Publication: Proseal laryngeal mask airway versus endotracheal tube for delivering positive pressure ventilation during lap aroscopic surgery.
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Date
2007-05
Authors
Othman, Marini
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Abstract
The purpose of our study is to assess whether the new Proseal Laryngeal Mask airway (PLMA) can be a suitable alternative to the standard use of Endotracheal Tube (ETT) as an airway adjunct to deliver positive pressure ventilation during laparoscopic surgeries. We compared haemodynamic changes (by measuring heart rates, systolic blood pressures, diastolic blood pressures and mean arterial pressures at different time intervals) throughout the surgery, the quality of airway maintenance by measuring Sp02 and ETC02 and recorded intra operative as well as post operative complications related to use of both airway devices. We performed a prospective single blinded study on 64 patients undergoing laparoscopic surgical procedures. These patients were randomized using block randomization and divided into two groups; PLMA and ETT group. Both groups have 32 patients. After standardized induction of anaesthesia, PLMA or ETT was inserted and the patient was connected to ventilator that delivered positive pressure ventilation at set tidal volume and rate. Anaesthesia was maintained with Nitrous oxide, Oxygen and Isoflurane. Both airway devices were removed at the end of surgery with the patients fully awake. The haemodynamic changes were recorded at different time intervals, together with Sp02 and ETC02 changes. The incidences of intra operative complications (coughing, regurgitation, bronchospasm, desaturation and gas leaking) were recorded if present. The presence of blood upon airway device removal that indicates airway trauma was also recorded. Then we recorded post operative complications if present (persistent cough, vomiting and sore throat). We found that there were no statistical differences in HR changes measured at different time intervals between PLMA and ETT. However there were statistically significant decrease in systolic blood pressures and mean arterial pressures for PLMA group at 1 minute, 5 minute, 10 minute and 15 minute post intubation. For diastolic blood pressures, the lower values in PLMA group were only significant at 10 and 15 minutes post intubations. Comparing Sp02 and ETC02 monitoring, generally there were no significant statistical differences for both groups studied. Our findings on intra operative complications were that both groups have no statistical difference in the incidence of coughing, regurgitation, desaturation, bronchospasm and gas leaking. For presence of blood upon airway devices removal, we found no statistical difference between PLMA and ETT groups. The incidence of post operative persistent coughing and vomiting were also found to be statistically insignificant for both groups, however incidence of post operative sore throat was significantly higher in ETT group compared to PLMA with p value ofO.OOl. Therefore we concluded that for laparoscopic surgery with positive pressure ventilation, PLMA is a suitable alternative to standard ETI use and may offer advantages in terms of haemodynamic changes, with lower incidences or no statistically significant peri operative complications related to its use.
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Anaesthesiology