Anest. intenziv. Med. 2008;19(2):77-81

LMA-ProSeal™ laryngeal mask is a safe option for securing the airways for laparoscopic cholecystectomyAnaesthesiology - Original Paper

Zvoníčková Dagmar^*, Zvoníček Václav, Klimeš Jiří, Volčík Aleš, Pelikán Karel

Anesteziologicko-resuscitační klinika, LF Masarykovy univerzity a Fakultní nemocnice u sv. Anny v Brně

Objective:
The aim of study was to find if LMA-ProSeal™ safely protects the airways during laparoscopic surgery.
Type of study:
Prospective study.
Setting:
Department of Anaesthesiology and Intensive Care, University Hospital.

Materials and methods:
Patients undergoing elective laparoscopic cholecystectomy were enrolled in the study. The results are presented as the median and the inter-quartile range, the statistical significance was evaluated by Mann-Whitney U Test and Wilcoxon match paired test.

Results:
Ninety-seven patients (M:F 35:62) aged 54 (37-64) years of age with body mass index (BMI) 26 (23-29) kg . m⁻² were enrolled in the study. Twenty-one patients (22%) were classed as severely obese (BMI > 30 kg . m⁻²). PLMA was inserted on the first attempt in 75 cases (77%), on the 2^nd attempt in 14 patients (14%) and in the remaining 8 (8%) patients the insertion was successful on the 3^rd attempt after a change of size of the PLMA. The PLMA cuff pressure was 40 (35-40) cm H₂O at the beginning of surgery; the capnoperitoneum pressure reached 13 (12-14) mm Hg. Peak airway pressure at the beginning of surgery (Pstart) was 17 (15-21) cm H₂O and increased to 22 (19-25) cm H₂O after CO₂ insufflation (Pcapno). Patients with BMI > 30 had higher Pstart [21(16-23) vs 17(14-20) cm H₂O; p = 0.002] and Pcapno [25 (22-30) vs 22 (19-25) cm H₂O; p = 0.001]. The difference between Pstart and Pcapno was also significant (p < 0.001).
A nasogastric tube was successfully inserted on the 1st attempt in 99% of patients. In one patient a "fold-over" position was revealed. No gastric contents were found in 40 (41%) patients at the end of surgery; in the remaining patients a residuum of 20 ml (10-30 ml) was detected. Regurgitation of gastric juices occurred in 3 patients. No signs of lung aspiration were found.

Conclusion:
PLMA is a safe method of airway protection during laparoscopic surgery.

Keywords: laparoscopic cholecystectomy; inspiratory pressure; regurgitation; pulmonary aspiration; laryngeal mask

Received: October 27, 2007; Accepted: January 8, 2008; Published: April 1, 2008  Show citation