Abstract
Background: The anesthetic technique employed in laparoscopic procedures offers many challenges and is limited most frequently to general anesthesia with controlled ventilation. Till date cuffed endotracheal tube is being considered ideal for such procedures but lesser invasive devices like PLMA are being successfully used nowadays.
Aims: The present study was conducted to compare PLMA and ETT for airway management in laparoscopy cholecystectomy under general anesthesia.
Material and Methods: The clinical trial included 50 patients scheduled for elective laparoscopy cholecystectomy. The ethical committee clearance and written consent were taken and patients were randomly allocated to either PLMA or ETT group. Insertion characteristics of PLMA and ETT and of nasogastric tube (NGT) via PLMA and ETT were noted. Hemodynamic responses, intra-operative as well as postoperative complications were also compared in both the groups.
Results: There was no demographic difference. The difference in insertion attempts as well as the time taken for insertion was significantly less in PLMA group than ETT group. We observed that HR,SBP, DBP, MAP values were comparable at all intervals except for those after insertion. There was no case of regurgitation or aspiration noted in any of the patients in each group. Post-operative complications were mainly seen in ETT group with no statistical difference.
Conclusion: PLMA and ETT show similar efficacy during laparoscopy cholecystectomy under general anesthesia and so PLMA is an efficient and safe tool for airway management.
Keywords: ProSeal, Laparoscopic cholecystectomy, alternative to endotracheal tube.
References
- Brimacombe J: The advantages of LMA over tracheal tube or facemask a metaanalysis. Canadian Journal of Anesthesia1995;42:1017-1023.
- Alexander CA, Leach AB: Incidence of sore throats with laryngeal mask. Anesthesia1989; 44:791.
- Stone JM, Karaliedde LD, Carter ML, Cumberland N. Bacteremia and insertion of laryngeal mask airways. Anesthesia 1992;42:77.
- Evans NR, Gardener SV, James MFM: Proseal Laryngeal Mask protects against aspiration of fluid in the pharynx. British Journal of Anesthesia 2002;88(4):584-587.
- Maltby JR, Beriault MT, Watson NC, Liepert DJ, Fick GH:LMA Proseal is an effective alternative to tracheal intubation for laparoscopic cholecystectomy. Canadian Journal of Anesthesia 2002:49(8):857-862.
- Shroff PP, Kamath S: Randomized comparative study between the Proseal Laryngeal Mask and the Endotracheal tube for laparoscopic surgery. Internet Journal of anesthesiology ISSN: 2006;11(1).
- Sharma B, Sood J, Sahai C, Kumra VP: Efficacy and safety performance of Proseal Laryngeal Mask Airway in Laparoscopic surgery: Experience of 1000 cases. Indian Journal Of Anesthesia 2008:52 (3):288-296.
- Parekh SS, Parekh Shivam Bipin, Chaula Doshi, Versha Vyas: Proseal Laryngeal Mask airway versus cuffed endotracheal tube for laparoscopic surgical procedures under general anesthesia: A random comparative study. Anesth Essays Res 2017 Oct-Dec11(4):958-963.
- Lim Y, Goel S, Btomacombe JR: The Proseal Laryngeal Mask Airway is an effective alternative to laryngoscopic –guided tracheal intubation for gynaecological laparoscopy. Anesth Intensive Care 2007 Feb;35(1):52-56.
- Idrees A, Khan FA: A comparative study of positive pressure ventilation via laryngeal mask airway and endotracheal tube. J Pak Med Assoc 2000; 50:333-338.
- Maltby JR, Beriault MT, Watson NC, Liepert DJ, Fick GH: Gastric distension and ventilation during laparoscopic cholecystectomy: LMA classic versus tracheal intubation.
- Chakraborty Arpan, Kumar G Parveen, Bhattacharya Prithwis: Gastric distension during laparoscopic cholecystectomy: Comparison between ETT and PLMA. Internet Journal of Anesthesiology ISSN :1092-406X.
- Brimacombe J, Keller C, Berry A: Gastric insufflation with the Proseal Laryngeal Mask. Anesthesia Analgesia 2001;92(6):1614.
- Roth H, Genzwuerker HV, Rothhas A, Finteis T, Schmeck J:Proseal Laryngeal Mask airway and the laryngeal tube suction for ventilation in gynaecological patients undergoing laparoscopic syrgery. Eur J Anesthesial 2005 Feb; 22(2):117-122.
- Maltby JR, Beriault MT, Watson NC, Liepert DJ, Fick GH: LMA Classic and LMA Proseal are effective alternatives to endotracheal intubation for gynaecologic laparoscopy. Canadian Journal OfAnesthesia2003;50(1):71-77.
- Sharma B, Sahai C, Bhattacharya A, Kumra VP, Sood J: Proseal Laryngeal Mask Airway: A study of 100 consecutive cases of laparoscopic surgery. Indian Journal of Anesthesia2003;47:467-472.
- Brimacombe J: Analysis of 1500 laryngeal mask uses by one anaesthetist in adults undergoing routine anesthesia. Anesthesia1996;51:76-80.
- Patodi V, Singh M, Sethi SK, Deepal V N, Jain N, Kumar V: A comparative study between Proseal Laryngeal Mask Airway and Endotracheal Tube for ease of insertion and haemodynamic changes in patients undergoing laparoscopic cholecystectomy under general anesthesia. IJRMS vol4, No.12 (2016).
- 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 anesthesia. Indian J Anaesth 2011; 55:129-134.
- Hohlrieder M, Brimacombe J, Von Goedecke A, Keller C: Postoperative nausea, vomiting, airway morbidity and analgesic requirements are lower for the Proseal laryngeal mask airway than the tracheal tube in females undergoing breast and gynaecological surgery. British Journal of Anesthesia 2007, Oct;99 (4):576-580.
Corresponding Author
Dr Vatika Bhardwaj
Senior Resident, Department of Anaesthesia, Sri Lal Bahadur Shastri Government Medical College Mandi, Himachal Pradesh, India
DOI: https://dx.doi.org/10.18535/jmscr/v7i12.59
