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

• Published in: Canadian journal of anesthesia Vol. 50; no. 1; pp. 71 - 77
• Main Authors: MALTBY, J. Roger, BERIAULT, Michael T, WATSON, Neil C, LIEPERT, David J, FICK, Gordon H
• Format: Journal Article
• Language: English
• Published: Toronto, ON Canadian Anesthesiologists' Society 2003; Springer Nature B.V
• Subjects: Abdominal surgery. Urology. Gynecology. Obstetrics; Adult; Anesthesia; Anesthesia depending on type of surgery; Anesthesia Recovery Period; Anesthesia, General; Anesthesia, Obstetrical; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Body Mass Index; Female; Fentanyl; Gastric Dilatation - etiology; Gynecologic Surgical Procedures; Humans; Intubation; Intubation, Intratracheal; Laparoscopy; Laryngeal Masks; Medical sciences; Pulmonary Ventilation - physiology; Time Factors; Human; Endoscopic surgery; Obesity; Nutrition disorder; Mask; Cuffed tube; General anesthesia; Laparoscopy; Artificial ventilation; Female genital diseases; Positive pressure; Female; Larynx; Endoscopy; Intubation; Technique; Trachea; Nutritional status; Comparative study; Technical equipment
• ISSN: 0832-610X; 1496-8975
• DOI: 10.1007/bf03020191

To compare the laryngeal mask airways (LMA), LMA-Classic(TM) (LMA-C) and LMA-ProSeal(TM) (PLMA) with the endotracheal tube (ETT) with respect to pulmonary ventilation and gastric distension during gynecologic laparoscopy. We stratified 209 women, aged > or = 18 yr, ASA physical status I-III, by body mass index as non-obese (< or = 30 kg x m(-2)) or obese (> 30 kg x 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 x 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. There were no crossovers and no statistically significant differences between LMA-C/PLMA and ETT groups for SpO(2,) P(ET)CO(2) or airway pressure before or during peritoneal insufflation in short (< or = 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. 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.