Comparative Evaluation of ProSeal LMA vs. Cuffed Endotracheal Tube in Patients Undergoing Laparoscopic Cholecystectomy under General Anesthesia

  • Dheeraj Kapoor Department of Anaesthesia and Intensive Care, Govt. Medical College and Hospital, Chandigarh-160030, India
  • Swati Jindal Department of Anaesthesia and Intensive Care,. Medical College and Hospital, Chandigarh-160030,India
  • Satinder Gombar Department of Anaesthesia and Intensive Care,. Medical College and Hospital, Chandigarh-160030,India
  • Nidhi Bajaj Department of Anaesthesia and Intensive Care,. Medical College and Hospital, Chandigarh-160030,India
  • Pradeep Atter Department of Anaesthesia and Intensive Care,. Medical College and Hospital, Chandigarh-160030,India
  • Usha Rani Dalal Department of Surgery,Govt. Medical College and Hospital, Chandigarh-160030,India
Keywords: Proseal LMA, endotracheal tube, general anesthesia, airway pressures, pneumoperitoneum, orogastric tube, laparoscopy

Abstract

Background: Proseal LMA (PLMA) has been used for airway maintenance during laparoscopic cholecystectomy. However, there is limited data regarding the effects of pneumoperitoneum, particularly on pulmonary mechanics. Objective of the present study was to evaluate and compare the use of PLMA with a cuffed endotracheal tube (ETT) with regard to changes in pulmonary mechanics, haemodynamic variables, degree of gastric inflation, ease of device insertion and possible adverse events in patients undergoing laparoscopic cholecystectomy.Methods: After written informed consent and institutional ethics committee approval, we enrolled one hundred patients (ASA physical status1/2), 18-60 years of age who were scheduled to undergo laparoscopic cholecystectomy under general anesthesia (GA). Patients were randomly allocated to one of the two groups of 50 each. Group 1: cuffed endotracheal tube and Group 2: ProSeal LMA. Patients as well as the surgeons were blinded to the airway device used. Insertion parameters, haemodynamic and ventilatory parameters (compliance, resistance and peak/plateau airway pressure) were measured at different time intervals before, during and after pneumoperitoneum.Results: Statistically significant (p< 0.05) but clinically insignificant difference was found in time taken for device insertion in the two groups (21.8 ± 5.9 s group I & 25.4 ± 5.7 s group II). Insertion of orogastric tube was easier and less number of attempts was required with PLMA. Hemodynamic parameters like heart rate, systolic, diastolic and mean blood pressures increased after the ETT insertion while there was a decrease/no change after PLMA insertion. There was a significant decline in the pulmonary compliance in Group 2, which was more pronounced after pneumoperitoneum. During pneumoperitoneum, higher peak and plateau airway pressures were noted in PLMA group than in ETT group. After desufflation these parameters returned to near pre-insufflation levels. There was no episode of arterial desaturation or end tidal carbon dioxide changes in either group.Conclusion: Our results indicate that in the PLMA group, the degree of changes in pulmonary mechanics caused by the pneumoperitoneum were significant however there was no incidence of arterial desaturation, or gastric regurgitation. Due to better hemodynamic stability with PLMA, it may even be better alternative than ETT in hypertensive/cardiac patients. Hence PLMA is a satisfactory airway device for laparoscopic cholecystectomy under GA, but further studies are required regarding its safety in patients with decreased pulmonary compliance like morbid obesity or obstructive pulmonary disease.

Author Biographies

Dheeraj Kapoor, Department of Anaesthesia and Intensive Care, Govt. Medical College and Hospital, Chandigarh-160030, India
Associate Professor, Department of Anaesthesia and Intensive Care,. Medical College and Hospital, Chandigarh-160030,India
Swati Jindal, Department of Anaesthesia and Intensive Care,. Medical College and Hospital, Chandigarh-160030,India
Assistant Professor, Department of Anaesthesia and Intensive Care,. Medical College and Hospital, Chandigarh-160030,India
Satinder Gombar, Department of Anaesthesia and Intensive Care,. Medical College and Hospital, Chandigarh-160030,India
Professor and Head, Department of Anaesthesia and Intensive Care,. Medical College and Hospital, Chandigarh-160030,India
Nidhi Bajaj, Department of Anaesthesia and Intensive Care,. Medical College and Hospital, Chandigarh-160030,India
Ex-Post Graduate Trainee,Department of Anaesthesia and Intensive Care,. Medical College and Hospital, Chandigarh-160030,India
Pradeep Atter, Department of Anaesthesia and Intensive Care,. Medical College and Hospital, Chandigarh-160030,India
Post Graduate Trainee,Department of Anaesthesia and Intensive Care,. Medical College and Hospital, Chandigarh-160030,India
Usha Rani Dalal, Department of Surgery,Govt. Medical College and Hospital, Chandigarh-160030,India
Professor, Department of General Surgery, Govt. Medical College and Hospital, Chandigarh-160030, India.

References

Brimacombe JR. History. In: Brimacombe JR, editor. Laryngeal Mask Anesthesia: Principles and practice. Philadelphia: Saunders Second edition; 2005:1-40.

Gal TJ. Airway management. In: Miller RD, editor. Miller’s Anesthesia. 6th edition: Elsevier Churchill Livingstone; 2005:1617-52.

Smith I. Anesthesia for laparoscopy with emphasis on outpatient laparoscopy. Anesthesiol Clin North America. 2001; 19(1):21-41.

Brimacombe JR. ProSealTM LMA for ventilation and airway protection. In: Laryngeal Mask Anesthesia: Principles and Practice. 2nd edition: Saunders, Philadelphia; 2005:505-38.

Brain AI, Verghese C, Strube PJ. The LMA ‘ProSeal’ - a laryngeal mask with an oesophageal vent. Br J Anaesth. 2000; 84(5):650-4.

Maltby JR, Beriault MT, Watson NC, Liepert DJ, Fick GH. LMA-Classic and LMA-ProSeal are effective alternatives to endotracheal intubation for gynecologic laparoscopy. Can J Anaesth. 2003; 50(1):71-7.

Sharma B, Sahai C, Bhattacharya A, Kumara V, Sood J. Proseal LMA: a study of 100 consecutive cases of laparoscopic surgery. Indian J Anaesth. 2003; 47(6):467-72.

Prerna P, Surekha K. Randomized comparative study between the Proseal Laryngeal Mask Airway And The Endotracheal Tube For Laparoscopic Surgery. Internet Journal of Anaesthesia 2004.

Miller DM, Camporota L. Advantages of Proseal TM and SLIPA TM airways over tracheal tubes for gynaecological laparoscopies. Can J Anaesth 2006; 53(2):188-93.

Hohlrieder M, Brimacombe J, Eschertzhuber S, Ulmer H, Keller C. A Study of airway management using the Proseal LMA compared with the tracheal tube on postoperative analgesia requirements following gynaecological laparoscopic surgery. Anaesthesia. 2007; 62(9):913-8.

Lim Y, Goel S, Brimacombe JR. The ProsealTM laryngeal mask airway is an effective alternative to laryngoscopic guided tracheal intubation for gynaecological laparoscopy. Anaesth Intensive Care 2007; 35(1):52-6.

Saraswat N, Kumar A, Mishra A, Gupta A, Saurabh G, Srivastava U. The comparison of Proseal laryngeal mask airway and endotracheal tube in patients undergoing laparoscopic surgeries under general anaesthesia. Indian J Anaesth. 2011; 55(2):129-34.

Sinha A, Sharma B, Sood J. ProSealTM as an alternative to endotracheal intubation in pediatric laparoscopy. Pediatric Anesthesia. 2007; 17(4):327-32.

Maltby JR, Beriault MT, Watson NC, Liepert D, Fick GH. The LMA-ProSeal is an effective alternative to tracheal intubation for laparoscopic cholecystectomy. Can J Anaesth. 2002; 49(8):857-62.

Sharma B, Sood J, Sahai C, Kumra VP. Efficacy and Safety Performance of ProsealTM Laryngeal Mask Airway in Laparoscopic Surgery: Experience of 1000 Cases. Indian J Anaesth 2008; 52(3):288-96.

Srivastava A, Longani S, Sinha GK. Comparative study of LMA Proseal and Tracheal Intubation for patients undergoing Laparoscopic Cholecystectomy in Indian population. Journal Advanced Medical and Dental Sciences Research. 2017; 5(9):73-7.

Cook TM, Lee G, Nolan JP. The ProSealTM laryngeal mask airway: A review of the literature. Can J Anaesth. 2005; 52(7):739-66.

García-Aguado R, Viñoles J, Brimacombe J, Vivó M, López-Estudillo R, Ayala G. Suction catheter guided insertion of the ProSeal TM laryngeal mask airway is superior to the digital technique. Can J Anaesth. 2006; 53(4):398-403.

Keller C, Brimacombe J, Keller K, Morris R. A comparision of four methods for assessing airway sealing pressure with the laryngeal mask airway in adults patients. Br J Anaesth. 1999; 82(2):286-7.

Lu PP, Brimacombe J, Yang C, Shyr M. The ProSeal Versus the CLMA for positive pressure ventilation during laparoscopic cholecystectomy. Br J Anaesth. 2002; 88(6):824-5.

Evans NR, Gardner SV, James MF, King JA, Roux P, Bennett P, et al. The ProSeal laryngeal mask: results of a descriptive trial with experience of 300 cases. Br J Anaesth 2002; 88(4):534-9.

Fujii Y, Tanaka H, Toyooha H. Circulatory responses to laryngeal mask airway insertion or tracheal intubation in normotensive and hypertensive patients. Can J Anaesth 1997; 44(10):1082-6.

Brimacombe J, Brimacombe N, Keller C. The ProSeal laryngeal mask airway: an easier and safer approach to tracheal tube/ laryngeal mask exchange. Anaesthesia. 2003; 58(12):1242-3.

Published
2018-09-11
How to Cite
1.
Kapoor D, Jindal S, Gombar S, Bajaj N, Atter P, Dalal U. Comparative Evaluation of ProSeal LMA vs. Cuffed Endotracheal Tube in Patients Undergoing Laparoscopic Cholecystectomy under General Anesthesia. AACC. 4(4):527-34.
Section
Research Article(s)