ABSTRACT
BACKGROUND: We evaluated the efficacy and safety of positive pressure ventilation (PPV) with a ProSeal laryngeal mask airway (PLMA), as compared with an endotracheal tube (ETT) and with a classic laryngeal mask airway (LMA) during laparoscopic cholecystectomy. METHODS: One hundred, ASA 1, 2 adults scheduled for elective laparoscopic cholecystectomy were randomly assigned to ETT, LMA or PLMA. Anesthesia was induced with fentanyl 2 microgram/kg, lidocaine 0.5 mg/kg and propofol 2 mg/kg and maintained with a continous infusion of propofol 6-12 mg/kg/h in 67% N2O, atracurium and fentanyl. ETT, LMA or PLMA was placed with atracurium 0.5 mg/kg. Respiratory and hemodynamic parameters were measured before and after intraabdominal CO2 insufflation. The surgeon assessed the degree of gastric distension change using a laparoscope. RESULTS: Oxygen saturation, end tidal CO2, inspiratory pressure, expiratory tidal volume and compliance of the respiratory system were similar in the three groups. Blood pressure and heart rate were lower in the PLMA and LMA groups than in the ETT group 5 min after induction (P < 0.05). Audible gas leakage occurred more so in the LMA group (48.5%) than in the PLMA group (8.8%). Because of inadequate ventilation, endotracheal intubation was changed in one case in the LMA group. The degrees of gastric distension change were similar in the three groups. The PLMA and LMA resulted in less coughing after removal than ETT (P < 0.05). A postoperative sore throat and dysphagia were similar in the three groups, but dysphonia was more frequent in the ETT group. CONCLUSION: During laparoscopic cholecystectomy, PPV with PLMA provide more effective pulmonary ventilation than LMA and fewer side effects than ETT.