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Canadian Journal of Anesthesia

, Volume 49, Issue 8, pp 857–862 | Cite as

The LMA-ProSeal™ is an effective alternative to tracheal intubation for laparoscopic cholecystectomy

  • J. Roger Maltby
  • Michael T. Beriault
  • Neil C. Watson
  • David Liepert
  • Gordon H. Fick
Cardiothoracic Anesthesia, Respiration and Airway

Abstract

Purpose

To compare LMA-ProSeal™ (LMA-PS) with endotracheal tube (ETT) with respect to pulmonary ventilation and gastric distension during laparoscopic cholecystectomy.

Methods

We randomized 109 ASA I–III adults to LMA-PS or ETT after stratifying them as non-obese or obese (body mass index > 30 kg·m−2). After preoxygenation, anesthesia was induced with propofol, fentanyl and rocuronium. An LMA-PS (women #4, men #5) or ETT (women 7 mm, men 8 mm) was inserted and the cuff inflated. A # 14 gastric tube was passed into the stomach in every patient and connected to continuous suction. Anesthesia was maintained with nitrous oxide, oxygen and isoflurane. Ventilation was set at 10 mL·kg−1 and 10 breaths·min−1. The surgeon, blinded to the airway device, scored stomach size on an ordinal scale of 0–10 at insertion of the laparoscope and upon decompression of the pneumoperitoneum.

Results

There were no statistically significant differences in SpO2 or PETCO2 between the two groups before or during peritoneal insufflation in either non-obese or obese patients. Median (range) airway pressure at which oropharyngeal leak occurred during a leak test with LMA-PS was 34 (18–45) cm water. Change in gastric distension during surgery was similar in both groups. Four of 16 obese LMA-PS patients crossed over to ETT because of respiratory obstruction or airway leak.

Conclusions

A correctly seated LMA-PS or ETT provided equally effective pulmonary ventilation without clinically significant gastric distension in all non-obese patients. Further studies are required to determine the acceptability of the LMA-PS for laparoscopic cholecystectomy in obese patients.

Keywords

Laparoscopic Cholecystectomy Tracheal Intubation Gastric Tube Rocuronium Laryngeal Mask Airway 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Le LMA-ProSeal™ remplace efficacement l’intubation endotrachéale pendant la cholécystectomie laparoscopique

Résumé

Objectif

Comparer le LMA-ProSeal™ (LMA-PS) et le tube endotrachéal (TET) quant à la ventilation pulmonaire et à la distension gastrique pendant la cholécystectomie laparoscopique.

Méthode

Le tirage au sort de 109 adultes d’état physique ASA I–III, répartis en deux groupes, LMA-PS ou ETT, a été stratifié sur les facteurs non obèses ou obèses (indice de masse corporelle > 30 kg·m−2). Après la préoxygénation, l’anesthésie a été induite avec du propofol, du fentanyl et du rocuronium. Un LMA-PS (no 4: femmes et no 5: hommes) ou un TET (7 mm: femmes et 8 mm: hommes) a été inséré, et le ballonnet gonflé. Un tube gastrique no 14 a été poussé dans l’estomac et relié à une aspiration continue. L’anesthésie a été maintenue avec du protoxyde d’azote, de l’oxygène et de l’isoflurane. La ventilation a été instaurée à 10 mL·kg−1 et 10 respirations·min−1. Le chirurgien a coté, sans connaître le dispositif d’intubation utilisé, la taille de l’estomac selon une échelle ordinale de 0–10 au moment de l’insertion du laparoscope et lors de la décompression du pneumopéritoine.

Résultats

Les SpO2 et PETCO2 n’ont pas présenté de différence intergroupe statistiquement significative avant ou pendant l’insufflation péritonéale chez les patients obèses ou non. La pression médiane des voies aériennes (limites) à laquelle une fuite oropharyngienne est survenue pendant une épreuve d’étanchéité avec le LMA-PS a été de 34 (18–45) cm d’eau. La variation de distension gastrique peropératoire a été comparable entre les groupes. Quatre des 16 patients obèses porteurs du LMA-PS ont été intégrés au groupe TET à cause d’obstruction respiratoire ou d’une fuite du masque laryngé.

Conclusion

Un LMA-PS ou un TET bien installé permet une ventilation également efficace sans distension gastrique significative chez tous les patients non obèses. D’autres études devront déterminer l’acceptabilité du LMA-PS pour la cholécystectomie laparoscopique chez les obèses.

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Copyright information

© Canadian Anesthesiologists 2002

Authors and Affiliations

  • J. Roger Maltby
    • 1
  • Michael T. Beriault
    • 1
  • Neil C. Watson
    • 1
  • David Liepert
    • 1
  • Gordon H. Fick
    • 2
  1. 1.Department of AnesthesiaUniversity of CalgaryCalgaryCanada
  2. 2.Department of Community Health SciencesUniversity of CalgaryCalgaryCanada

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