PROSEAL VERSUS THE CLASSIC LARYNGEAL MASK AIRWAY AND CUFFED-ENDOTRACHEAL TUBE FOR POSITIVE PRESSURE VENTILATION DURING LAPAROSCOPY
Abla El Hadidi
Department of Anaesthesiology, Theodore Bilharz Research Institute
Objective: The aim of this study was to test whether the ProSeal Laryngeal Mask Airway (PLMA) is a more effective ventilatory device than the cLMA for laparoscopic cholecystectomy.
Methods: Ninety patients of both sexes admitted for laparoscopic cholecystectomy were included in this study and randomized into 3 equal groups for airway management with ProSeal laryngeal mask airway (PLMA) (group I), classic laryngeal mask airway LMA (group II) or cuffed endotracheal tube ETT (group III). Haemodynamic data were measured. Ease of insertion, air leak, position of the tube, ventilation and oxygenation aspiration and complications were assessed. Airway sealing pressure and lower oesophageal sphincter pressure (LOS) were measured.
Results: Hemodynamic changes in all groups were within the clinically accepted range. No failure of insertion was recorded in the 3 groups. First insertion attempt was successful in 80% of PLMA and 90% of LMA groups. Air leak during mechanical ventilation was detected in 1 patient in group I and 3 patients (10%) in group II (p = 0.160). PLMA position was grade 4 in 30% versus 40% in group II (p = 0.975). Airway sealing pressure in group I was 31.3±3.3 cm H2O, and 18.1±1.3 cm H2O in group II (p < 0.001). After carboperitoneum, ventilation and oxygenation were optimal in all patients of groups I and III and 80% in group II. (p = 0.012). Gastric tube insertion was successful in 90% of group I and 46.7% in group II and all cases of group III (p < 0.001). Aspiration was detected in 1 patient in groups I and III and in 2 patients in group II. LOS dropped significantly in PLMA and LMA groups. There was no significant difference between the 3 groups regarding the frequency of postoperative side effects.
Conclusion: PLMA is a more effective ventilatory device for laparoscopic cholecystectomy than the cLMA. It is hemodynamically safe with a higher airway sealing pressure and lesser frequency of aspiration, but more traumatic to the airway.