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



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


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.


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.


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.


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



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.


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.


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.


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.


  1. 1.
    Brain AIJ. The laryngeal mask — a new concept in airway management. Br J Anaesth 1983; 55: 801–5.PubMedCrossRefGoogle Scholar
  2. 2.
    Maltby JR, Loken KG, Watson NC. The laryngeal mask airway: clinical appraisal in 250 patients. Can J Anaesth 1990; 37: 509–13.PubMedGoogle Scholar
  3. 3.
    Verghese C, Brimacombe JR. Survey of laryngeal mask airway usage in 11,910 patients: safety and efficacy for conventional and nonconventional usage. Anesth Analg 1996: 82: 129–33.PubMedCrossRefGoogle Scholar
  4. 4.
    Buniatian AA, Dolbneva EL. Laryngeal mask under total myoplegia and artificial pulmonary ventilation during laparoscopic cholecystectomies (Russian). Vestn Ross Akad Med Nauk 1997; 9: 33–8.PubMedGoogle Scholar
  5. 5.
    Brimacombe JR. Positive pressure ventilation with the size 5 laryngeal mask. J Clin Anesth 1997; 9: 113–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Fassoulaki A, Paraskeva A, Karabinis G, Melemeni A. Ventilatory adequacy and respiratory mechanics with laryngeal mask versus tracheal intubation during positive pressure ventilation. Acta Anaesthesiol Belg 1999; 50: 113–7.PubMedGoogle Scholar
  7. 7.
    Maltby JR, Beriault MT, Watson NC, Fick GH Gastric distension and ventilation during laparoscopic cholecystectomy: LMA-Classic vs. tracheal intubation. Can J Anesth 2000; 47: 622–6.PubMedGoogle Scholar
  8. 8.
    Bapat PP, Verghese C. Laryngeal Mask Airway and the incidence of regurgitation during gynecologic laparoscopies. Anesth Analg 1997; 85: 139–43.PubMedCrossRefGoogle Scholar
  9. 9.
    Brain AI, Verghese C, Strube PJ. The LMA ‘ProSeal’ — a laryngeal mask with an oesophageal vent. Br J Anaesth 2000; 84: 650–4.PubMedGoogle Scholar
  10. 10.
    Brimacombe J, Keller C, Berry A. Gastric insufflation with the ProSeal laryngeal mask. Anesth Analg 2001; 92: 1614–5.PubMedCrossRefGoogle Scholar
  11. 11.
    Ho-Tai LM, Devitt JH, Noel AG, O’Donnell, MP. Gas leak and gastric insufflation during controlled ventilation: face mask versus laryngeal mask airway. Can J Anaesth 1998, 45: 206–11.PubMedGoogle Scholar
  12. 12.
    Weiler N, Latorre F, Eberle B, Goedecke R, Heinrichs W. Respiratory mechanics, gastric insufflation pressure, and air leakage of the laryngeal mask airway. Anesth Analg 1997; 84: 1025–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Lind JF, Warrian WG, Wankling WJ. Responses of the gastroesophageal functional zone to increases in abdominal pressure. Can J Surg 1966; 9: 32–8.PubMedGoogle Scholar
  14. 14.
    Jones MJ, Mitchell RW, Hindocha N. Effect of increased intra-abdominal pressure during laparoscopy on the lower esophageal sphincter. Anesth Analg 1989; 68: 63–5.PubMedCrossRefGoogle Scholar
  15. 15.
    Brimacombe JR, Berry A. The incidence of aspiration associated with the laryngeal mask airway: a meta-analysis of published literature. J Clin Anesth 1995; 7: 297–305.PubMedCrossRefGoogle Scholar
  16. 16.
    Warner MA, Warner ME, Weber JG Clinical significance of pulmonary aspiration during the perioperative period. Anesthesiology 1993; 78: 56–62.PubMedCrossRefGoogle Scholar
  17. 17.
    Sidaras G, Hunter JM. Is it safe to artificially ventilate a paralysed patient through the laryngeal mask? The jury is still out (Editorial). Br J Anaesth 2001; 86: 749–53.PubMedCrossRefGoogle Scholar
  18. 18.
    Honemann CW, Hahnenkamp K, Mollhoff T, Baum JA. Minimal-flow anaesthesia with controlled ventilation: comparison between laryngeal mask airway and endotracheal tube. Eur J Anaesth 2001; 18: 458–66.CrossRefGoogle Scholar
  19. 19.
    Brimacombe J. Analysis of 1500 laryngeal mask uses by one anaesthetist in adults undergoing routine anaesthesia. Anaesthesia 1996; 51: 76–80.PubMedCrossRefGoogle Scholar
  20. 20.
    Crosby ET, Cooper RM, Douglas MJ, et al. The unanticipated difficult airway with recommendations for management. Can J Anaesth 1998; 45: 757–76.PubMedGoogle Scholar

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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