Canadian Journal of Anesthesia

, Volume 50, Issue 1, pp 71–77 | Cite as

LMA-Classic™ and LMA-ProSeal™ are effective alternatives to endotracheal intubation for gynecologic laparoscopy

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

Abstract

Purpose

To compare the laryngeal mask airways (LMA), LMA-Classic™ (LMA-C) and LMA-ProSeal™ (PLMA) with the endotracheal tube (ETT) with respect to pulmonary ventilation and gastric distension during gynecologic laparoscopy.

Methods

We stratified 209 women, aged ≥ 18 yr, ASA physical status I–III, by body mass index as non-obese (≤ 30 kg·m−2) or obese (> 30 kg·m−2) and randomized them to LMA-C/PLMA or ETT groups for airway management. Anesthesia was induced with propofol, fentanyl and succinylcholine or rocuronium. In the LMA-C/PLMA group we used a size 4 LMA-C in non-obese patients and size 4 or 5 PLMA in obese patients. In the ETT group we used a cuffed 7.0 mm ETT in all patients. Anesthesia was maintained with isoflurane in nitrous oxide and 30–50% oxygen, fentanyl and neuromuscular blockade with mechanical ventilation (tidal volume 10 mL·kg−1). The staff surgeon, blinded to the type of airway, scored stomach size on an ordinal scale 0–10 at initial insertion of the laparoscope and immediately before the conclusion of the surgical procedure.

Results

There were no crossovers and no statistically significant differences between LMA-C/PLMA and ETT groups for SpO2, PETCO2or airway pressure before or during peritoneal insufflation in short (≤ 15 min) or long (> 15 min) periods of peritoneal inflation. Differences between groups with respect to stomach size changes during surgery were not statistically significant.

Conclusion

A correctly placed LMA-C or PLMA is as effective as an ETT for positive pressure ventilation without clinically important gastric distension in non-obese and obese patients.

Le ML Classique™ et le ML ProSeal™ peuvent remplacer efficacement l’intubation endotrachéale pour la laparoscopie gynécologique

Résumé

Objectif

Comparer les masques laryngés (ML), ML Classique™ (MLC) et le ML ProSeal™ (MLP), au tube endotrachéal (TET) quant à la ventilation pulmonaire et à la distension gastrique pendant la laparoscopie gynécologique.

Méthode

Nous avons réparti 209 femmes, ≥ 18 ans, d’état physique ASA I–III, selon l’indice de masse corporelle, comme non obèses (≤ 30 kg·m−2) ou obèses (> 30 kg·m−2) et leur avons assigné au hasard le MLC/MLP ou le TET pour maintenir la perméabilité des voies aériennes. L’anesthésie a été induite avec du propofol, du fentanyl et de la succinylcholine ou du rocuronium. Dans le groupe MLC/MLP, un MLC de taille 4 a été utilisé chez les patientes non obèses et un MLP de taille 4 ou 5 chez les patientes obèses. Dans le groupe TET, un TET de 7,0 mm à ballonnet a été inséré chez toutes les patientes. L’anesthésie a été entretenue avec de l’isoflurane dans du protoxyde d’azote et de l’oxygène à 30–50 %, du fentanyl et un blocage neuromusculaire associé à une ventilation mécanique (volume courant de 10 mL·kg−1). Le chirurgien en service, qui ne connaissait pas le type d’appareil utilisé pour les voies aériennes, a évalué la taille de l’estomac sur une échelle ordinale de 0–10 lors de l’insertion initiale du laparoscope et immédiatement avant la fin de l’intervention chirurgicale.

Résultats

Il n’y a pas eu d’abandon de technique respiratoire et aucune différence significative au plan statistique entre les groupes MLC/MLP et TET, concernant la SpO2, la PETCO2 ou la pression des voies aériennes, avant ou pendant l’insufflation péritonéale, qu’il s’agisse d’insufflation courte (≤ 15 min) ou longue (> 15 min). Les différences intergroupes quant aux changements de la taille de l’estomac pendant l’opération n’ont pas été statistiquement significatives.

Conclusion

Un MLC ou un MLP bien mis en place sont aussi efficaces qu’un TET pour la ventilation à pression positive sans distension gastrique significativement importante chez des patientes obèses ou non.

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Copyright information

© Canadian Anesthesiologists 2003

Authors and Affiliations

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

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