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A Comparative Evaluation of the Laryngeal Mask Airway - Proseal and Tracheal Intubation for Laparoscopic Cholecystectomy
| Content Provider | Semantic Scholar |
|---|---|
| Author | Kumar, Kumarappan Senthil |
| Copyright Year | 2009 |
| Abstract | INTRODUCTION: Tracheal intubation and controlled ventilation is the gold standard for the anaesthetic management of a patient undergoing laparoscopic cholecystectomy. The problems common to laproscopic procedures are due to carbon dioxide insufflations. The raised intra-abdominal pressure causes a potential danger of gastric regurgitation and pulmonary aspiration. The Classic LMA is not a very popular device for positive pressure ventilation for fear of gastric distension, aspiration of gastric contents and inadequate ventilation. The ProSeal laryngeal mask airway (PLMA) introduced in 2000AD, is a modification of the Classic Laryngeal Mask Airway (CLMA). The cuff of the PLMA is specially designed with an aim to provide a more effective seal around the glottic opening for providing positive pressure ventilation and the drain tube provides a bypass channel for regurgitated gastric contents and also a nasogastric tube can be passed through the drain tube to deflate and aspirate the gastric contents that is essential in laparoscopic surgeries. Nowadays open surgeries are progressing to minimally invasive keyhole surgery i.e laparoscopic surgeries. These laparoscopic surgeries need pneumoperitoneum which will cause increased intra abdominal pressure, elevation of diaphragm, alteration in patient positioning. All these will have a impact in ventilator parameters. Hence a prospective randomized study was designed to compare the use of the PLMA and Endo tracheal tube as a ventilatory device in patients undergoing elective laparoscopic cholecystectomies under general Anaesthesia with controlled ventilation. AIM OF THE STUDY: The aim of the study was to compare the Proseal Laryngeal Mask Airway with Endo tracheal tube in laparoscopic cholecystectomy based on the: Ventilation parameters: oxygen saturation, End tidal carbondioxide, Minute ventilation, Airway pressure, Ease of insertion of the device and nasogastric tube, Trauma. MATERIALS AND METHODS: Study Design: This study was a randomized prospective comparative study. Study setting and population: After obtaining institutional ethical committee clearance, the study was conducted in 40 adult patients of either sex between the age group of 18-50 years belonging to ASA physical status 1 posted for elective laparoscopic cholecystectomy at Surgical Gastroenterology OT complex, Department of Anaesthesiology, Stanley medical college and Hospital, Chennai, from March 2008 to June 2008. Inclusion criteria: 1. Adults of either sex, 2. Age between 18 and 50 years, 3. ASA physical status 1, 4. Mallampatti Airway class I and II. Exclusion criteria: 1. Body mass index > 30 kg/m2, 2. Age below 18 and above 50 years, 3. Mallampatti classification >II, 4. Symtoms related to laryngopharyngeal abnormality, 5. Musculoskeletal abnormalities affecting the cervical vertebrae. SUMMARY: The comparative evaluation of the PLMA and tracheal intubation for laparoscpic cholecystecomy showed no significant difference between the two groups based on the demographic variables The PLMA group maintained effective oxygen saturation similar to ETT group during pneumoperitoneum. The ETCO2 values were within normal limits in both the groups during pneumoperitoneum and baseline. The changes in minute ventilation required for effective pulmonary ventilationduring pneumoperitoneum were similar between both the groups. Significant increase in airway pressure both before and after pneumoperitoneum was seen in both the study and control group. This is to maintain adequate minute ventilation and gas exchange. The duration of the surgical procedure was same in both the groups. Regarding events related to extubation / PLMA removal there were no significant differences between the two goups. CONCLUSION: In this study, the PLMA and the ETT show similar efficacy during laparoscopic surgery under general anaesthesia with controlled ventilation. The PLMA aids easy and rapid insertion of the nasogastric tube. Though there is an increase in airway pressure during laparoscopy in PLMA it does not exceeds 30 cm of H2O, and it provides adequate pulmonary ventilation maintaining oxygen saturation and effective elimination of carbon dioxide similar to endotracheal tube. In this study it is concluded that, in patients with BMI < 30 kg/m2 the Proseal Laryngeal mask Airway is safe as compared with Endotarcheal tube for laparoscopic cholecystectomy under General Anaesthesia with controlled ventilation. |
| File Format | PDF HTM / HTML |
| Alternate Webpage(s) | http://repository-tnmgrmu.ac.in/7243/1/201000209senthilkumar.pdf |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
