tube parallel to
the ventilation tube permits drainage of passively
regurgitated gastric fluid away from the airway and
serves as a passage for gastric tube.[2] The PLMA is a
relatively new airway device in developing nations.
This study is therefore undertaken to compare PLMA
with standard tracheal tube for the number of attempts
and time taken for insertion, haemodynamic changes,
oxygenation, ventilation and intraoperative and
postoperative laryngopharyngeal morbidity (LPM)
occurring during general anaesthesia in young healthy
adult patients undergoing laparoscopic surgeries.
METHODS
After obtaining the Ethics committee approval and
written informed consent, this prospective randomised
study was conducted on 60 healthy patients. The
patients were of either sex belonging to ASA physical
status grade I and II, aged 20-65 years and body weight
40-76 kg, who underwent laparoscopic procedures
under general anaesthesia. Patients with anticipated
difficult airway, obesity (body mass index > 35 kg/m2),
oropharyngeal pathology, cardiopulmonary disease,
cervical spine fracture or instability, or at increased
risk of aspiration (gastro-esophageal reflux disease,
hiatus hernia, and pregnant patients) were excluded
from the study.
Patients were randomised for airway management
with the PLMA or endotracheal tube (ETT) by
opening an opaque envelope inside the operation
theatre containing the computer-generated random
assignment into two groups of 30 each. Patients in
group P were to receive a PLMA and patients in group
E were to undergo endotracheal intubation. Patients
were premedicated with oral alprazolam 0.5 mg the
night before surgery and on the day of surgery. After
intravenous (IV) access was obtained, ranitidine 50
mg and metoclopramide 10 mg were administered
30 minutes before surgery. In the operation theatre,
standard monitors were attached and baseline
parameters were recorded. Injections of midazolam
0.02 mg/kg, glycopyrrolate 0.005 mg/kg, and fentanyl
1-2 µg/kg were administered 1-2 min before induction.
After preoxygenation with 100% O2 for 3-5 minutes,
anaesthesia was induced with injection of propofol
2-2.5 mg/kg till the loss of verbal commands.
Neuromuscular blockade to facilitate placement of
device was achieved by vecuronium 0.08-0.1 mg/
kg. Following induction and adequate paralysis, the
corresponding airway was inserted in each group. The
airway devices were inserted by anaesthesiologists
with at least 1 year experience with PLMA and ETT.
In group P, size 3 or 4 PLMA (according to weight)
was used. For the purpose of standardisation, we used
the introducer for inserting the PLMA for all cases
as recommended by the manufacturer. In group E,
endotracheal intubation (7.5 in females and 8 in males)
was performed in standard manner. 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 chest movement on manual ventilation
• Square wave capnography
• Expired tidal volume of more than 8 ml/kg
• No audible leak from the drain tube with peak
airway pressure (PAP) less than 20 cm H2O. A leak
below 20 cm H2O was taken as significant and
suggested a malposition
• The gel displacement test, done by placing a blob
of gel at the tip of the drain tube (DT) and noting
the airway pressure at which it was ejected
The last two tests were specific for group P.
Anaesthesia was maintained with oxygen, nitrous
oxide, halothane, and vecuronium.
The outcomes measured were as follows:
• Insertion characteristics of the PLMA or ETT and
the nasogastric tube (NGT) via the PLMA and the
ETT (NGT was introduced in all cases).
• Easy insertion – insertion at first attempt with
no resistance; difficult insertion –insertion with
resistance or at second attempt; and failed insertion
– insertion not possible.
• Haemodynamic responses (heart rate and mean
arterial blood pressure) were recorded before
induction; at the time of insertion; 1 and 3, 5
min after insertion of device; after achieving
carboperitoneum, and during removal of devices.
• Oxygen saturation (SpO2) and end-tidal carbon
dioxide (EtCO2); at a tidal volume of 8 ml/kg,
fraction of inspired oxygen (FiO2) 0.33, respiratory
rate of 12/min and I/E of 1:2 were recorded.
• The aim was to maintain target SpO2 (>95%)
and EtCO2 (<45 mm Hg) by adjusting the FiO2,
respiratory rate and tidal volume. When SpO2 was
94-90% the oxygenation was graded as suboptimal
and failed if it was <90%.
• Oropharyngeal seal pressure was determined by
closing the expiratory valve at a fixed gas flow of 5
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Saraswat, et al.: Proseal LMA vs endotracheal tube in laparoscopic surgeries
l/min and recording the airway pressure at which
equilibrium was reached. The airway pressure was
not allowed to exceed 40 cm H2O.
• The PAP was recorded when intra-abdominal pressure
(IAP) reached 16 mm Hg. For standardisation, IAP
was maintained at 12-16 mm Hg.
• Incidences of gastric distension (by surgeon),
regurgitation, aspiration, intraoperative and
postoperative laryngopharyngeal morbidity were
noted.
Statistical analysis
Data were analysed using INSTAT 3 (GraphPad Software,
California, USA). The primary variables studied were
oxygenation and adequacy of ventilation. Secondary
variables were time to achieve an effective airway, airway
interventions required, haemodynamic parameters,
cuff leak pressure, and PAP. Sample size of 60, with
30 patients in each group was determined for primary
variables (O2 saturation and EtCO2), using the following
information from various previous studies: standard
deviations of 5% and 5 mm Hg for the two variables,
respectively, were considered statistically significant.
If the statistically significant difference in a decrease in
oxygen saturation was less than 95% for one of the devices,
it was considered to be clinically significant. Sample
size was calculated assuming a two-sided test with
α = 0.05 and the power of 0.9. Two-sided independent
Student’s t tests to analyse continuous data, and Fisher’s
exact test for categorical data. P<0.05 was considered as
significant.
RESULTS
The surgical procedures, patient characteristics and
details of anaesthesia and airway management are
shown in Figure 1. Demographic data were comparable
in both groups.
Size 3 PLMA placement was attempted in 19 patients,
size 4 in 11 patients [Table 1]. Insertion success rate
was 86.67% for the first attempt, and two attempts
were made in 13.33% patients. Insertion was easy
in 23 and difficult in 7 patients. In Group E, the
insertion success rate was 83.37% for the first attempt;
two attempts were made in 13.33% of patients and
third attempt was required in 3.33% patients. There
was no failed insertion reported in either group.
Mean time (range) taken for successful placement was
15.77 s (12-21 s) and 16.93 s (11-28 s) for PLMA and
ETT, respectively.
Time taken for successful passage of NGT was 9.77
s (6-16 s) and 11.5 s (8-17 s) for P and E groups,
respectively.
On comparing the trends within groups statistically
significant (P<0.05) increase in heart rate and the
mean blood pressure was observed 10 seconds
after intubation and persisted till 3 minutes after
intubation and during the time of extubation in
the ETT group. However, statistically significant
(P<0.05) increase in the heart rate and mean blood
pressure in PLMA group was seen only 10 seconds
after insertion [Figure 2].
The EtCO2 was comparable in both groups throughout
the surgery (P>0.05) and did not increase beyond
45 mm Hg.
The PAP in group P showed a statistically significant
(P<0.05) increase in value after insertion till 6 minutes
after pneumoperitoneum was attained, and thereafter
it was insignificant.
Figure 1: Demographic data and type of procedures done
Table 1: Details of airway management
Airway device details PLMA ETT P value
Size of device (3/4,7.5/8) 19/11 23/7
Attempt of insertion (1/2/3/
failed)
26/4/0/0 25/4/1/0
Time taken for insertion of
device, Mean (SD)
15.77 (2.97) 16.93 (4.07) 0.209
Attempts at gastric tube
insertion (1/2/3/failed)
27/3/0/0 20/7/3/0
Time taken for insertion of
gastric tube, Mean (SD)
9.77 (2.44) 11.5 (2.28) 0.006
Oropharyngeal seal
pressure, Median
35 cm of
H2O
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Saraswat, et al.: Proseal LMA vs endotracheal tube in laparoscopic surgeries
Both groups maintained oxygen saturation
perioperatively except in one patient in the PLMA
group where oxygen saturation dropped to 94%
(suboptimal oxygenation) after placing patients in
the reverse Trendelenburg position. The oxygen
saturation returned to normal after the PLMA was
repositioned.
Oropharyngeal seal pressure for PLMA group observed
was 35 mm Hg (median), with no clinically audible
leak throughout the surgery. The PAP, however, did
not increase beyond the oropharyngeal seal pressure
in the PLMA group [Table 1].
In the present study, coughing after removal of PLMA
was seen in 6.67% patients, while it was seen in
3.33% patients in the ETT group. Blood staining of
device on removal was seen in 10% patients in group
P and in 16.67% patients in group E. Minor trauma
to the lip and gums was seen in 1 patient (3.33%) in
group E. There was no incidence of intraoperative or
postoperative laryngospasm, bronchospasm, in either
group. There was no incidence of regurgitation or
clinically detectable pulmonary aspiration in either
group [Table 2]. In 3 patients, gastric distention was
successfully decompressed via NGT suction. Sore
throat postoperatively was seen in 10% patients in
group P and in 20% patients in group E. After 24
hours, no patient in group P but 2 patients (6.67%) in
E group complained of sore throat.
DISCUSSION
The PLMA is a new entrant to the family of LMA
with some added features over the classic LMA.[3]
This study was conducted with the aim of comparing
PLMA and ETT as a ventilatory device in 60 patients
undergoing laparoscopic surgeries. We chose this study
because increased intra-abdominal pressure from
pneumoperitoneum requires higher airway pressures
for adequate pulmonary ventilation, for which the
PLMA has proved to be adequate in previous[1,2,4] studies.
Although PLMA was easier to insert with higher success
rate (86.67%) in the first attempt than the ETT (83.33%),
this was not statistically significant. Mean time taken
for successful placement was 15.77 s and 16.93 s for
groups P and E, respectively. Studies by Cook, Shroff
and coworkers (median effective time 15 s) corroborated
with our study findings.[4,5] Sharma and coworkers,
in their study of 100 and 1,000 PLMA insertions,
reported a mean insertion time of 13.51 s and 12 s,
respectively.[1,6] This lesser time could be attributed to the
fact that their study was conducted by anaesthesiologists
who had more experience in working with PLMA.
A NGT was inserted in all patients. The mean insertion
time taken to insert NGT through PLMA was significantly
less (9.77 s) than via nose (11.5 s) in intubated patients.
Similarly, the success rate of NGT in the first attempt
was higher (90%) via Proseal than via nasal route in
intubated patients (66.67%). These factors may be of
clinical relevance in patients with hypertension, head
injury, and ischaemic heart disease.
There was minimum haemodynamic stress response
with PLMA when compared with endotracheal
intubation. These findings are similar to those of
previous studies.[1,2,7]
Figure 2: Haemodynamic parameters
Statistically signicant increase in heart rate and mean blood pressure
was observed 10 seconds after intubation and persisted till 3 minutes
after intubation and also during extubation in the ETT group. However,
statistically signicant increase in Proseal-LMA group was seen only
10 seconds after insertion.
Table 2: Laryngopharyngeal morbidity
PLMA ETT P
Intraoperative
1. Leak 1 -
2. Gastric insufation 3 -
3. Regurgitation, aspiration - -
At removal
1. Coughing 2 1 0.556
2. Blood staining of device 3 5 0.45
3. Trauma to lip, teeth, tongue 4 1 0.17
Postoperative
1. Vomiting - -
2. Sore throat 3 7 0.171
3. Dysphagia, dysphonia, dysarthia - -
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Saraswat, et al.: Proseal LMA vs endotracheal tube in laparoscopic surgeries
The increase in heart rate during intubation is attributed
to sympathetic stimulation during laryngoscopy
and the passage of the ETT through the vocal
cords.[1,8,9] The PLMA being a supraglottic device does
not require laryngoscopy and probably does not evoke
a significant sympathetic response. Attenuation of this
response may be due to diminished catecholamine
release.[10] This could be due to the fact that the PLMA
is relatively simple and atraumatic to insert and does
not require laryngoscopy.[9]
Following peritoneal insufflation, CO2 is absorbed
transperitoneally, and the rate at which this occurs
depends on gas solubility, perfusion of the peritoneal
cavity, and duration of the pneumoperitoneum.[11]
Both groups maintained adequate oxygenation and
ventilation perioperatively, except in one patient in
the PLMA group, where oxygen saturation dropped to
94% (suboptimal oxygenation) after placing the patient
in reverse Trendelenburg position. We repositioned
the PLMA and oxygen saturation returned to normal
thereafter.
Maltby et al. and Sharma et al. found no statistically
significant differences in SpO2 or EtCO2 between
the two groups before or during peritoneal
insufflations.[7,11]
However, Sharma and colleagues in a later study noted
that although all patients had optimal oxygenation,
three patients had EtCO2 in excess of 55 mm Hg after
CO2 insufflation.[6] This was explained by the fact
that the airway tube was narrow and the epiglottis
downfolded in some patients. The incidence of
epiglottic downfolding has been reported to be as high
as 31-66%.[12]
The observed oropharyngeal seal pressure for PLMA
group was 35 mm Hg (median), with no clinically
audible leak throughout the surgery. The PAP did
not increase beyond the oropharyngeal seal pressure
throughout surgery. This is in accordance with the
findings of previous studies.[1,3,6,7]
In three patients, gastric distention was successfully
decompressed by suctioning the NGT. There was no
incidence of regurgitation or aspiration in either group.
Similar results have been reported by others.[1,13,14]
The incidence of sore throat was comparatively
more in the intubation group E (20%) than in group
P (10%). All patients were administered gargles and
steam inhalation. After 24 hours, none of the patients
in the Proseal group had sore throat; however, two
patients in group E had persistent sore throat till 48
hours. Higgins et al. and Shroff et al. also found the
greatest incidence of sore throat in patients undergoing
intubation than in those in whom a PLMA was
used.[4,14] The virtual absence of sore throat in PLMA
group could be explained by the fact that it is a
supraglottic device and mucosal pressures achieved
are usually below pharyngeal perfusion pressures.[15]
Although endotracheal intubation is the gold
standard in laparoscopic surgeries done under general
anaesthesia, the PLMA proved to be an equally
effective airway tool in laparoscopic surgeries in terms
of adequate oxygenation and ventilation with minimal
intraoperative and postoperative complications. The
haemodynamic stress response was also minimal with
PLMA when compared to endotracheal intubation.
It provided equally effective pulmonary ventilation
despite high airway pressures without significant
gastric distention, aspiration, and regurgitation.
CONCLUSION
Hence, we conclude that the PLMA proved to be
a suitable and safe alternative to ETT for airway
management in elective fasted, adult patients
undergoing laparoscopic surgeries.
REFERENCES
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laryngeal mask airway: A study of 100 consecutive cases of
laparoscopic surgery. Indian J Anaesth 2003;47:467-72.
2. Misra MN, Ramamurthy B. The Pro-Seal LMAtm and the
tracheal tube: A comparison of events at insertion of the airway
device. Internet J Anesthesiol 2008. Vol. 16. [Last accessed on
2010 Jul 9].
3. Brain AI, Verghese C, Strube PJ. The LMA ‘ProSeal’ – a laryngeal
mask with an oesophageal vent. Br J Anaesth 2000;84:650-4.
4. Shroff P, Surekha K. Randomized comparative study between
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for laparoscopic surgery. Internet J Anesthesiol 2006. Vol. 11.
[Last accessed on 2010 Jul 9].
5. Cook TM, Nolan JP, Verghese C, Strube PJ, Lees M, Millar JM,
et al. A randomized crossover comparison of the proseal with
the classic laryngeal mask airway in unparalysed anaesthetized
patients. Br J Anaesth 2002;88:527-33.
6. Sharma B, Sood J, Sahai C, Kumara VP. Efficacy and safety
performance of proseal laryngeal mask airway in laparoscopic
surgery: Experience of 1000 cases. Indian J Anaesth 2008;52:
288-96.
7. Maltby JR, Beriault MT, Watson NC, Liepert DJ, Fick GH. The
LMA proseal is an effective alternative to tracheal intubation for
laparoscopic cholecystectomy. Can J Anaesth 2002;49:857-62.
8. Fujii Y, Tanaka H, Toyooha H. Circulatory responses to laryngeal
mask airway insertion or tracheal intubation in normotensive
and hypertensive patients. Can J Anaesth 1997;44:1082-6.
9. Evans NR, Gardner SV, James MF, King JA, Roux P, Bennett P,
et al. The proseal laryngeal mask: Results of a descriptive trial
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with experience of 300 cases. Br J Anaesth 2002;88:534-9.
10. Lamb K, James MF, Janicki PK. Laryngeal mask airway for
intraocular surgery, effects on intraocular pressure and stress
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11. Piper J. Physiological equilibria of gas cavities in the body. In:
Fenn WO, Rahn M, editors. Handbook of Physiology. Section 3:
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12. Brimacombe J. The proseal laryngeal mask airway: An easier
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13. Maltby JR, Beriault MT, Watson NC, Liepert DJ, Fick GH.
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Anaesth 2003;50:71-7.
14. Higgins PP, Chung F, Mezei G. Postoperative sore throat after
ambulatory surgery. Br J Anaesth 2002;88:582-4.
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Anaesth 1992;69:621-30.
ANNOUNCEMENT
9th Congress of SAARC Associaon of Anaesthesiologists
Thursday, 25th August – Sunday, 28th August 2011
Hosted by: Indian Society of Anaesthesiologists Organized by : ISA – Karnataka State & Bangalore City Branch
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... 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. ...
... However, there was detection bias noted in few studies. [11,16,18,28] Hoarseness was reported in eight studies. [4,[8][9][10][11]18,21,25] Analysis of pooled data showed 38% reduction in incidence of hoarseness in SAD group as compared to ET intubation group (RR 0.38, P < 0.01 [0.21, 0.69], i 2 = 72%) [ Figure 3b]. ...
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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.
... It also has a gastric drainage tube that separates the respiratory tract from the esophagus and helps remove gastric fluids, reducing the risk of aspiration. [2][3][4][5] Despite the advantages, there are problems about using SADs in certain surgical positions, like the Trendelenburg position, used in laparoscopic surgeries. This position can lead to increased airway pressures due to the effects of pneumoperitoneum, and if SADs leak air, it can inflate the stomach excessively, increasing the risk of aspiration. ...
... Methodology: Before arrival at the operating room, the patient was assessed preoperatively in the preoperative room; antral CSA was calculated using ultrasound. The stomach of the patient in a supine position was imaged, and the antral CSA of the stomach was measured by an experienced anesthesiologist with a curved array transducer of a SonoSite 21 EDGE II Ultrasound System using a curvilinear probe (2)(3)(4)(5). Between the left liver lobe in the anterior position and the pancreas in the posterior position in a sagittal or parasagittal scanning plane in the epigastrium, the antrum was located superficially. ...
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Background In the context of perioperative care, the concern of gastric content aspiration during surgical procedures is crucial, though relatively rare. Supraglottic devices after the creation of pneumoperitoneum and positive pressure ventilation may cause gastric insufflation. This study explores the unique aspects of antral cross-sectional area (CSA) measurement as a novel indicator in comparing the use of ProSeal laryngeal mask airway (LMA) and endotracheal intubation in airway management during lower abdominal surgeries and assessing postoperative recovery in both the groups. Methods The study commenced after obtaining approval from Institutional Ethical Committee (IEC number-AIIMS/IEC/22/251 Date: 27/05/2022) and after registration in Clinical Trials Registry - India (CTRI) (CTRI/2022/07/044102 Registered on: 18/07/2022) and was conducted from August 2022 to August 2023. A total of 72 ASA I and II participants were included in two groups: endotracheal tube (ETT) (Group E) and PLMA (Group P). The primary outcome was the antral CSA, and secondary outcomes included hemodynamic and respiratory parameters, time to start clear fluid, light diet, and length of stay. Results Our results showed that there was no statistically significant difference between the two groups in antral CSA at various time intervals. The hemodynamic variables were significantly higher in the endotracheal tube group ( P < 0.0001). The absence of significant differences in time to start clear liquids, time to start a light diet, and time to achieve bowel movements between the ETT and PLMA groups suggested that both airway management techniques are equally safe in facilitating postoperative recovery concerning gastrointestinal functions. Conclusions Patients who underwent minimally invasive lower abdominal surgeries, choice of airway management technique, whether ETT or PLMA, did not substantially impact antral CSA, vital parameters, respiratory parameters, or postoperative recovery.
... Figure 3 depict that there was no significant changes in percentage saturation of Oxygen in both groups in relation to different timing of measurement and it was >97% at any point. In a research study, there also found no significant differences in outcomes in between the use of ETT and LMA tube 51 . ...
... P-values suggests insignificant result here (>0.05). In a study of Namita S. et al 51 . it was found that in case of haemodynamic status, there was no significant comparative results between ETT and LMA groups also. ...
Article
Background: Evidence based data in the very recent years suggest that in spite of tremendous advances in contemporary anaesthetic practice and advances, airway management continue to be of paramount importance to anaesthesiologists and data regarding the outcomes of use of LMA (laryngeal mask airway) in contrast to ETT (endotracheal tube) are scanty in our clinical setup. Aims & Objectives: In this RCT (Randomized Control Clinical Trial), the ultimate aim was to depict the anaesthetic safety and haemodynamic changes of use of LMA in contrast to ETT for the patients of routine laparoscopic cholecystectomy (ASA II & III). Methods and Materials: This randomized control clinical trial (RCT) was conducted in BIRDEM General Hospital, Dhaka, Bangladesh with a total number of 60 patients (30 patients with endotracheal tube & 30 patients with LMA) were selected on the basis of systemic random sampling. The haemodynamic changes, oxygenation, ventilation and intraoperative and postoperative laryngopharyngeal complication (LPM) were noted. Results: The ultimate result of this study suggest that in Group A (ETT group), mean±SD of age was 48±1.9 and in Group B (LMA group), it was 52±1.7. Demographic status suggests that the average BMI in both group were 28.9 and 30.6 respectively. In ETT group, majority of patients (69%) had ASA grade II, in contrast, in LMA group, it was 52%. Average anaesthetic duration in both group were 45 & 50 minutes respectively. There found significant difference in haemodynamic parameter during Intubation and LMA insertion. There were no statistically significant differences in oxygen saturation (SpO2) between the two groups before or during peritoneal insufflation. Laryngeal complications, like coughing and vomiting following removal of tube were found in 6.7% and 3.3% patients respectively with the use of LMA. No case of tube leak, gastric insufflation, regurgitation, aspiration, trauma to lip, teeth, tongue, dysphagia, dysphonia and dysarthia was recorded. P-values suggests statistically insignificant result here (>0.05). Conclusion: The effectiveness and safety of LMA in terms of intra and postoperative haemodynamic status, SaO2 and laryngeal complications are clinically comparable to those of endotracheal tube. And LMA insertion causes less changes of haemodynamic parameters when compared with that of ET intubation. Our finding suggests that LMA can be safe and beneficial alternative to ETT. JBSA 2017; 30(1): 34-40
... However, rigid laryngoscopy can cause hemodynamic responses, damage to oropharyngeal structures during intubation, and other invasive complications, highlighting the need for better alternatives like Supraglottic Airway Devices (SADs). 5 The second generation of SADs includes a gastric drain tube that separates the respiratory and alimentary tracts, offering a better oropharyngeal seal and improved protection against regurgitation and pulmonary aspiration compared to the first generation. 6 In 1981, Archie Brain invented the laryngeal mask airway (LMA) to overcome the concerns of position instability and epiglottic blockage observed in mask and other airway usage while creating no higher gastric insufflation than endotracheal tubes (ETT).7 ...
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Background: Many supraglottic airway devices are utilized instead of intubation. In this single-blind, interventional prospective trial, we compared I-Gel, LMA Supreme, and Ambu AuraGain in laparoscopic procedures performed under general anaesthesia. The aim and objectives were to compare the time and number of attempts required for SGA, Nasogastric tube insertion, the intra-operative and post-operative SGA complications and the Oropharyngeal seal pressure. Material and Methods: Following institutional review board approval and written informed consent. A comparative, single-blind, interventional prospective study was conducted. Patients with American Society of Anesthesiologists physical status 1 and 2 who met the qualifying requirements were randomly assigned to one of three groups: Group A I-Gel (n=30), Group B LMA Supreme (n=30), or Group C Ambu AuraGain (n=30). The major purpose was to compare the duration and number of attempts required for SGA insertions. Results: Demographic data were not different across the groups. Group A I-Gel had a significantly lower SAD insertion time (19.93±1.91 s) compared to Group B LMA Supreme (25.63±1.75) and Group C Ambu AuraGain (29.77±2.47). One number of attempt was significantly (p=0.01) lower in Ambu AuraGain (43.3%) than LMA Supreme (50%) and I-Gel (80%) group. The pairwise comparison revealed that there was significant difference in number of attempts required for LMA insertion between Ambu AuraGain& I-Gel (p=0.006) and LMA Supreme & I-Gel (p=0.03). The OLP forGroup C (30.83±2.10 cm H2O) was greater than Group B (26.10±1.66 cm H2O) and Group A (22.70±1.44 cm H2O). There was no significant difference (p>0.05) in the number of attempts needed for nasogastric tube insertion between the groups. There was no significant difference (p>0.05) in perioperative and postoperative complications within or between groups. Conclusion: Ambu AuraGain has higher oropharyngeal seal pressures than I-gel and Supreme LMA, as well as comparable hemodynamic stability and postoperative outcomes, making it a better SAD for laproscopic procedures than I-gel and Supreme LMA. I-Gel's shorter insertion time makes it better suited for resuscitation and emergencies.
... Patients were extubated, when the extubation criteria, as follows, were fulfilled: sustained head lift and hand grip for 5 seconds, adequate level of consciousness and maximum inspiratory pressure ≥40 to 50 cm H2O respectively. 11 Extubation quality was rated using extubation quality 5point scale: 2-smooth extubation, minimal coughing; 3moderate coughing (3 or 4 times); 4-severe coughing (5 to 10 times) and straining; 5-poor extubation, very uncomfortable (laryngospasm and coughing >10 times). ...
Article
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Background: Airway management poses significant challenges for anesthesia and critical care providers. The Ambu Aura is an innovative supraglottic airway device that is compatible with magnetic resonance imaging. It is designed to be disposable, phthalate-free, and allows for the use of traditional cuffed tracheal tubes in patients of all ages. The present study was aimed to compare the hemodynamic changes and complications in endotracheal tube and Ambu AuraGain extubation in patients undergoing surgery. Methods: This was a randomized, controlled study conducted on 30 ASA I/II patients undergoing surgery. The patients were divided into two groups, group T (n 15): endotracheal tube and group A (n = 15): Ambu AuraGain respectively. The hemodynamic parameters such as heart rate (HR), mean arterial pressure (MAP) were measured at extubation and at 1 minute, 3 minutes, 5 minutes, 7 minutes, 10 minutes, 13 minutes and 15 minutes after extubation and compared between the groups. Results: Ambu AuraGain showed significant decrease in HR and MAP 1 minute, 3 minutes, 5 minutes, 7 minutes, 10 minutes, 13 minutes and 15 minutes after extubation when compared to endotracheal tube and it was found to be significant. Further, the frequency of cough (6.7% versus 26.7%; p=0.002) and laryngospasm (0% versus 13.3%; p=0.002) was lower in Ambu AuraGain when compared to endotracheal tube. Conclusions: Ambu AuraGain may be a viable alternative to traditional endotracheal tubes in clinical settings with good safety profile.
... According to Alvarado & Panakos, the ETT size formula for children is (Age/4 + 3.5) for cuffed tubes and (Age/4 + 4) for uncuffed tubes [3]. Despite its popularity, there are several drawbacks, such as laryngospasm, a sore throat following extubation, and damage to the tracheal mucosa [4]. ...
Article
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The present systematic review compares the effects of the laryngeal mask airway (LMA) and the endotracheal tube (ETT) on hemodynamic response and airway difficulties in pediatric anesthesia patients. The terms "children," "postoperative," "pediatrics," "laryngeal mask airway," "endotracheal tube," and "subglottic" were utilized. The scope of the literature review was limited to randomized controlled trials (RCTs), and PubMed, Google Scholar, and the Cochrane Library were among the databases searched. Two reviewers used the Cochrane Risk of Bias Tool to assess quality. Eight RCTs in total were included. When compared to the ETT, results showed that the number of attempts for endotracheal intubation was fewer than for the placement of the LMA. Additionally, there was an increase in blood pressure, heart rate, and mean arterial pressure with the use of the ETT. The incidence of postoperative respiratory complications, including laryngospasm, bronchospasm, and sore throat, was higher with the use of the ETT. We conclude that the use of the LMA can be a safe alternative to the ETT in pediatric patients, producing fewer hemodynamic changes and postoperative complications.
... [2] Such use of SADs was reported way back in the late 20th century when LMA-classic was reported to be used for ambulatory anaesthesia. [4] The clinical use of SADs, particularly PLMA and I-gel, extended to involve general anaesthesia with positive pressure ventilation and during cardiopulmonary resuscitation requiring airway management. [5] The PLMA is designed with a cuff that extends over the posterior surface of the mask as well as around its periphery, which pushes the mask anteriorly to provide a better seal around the glottic aperture and permits peak airway pressure of more than 30 cmH2O without leaks. ...
Article
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Background Supraglottic airway devices (SADs) may be used during laparoscopic procedures in place of the often utilised endotracheal tube. The Proseal laryngeal mask airway (PLMA) is designed with an inflatable cuff, which provides an excellent oropharyngeal seal, and the I-gel is a newer SAD designed with a softer and noninflatable cuff and sharing similar features with PLMA. Aim and Objectives This study compared the ease of insertion, haemodynamic and ventilatory parameters as well as morbidities associated with these SADs when used for airway management during diagnostic laparoscopic procedures. Patients and Methods Eighty American Society of Anaesthesiologist I and II patients aged 18–60 years undergoing diagnostic laparoscopic surgery under controlled ventilation had either I-gel or PLMA used for airway management. Anaesthesia was induced with standard dose of propofol, patient received atracurium, fentanyl and the SAD inserted. Pulse oximetry, capnography, noninvasive blood pressure, oropharyngeal leak pressure (OLP), and evidence of pharyngolaryngeal morbidity were assessed. Data were analysed using the Statistical Package for Social Sciences version 21.0. The quantitative variables were analysed using the Student’s t test and the qualitative using the Chi-square test. A P value of less than 0.05 was considered significant. Results The success rates at first insertion for I-gel and PLMA were 95% and 80%, respectively (P = 0.04). The mean changes in mean arterial pressure following insertion were 9.6 mmHg (±4.7) and 10.6 mmHg (±8) for I-gel and PLMA, respectively (P = 0.02). The OLP during insufflation was higher in the PLMA (35.8 cmH2O) than in the I-gel group (27.9 cmH2O) (P = 0.57). In the I-gel group, 12.5% of the patients had oropharyngeal morbidities compared with 37.5% in the PLMA group (P = 0.009). Conclusion Both I-gel and PLMA provide optimal ventilation during abdominal insufflation, with PLMA providing a better oropharyngeal seal, whereas I-gel has a better haemodynamic profile.
Article
: Minimally invasive robotic approaches have become standard in many institutions over the last decade for various pediatric urological procedures. The anesthetic considerations for common laparoscopic and robotic-assisted surgeries are similar since both require the insufflation of CO2 to adequately visualize the operative area. However, few studies exist regarding anesthesia for robotic procedures in children. We hypothesized that pediatric patients undergoing robotic urologic surgeries would require specific anesthetic strategies, especially given the inherently longer durations of these procedures. This study aimed to evaluate anesthetic considerations, current robotic procedures, optimal patient positioning, and port placement for robotic-assisted surgery in pediatric patients. A comprehensive literature review of all published manuscripts from PubMed, EMBASE database, and Google Scholar was performed, focusing on robotic procedures involving pediatric patients, anesthesia for pediatric urology patients, and related topics from 1996 to 2023. Forty published manuscripts were identified and reviewed in depth. In pediatric cases, insufflation pressures and volumes are lower due to the laxity of the abdominal wall. However, the increase in intra-abdominal pressure and absorption of CO2 may result in disproportionate changes in cardiopulmonary function. Specific patient positioning for robotic approaches may further compound these physiological changes. Correct patient positioning is essential to facilitate surgery optimally and safely. Understanding the physiological changes that can occur during a pediatric patient’s robotic urologic surgery allows for safer anesthesia management.
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Background: A recently introduced supraglottic airway device (SAD) has been claimed to be an efficient supraglottic airway. It can also be used as a conduit for endotracheal intubation. However, LMA frequently used for this purpose; hence in this randomized study, success rate of blind tracheal intubation through two different SADs i-gel and LMA was evaluated. Methods: This is a prospective study was conducted in the Department of Anesthesia at Sapthagiri Institute of Medical Sciences & Research Centre among 140 patients fulfilling the criteria. Fasting patients with ages 20-50 years undergoing elective procedures under general anesthesia with ASA physical status 1 and 2 and Mallampatti class I and II were included in the study. Whereas patients with ASA physical status 3 or 4, and having contraindications to insertion of LMA or i-gel™ such as; mouth opening less than 2 cm, increased risk of aspiration, anticipated difficult intubation and facemask ventilation, with Mallampatti class III to IV were excluded. Results: One of the groups was administered the I-gel (Group G) and the other group was given I-LMA (Group L). Two groups were statistically similar in terms of distribution of ASA physical status grading (p<0.05). Two groups were statistically similar in terms of mallampati score distribution. Distribution of duration of surgery was not statistically significant in both the groups (p>0.05). It was observed that insertion I-gel was easy in 50 out of 70 patients. Difficulin 56 out of 70 patients. Difficult to insertion took place in 14 patients. The comparison of ease of insertion between the two groups did not reveal any statistical significance (p>0.05). Conclusion: We concluded I-gel aids easy and rapid insertion as a supraglottic airway device, but when it is used as a conduit for blind endotracheal intubation, the failure rate is high as there is more incidence of oesophageal intubation. On the contrary, ILMA being a gold standard device meant for intubation guide has a high first attempt success rate for blind endotracheal intubation.
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Background: Supraglottic airway devices are frequently used instead of endotracheal intubation in laparoscopic surgeries. Two such devices, I-gel (IG) and Baska mask (BM), have been compared with respect to their sealing properties and leak fraction (LF) in comparison to the endotracheal tube. Aims and Objectives: The aim of the present study is to compare the performance of IG and BM with endotracheal tube in patients undergoing laparoscopic cholecystectomy under general anesthesia. Materials and Methods: In this randomized trial, 84 patients scheduled for laparoscopic cholecystectomy under general anesthesia were randomized to group (endotracheal tube [ETT], n=28), group BM (BM, n=28), or group IG (IG, n=28). All the patients received standard general anesthesia and the airway was maintained with either of three devices. The primary outcomes were the difference in the LF and airway sealing pressure (ASP) at different time points before and after pneumoperitoneum. Secondary outcomes were insertion-time, number of insertion attempts, and gastric insufflations. Heart rate and blood pressure were recorded. Complications such as sore throat, coughing, laryngospasm, blood staining of the device, and aspiration were noted. Results: P-values of LF of the three groups at time points T- after insertion (Ti), T-after pneumoperitoneum (Tp), and T- after peritoneal deflation (Tr) were 0.000 each and P-values of ASP at those time points were 0.000 each, respectively. Insertion time was significantly less for IG than ET (P<0.001). Heart rate and blood pressure showed P-values at Ti and Tp (P=0.004 and 0.000). Conclusion: It was concluded that IG or BM can maintain an airway with adequate seal and were not associated with any incidence of aspiration or laryngospasm. IG placement was found to be easier whereas the ease of ventilation was noted with BM.
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.
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Sore throat is a common complication of anaesthesia that affects patient satisfaction after surgery. We studied 5264 ambulatory surgical patients prospectively to determine the patient, anaesthetic, and surgical factors associated with sore throat. In 5264 patients, 12.1% reported a sore throat. Patients with tracheal tube had the greatest incidence, 45.4%, followed by patients with laryngeal mask airway, 17.5%, while patients with a facemask had a lower incidence of sore throat, 3.3%. Female patients had more sore throats than male patients (13.4 vs 9.1%). Airway management had the strongest influence on the incidence of sore throat. Sore throat in ambulatory surgical patients was associated with female sex, younger patients, use of succinylcholine, and gynaecological surgery. Airway management, female sex, younger patients, surgery for gynaecological procedure, and succinylcholine predicts postoperative sore throat. Increased awareness of the predictive factors can help to avoid this combination and improve patient satisfaction.
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The ProSeal laryngeal mask airway (PLMA) is a new laryngeal mask device with a modified cuff and a drainage tube. We assessed the PLMA in 300 anaesthetized adults either paralysed or breathing spontaneously. We assessed insertion characteristics, airway seal pressures, haemodynamic response to insertion, ease of gastric tube placement, gastric insufflation, and postoperative sore throat. Insertion was successful in 294 patients (98%) and graded as easy in 274 patients (91%). We found no difference in ease of insertion or success rate with either the introducer or the finger insertion method, or in paralysed or non-paralysed patients. Mean airway seal pressure was 29 cm H2O, and 59 patients (20%) had seal pressures greater than 40 cm H2O. No gastric insufflation was detected. Gastric tube placement was successful in 290 of 294 patients (98.6%). There was no cardiovascular response to insertion, with a small reduction in heart rate 5 min after insertion and significant decreases in mean arterial pressure at 1 and 5 min after insertion. Sore throat was noted in 23% patients after operation and in 16% of patients after 24 h, with 90% of the sore throats described as mild. The PLMA is a reliable airway management device that can give an effective glottic seal in paralysed and non-paralysed patients. The device allows the easy passage of a gastric tube, causes a minimal haemodynamic response to insertion, and an acceptable incidence of sore throat.
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The ProSeal is a wire-reinforced laryngeal mask airway with an additional drain tube that leads to the distal tip of the laryngeal cuff. The design should improve the seal with the larynx. The ProSeal and classic laryngeal mask airways were compared in 180 patients in a randomized crossover study. Patients were anaesthetized without neuromuscular blocking drugs. The ProSeal took more time and more attempts to insert successfully than the classic laryngeal mask airway. Insertion was successful on the first attempt in 81% of cases with the ProSeal and 90% with the classic laryngeal mask airway. The ProSeal required more air to achieve an intracuff pressure of 60 cm H2O (6 ml more for size 4 and 12 ml more for size 5). Laryngeal seal pressure was better with the ProSeal than the classic laryngeal mask airway. Median seal pressure was 29 cm H2O with the ProSeal and 18 cm H2O with the classic laryngeal mask airway. Laryngeal seal pressure was greater than 20 cm H2O in 87% of patients with the ProSeal and 41% with the classic laryngeal mask airway. Laryngeal seal pressure was greater than 40 cm H2O in 21% of patients with the ProSeal and in none of the patients with the classic laryngeal mask. Once placed, the ProSeal remained a stable and effective airway. Gastric tube insertion through the drain tube was attempted in 147 cases and was successful in 135 (92%). The ProSeal is more difficult to insert than the classic laryngeal mask airway but allows positive pressure ventilation more reliably than the classic laryngeal mask airway.
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Article
Tracheal intubation, performed routinely during general anaesthesia in patients undergoing intraocular surgery, may have adverse effects on cardiovascular function and intraocular pressure. This study assessed the suitability of the laryngeal mask airway (LMA) as a substitute for tracheal; intubation. Intraocular and systemic pressor effects, heart rate changes and catecholamine concentrations were measured in two groups of 10 patients receiving standardized anaesthesia with either a trachealtube (TT) or a LMA. There were significantly smaller changes in the pressor responses to insertion and in concentrations of catecholamines at critical times in the anaesthetic sequence in the LMA group. Mean (SEM) rate-pressure product was significantly smaller in the LMA group compared with the TT group after both insertion (8276 (730) vs 13307 (1348), P<0.01) and removal (10 152 (595) vs 14 137 (1044). P < 0.07; of the airway device. The change in intraocular pressure was significantly less in the LMA group at all time points after airway instrumentation than that in the TT group, with the greatest difference after extubation (−2.3 (2.4) mm Hg vs 74.5 (3.4) mm Hg. P < 0.071
Article
SUMMARY We have studied the tone of the lower oesophageal sphincter (LOS) in 40 adults undergoing routine body surface surgery and allocated randomly to receive anaesthesia either by face mask and Guedel airway or by laryngeal mask airway. In the laryngeal mask group there was a mean (SEM) decrease in barrier pressure (LOS minus gastric pressure) of 3.6 (1.4) cm H2, compared with a mean increase of 2.2 (1.2) cm H2O in the face mask group (P < 0.005).
Article
The effects of laryngeal mask airway (LMA) insertion and tracheal intubation on circulatory responses were studied in normotensive (n = 24) and hypertensive (n = 22) patients. In a randomized, double-blind manner, LMA insertion or tracheal intubation was performed after induction of anaesthesia with thiopentone and muscle relaxation with succinylcholine. In both normotensive and hypertensive patients, heart rate (HR), mean arterial pressure (MAP) and rate-pressure product increased after tracheal intubation or LMA insertion compared with baseline (P < 0.05). The haemodynamic changes were greater after intubation than after LMA insertion (P < 0.05). Following intubation of the trachea or insertion of the LMA, HR increased more markedly in hypertensive patients than in normotensive patients (P < 0.05). Plasma adrenaline and noradrenaline concentrations after tracheal intubation or LMA insertion increased compared with baseline values (P < 0.05) in normotensive and hypertensive patients. The increase in noradrenaline concentration after tracheal intubation was greater than that after LMA insertion (P < 0.05). No patient revealed ECG evidence of myocardial ischaemia. We conclude that insertion of LMA is associated with less circulatory responses than tracheal intubation in both normotensive and hypertensive patients.
Article
This study was undertaken to evaluate the haemodynamic changes of tracheal extubation or removal of a laryngeal mask airway (LMA) in normotensive and hypertensive patients. In a randomized trial of normotensive and hypertensive patients (n = 40 of each), tracheal extubation or LMA removal was performed. Changes in heart rate (HR), mean arterial pressure (MAP) and rate-pressure product (RPP) were measured before and 1, 2, 3, 5, and 10 min after tracheal extubation or LMA removal. In normotensive patients, HR, MAP and RPP increased following tracheal extubation or LMA removal, and remained elevated for a maximum three minutes (P < 0.05). In hypertensive patients, the haemodynamic increases in response to extubation or LMA removal were observed for up to five minutes (P < 0.05). The immediate cardiovascular responses to extubation were greater than those related to LMA removal in both normotensive and hypertensive patients (normotensive: HR; 95 +/- 14 vs 81 +/- 11, MAP; 124 +/- 18 vs 106 +/- 10, RPP; 14,951 +/- 2720 vs 10,654 +/- 1898, hypertensive: HR 105 +/- 10 vs 87 +/- 13, MAP; 146 +/- 17 vs 119 +/- 12, RPP; 20,492 +/- 1674 vs 12,862 +/- 2115, mean +/- SD, P < 0.05). Following extubation or LMA removal, these haemodynamic variables increased more markedly in hypertensive patients than in normotensive patients (P < 0.05). Removal of LMA is associated with less cardiovascular change than tracheal extubation in both normotensive and hypertensive patients.