DOI: 10.1097/01.sa.0000158574.93830.22
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Issn Print: 0039-6206
Publication Date: 2005/04/01
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Excerpt
(J Clin Anesth, 15:428-432, 2003)
Department of Anesthesia and Intensive Care, Casa di Cura "Poliambulanza," Brescia, Italy.
The standard Laryngeal Mask Airway (LMA) differs from the LMA-ProSeal (PLMA) in that the latter features an additional drainage tube and a larger wedge-shaped cuff. Device improvements offered by the PLMA may be advantageous in laparoscopic surgery, but this has not been tested in a clinical setting. Adult patients scheduled for laparoscopic surgery with general anesthesia and mechanical ventilation were randomized to receive the LMA or the PLMA for airway management.
Thirty patients were assigned to the LMA and 30 to the PLMA. Both devices were equipped with a gastric tube. The 2 patient groups were similar in mean age, sex distribution, body mass index, American Society of Anesthesiologists physical status, types and duration of surgery, and anesthesia and ventilation protocols. Heart rate, arterial pressure, inspiratory and expiratory tidal volume, airway pressure, end-tidal CO2 partial pressure, and pulse oximetry were recorded. The LMA and PLMA groups were compared for frequency of airway seal and of early (in the recovery room) and late (1 week after surgery) sore throat.
All patients successfully completed the protocol. The gastric tube was able to be placed in all those receiving the LMA and in all but 1 receiving the PLMA. In 3 PLMA group patients, the gastric tube had to be replaced through the nose at the end of the surgical procedure for postoperative gastric drainage. Equal proportions of patients (87% of LMA and 90% of PLMA patients) had no sore throat during the recovery room stay, and findings were similar at the 1-week evaluation. The leak fraction was similar with both devices. The PLMA drainage tube was not patent in 1 case, despite a leak fraction of 5%, and no air leak was clinically detectable.
During laparoscopic surgery, the LMA and the PLMA provided similar airtight efficiency. Only a few patients reported sore throat in the early or late postoperative periods, and those with symptoms described them as mild. The drainage tube patency of the PLMA must always be tested for kinking, despite optimal airway seal.
