A comparative study of supraglottic airway devices Baska mask and ProSeal-laryngeal mask airway in short gynaecological procedures

Background: Baska Mask® (BM) a newer Supraglottic Airway Device (SAD) considered to cause low incidence of Postoperative Pharyngolaryngeal Complications (POPC). This study was designed to assess efficacy, safety and early and late POPC between BM and commonly use ProSeal LMA (PMLA).Methods: Patients between 18 to 60 years of age undergoing elective short gynecological procedures were randomized into two groups, to receive ventilation with either BM (group 1, n=50) or an PMLA (group 2, n=50).Results: There was no significant difference in the ease of insertion for both the devices (p<0.24). There was no significant difference in the number of attempts for both the devices (p<0.69). When compared to PLMA, the time (in seconds) required for insertion of BM was significantly less in duration (20.9 vs. 16) (p<0.0001). Between the two groups significant hemodynamic changes noticed after removal of SGA. The blood staining of device was similar in both groups. Failure to place device, postoperative complication like laryngospasm and bronchospasm did not occur in both BM and PLMA groups.Conclusions: In conclusion, findings of this study support that BM takes significantly shorter placement time and provides a better seal as compared to PLMA but without any reduction in laryngopharyngeal complications.

Comparative Evaluation of Effective Dose 50 (ED 50) of Propofol in Adult Patients with Saline-Propofol, Dexmedetomidine-Propofol and Fentanyl - Propofol for Laryngeal Mask Airway Insertion

Introduction: Propofol a short acting intravenous anaestheticis widely used with various adjuncts to facilitate improvedinsertion conditions of Proseal Laryneal Mask Airway(PLMA). We compared the median effective dose (ED 50)propofol requirement and insertion conditions of PLMA withsaline - propofol, dexmedetomidine - propofol and fentanyl -propofol.Material and Methods: This was a prospective randomizeddouble blind study conducted in 100 adult patients of AmericanSociety of Anaesthesiology (ASA) class I/II scheduled toundergo elective surgical procedures. They were randomlyallocated into four groups of 25 each - Group N normal saline,Group F1 fentanyl 1 mcg/kg, Group F2 fentanyl 2mcg/kg andGroup D dexmedetomidine 1mcg/kg. The study drug wasdiluted in 50ml saline and infused over 10 minutes followedby a predetermined dose of propofol as per Dixon’s up anddown method. The ease of PLMA insertion was assessed asper Muzi mouth opening score. Hemodynamic parameterswere observed starting from baseline (T0), at 10 min post testdrug infusion (T1), post propofol injection (T2), 1min postLMA insertion (T3) and till 3 minutes post LMA insertion(T4).Results: The ED50 of propofol for the insertion of PLMAwith normal saline, fentanyl (1mcg/kg), fentanyl (2 mcg/kg)and dexmedetomidine (1mcg/kg) as adjuncts were found outto be 3.25mg/kg, 2mg/kg, and 1.67mg/kg and 1.92mg/kgrespectively. PLMA insertion conditions and hemodynamicparameters were comparable between the four groups. Leastincidence of apnoea was noted in group D with only 8 patientsrequiring assisted ventilation.Conclusion: Dexmedetomidine significantly reduces therequirement of induction dose propofol for PLMA insertionwhile providing stable hemodynamic and excellent insertionconditions

Comparison of ProSeal laryngeal mask airway, classical laryngeal mask airway with endotracheal tube in gynecological laparoscopy under controlled ventilation

Background: PLMA is a recent, complex, and ingenious development with some added feature of classic LMA like modified dual cuff, drain tube, positive pressure ventilation at higher peak inspiratory pressure. Study was to evaluate and compare the use of classical laryngeal mask airway, ProSeal laryngeal mask airway, and endotracheal tube with controlled ventilation in patients undergoing gynecological laparoscopic procedure.Methods: About 150 patients, ASA risk I and II, posted for elective gynecological laparoscopy were recruited in the study. All the patients between 18 to 45years of age were randomly divided in three groups, group PLMA, group CLMA, group ETT (50 patients each). Attempt of insertion of airway device, leaks pressure, pulmonary ventilation, hemodynamic; heart and MAP, gastric distention was recorded. All patients were of middle age group, comparable in weight. Mean duration of laparoscopy was comparable in all the groups.Results: Significant rise in heart rate and mean arterial pressure seen in group ETT after induction of anesthesia. Changes in the end tidal CO2 and peak airway pressure after induction of anesthesia, before and after pneumoperitonium were comparable in all three groups. After head low position peak airway pressure is slightly raised in group PLMA, group CLMA. Gastric distension was noted higher in group 10 % as compare to group PLMA (8%) and group (2%). Incidence of sore throat (22%), nausea vomiting (14%) and airway trauma (14%) was higher in group ETT.Conclusions: Hemodynamic stability was better in and CLMA group at time of induction and comparable in all three groups at time of pneumoperitoneum and trendelenburg position along with pulmonary ventilation. Post-operative sore throat, nausea vomiting was higher with

Simple method for determining the size of the ProSeal laryngeal mask airway in children: a prospective observational study / Método simples para determinar o tamanho da máscara laríngea ProSeal em crianças: um estudo observacional, prospectivo

Abstract Background and objectives: The size of the ProSeal laryngeal mask airway in children is determined by the patient's weight. However, in some instances, an alternative method may be required. This study aimed to compare sizing by the auricle with conventional ProSeal laryngeal mask airway sizing by weight in children. Methods: After approval by the institutional ethics board and written informed consent from parents, 197 children with American Society of Anesthesiologists physical status I-II who were scheduled for a routine genitourinary operation were included in the study. The correct ProSeal laryngeal mask airway size was determined according to the size of the auricle in children. The results were compared with the standard weight-based method recommended by the manufacturer's guidelines. The patients were classified into different groups depending on the ProSeal laryngeal mask airway sizes as determined by both methods. Agreement between both techniques was evaluated with κ coefficient statistics. Results: Insertion and adequate ventilation were achieved in 185 patients at the first attempt, and 12 patients required a second attempt. Three patients had to be intubated. Agreement between the two methods of size selection of the ProSeal laryngeal mask airway was moderate using κ statistics. Conclusions: Choosing the size of the ProSeal laryngeal mask airway in children according to the auricle of the child is valid and practical. In particular, this is an alternative method in situations where the patient's weight is unknown, such as in emergency situations.

Resumo Justificativa e objetivos: O tamanho da máscara laríngea ProSeal (MLPS) em crianças é determinado com base no peso do paciente. No entanto, em alguns casos, pode ser necessário um método opcional. Este estudo teve como objetivo comparar o tamanho da MLPS convencional pela orelha e pelo peso em crianças. Métodos: Após aprovação do Comitê de Ética institucional e receber o consentimento informado assinado pelos pais, 197 crianças com estado físico ASA I-II (de acordo com a classificação da Sociedade Americana de Anestesiologistas), programadas para uma operação geniturinária de rotina, foram incluídas no estudo. O tamanho correto da MLPS foi determinado de acordo com o tamanho da orelha em crianças. Os resultados foram comparados com os do método padrão, baseado no peso, recomendado pelas diretrizes do fabricante. Os pacientes foram classificados em diferentes grupos, a depender dos tamanhos das MLPS, conforme determinado por ambos os métodos. A concordância entre as duas técnicas foi avaliada com as estatísticas do coeficiente kappa (k). Resultados: Inserção e ventilação adequada foram obtidas em 185 pacientes na primeira tentativa e 12 pacientes precisaram de uma segunda tentativa. Três pacientes precisaram ser intubados. A concordância entre os dois métodos de seleção do tamanho da MLPS foi moderada com a estatística κ. Conclusões: A escolha do tamanho da MLPS em crianças de acordo com a orelha da criança é válida e prática. Em particular, é um método opcional em situações nas quais o peso do paciente é desconhecido, como em situações de emergência.

Comparison of sevoflurane concentration for insertion of proseal laryngeal mask airway and tracheal intubation in children (correlation with BIS) / Comparação da concentração de sevoflurano para a inserção de ML proseal e intubação traqueal em crianças (correlação com BIS)

BACKGROUND: Sevoflurane is an inhalational agent of choice in paediatric anaesthesia. For management of airways in children a suitable alternative to ETT is a paediatric proseal laryngeal mask airway (benchmark second generation SAD). Various studies have shown that less sevoflurane concentration is required for LMA insertion in comparison to TI. BIS is a useful monitor of depth of anaesthesia. AIMS: To compare concentration of sevoflurane (end tidal and MAC value) required for proseal laryngeal mask airway insertion and tracheal intubation in correlation with BIS index. METHOD: The prospective randomised single blind study was done in children between 2 and 9 years of ASA I and II and they were randomly allocated to Group P (proseal laryngeal mask airway insertion) and Group TI (tracheal intubation). No sedative premedication was given. Induction was done with 8% sevoflurane and then predetermined concentration was maintained for 10 min. Airway was secured either by proseal laryngeal mask airway or endotracheal tube without using muscle relaxant. End tidal sevoflurane concentration, MAC, BIS, and other vital parameters were monitored every minute till insertion of an airway device. Insertion conditions were observed. Statistical analysis was done by ANOVA and Students t test. RESULTS: Difference between ETLMI (2.49 ± 0.44) and ETTI (2.81 ± 0.65) as well as MACLMI (1.67 ± 0.13) and MACTI (1.77 ± 0.43) was statistically very significant, while BISLMI (49.05 ± 10.76) and BISTI (41.25 ± 3.25) was significant. Insertion conditions were comparable in both the groups. CONCLUSION: We can conclude that in children airway can be secured safely with proseal laryngeal mask airway using less sevoflurane concentration in comparison to tracheal intubation and this was supported by BIS index.

JUSTIFICATIVA: Sevoflurano é um agente inalatório de escolha em anestesia pediátrica. Para o manejo de vias aéreas em crianças, uma opção adequada para o TET é uma MLP pediátrica (referência de segunda geração SAD). Vários estudos mostraram que uma menor concentração do sevoflurano é necessária para a inserção da ML em comparação com a IT. O BIS é um monitor útil da profundidade da anestesia. OBJETIVOS: Comparar a concentração de sevoflurano (valores no fim da expiração e da CAM) necessária para a inserção de MLP e intubação traqueal em correlação com o BIS. MÉTODO: Estudo prospectivo, randômico e cego conduzido com crianças entre 2-9 anos, estado físico ASA I-II, randomicamente alocados nos grupos P (inserção de MLP) e IT (intubação traqueal). Pré-medicação sedativa não foi administrada. A indução foi feita com sevoflurano a 8% e, em seguida, a concentração predeterminada foi mantida durante 10 minutos. A via aérea foi garantida por MLP ou tubo endotraqueal, sem o uso de relaxante muscular. A concentração de sevoflurano no fim da expiração, CAM, BIS e outros parâmetros vitais foram monitorados a cada minuto até a inserção do dispositivo respiratório. As condições de inserção foram observadas. A análise estatística foi feita com o teste t de Student e Anova. RESULTADOS: As diferenças entre TEIML (2,49 ± 0,44) e TEIT (2,81 ± 0,65), bem como CAMIML (1,67 ± 0,13) e CAMIT (1,77 ± 0,43), foram estatisticamente muito significativas; enquanto BISIML (49,05 ± 10,76) e BISIT (41,25 ± 3,25) foram significativos. As condições de inserção foram comparáveis em ambos os grupos. CONCLUSÃO: Podermos concluir que a MLP em comparação com a intubação traqueal pode ser segura para a via aérea de crianças com o uso de menos concentração de sevoflurano, o que foi confirmado pelo BIS.

Safety and effectiveness of ProSeal laryngeal mask airway in posterior spinal surgery / 中国医师进修杂志

Objective To explore the effect iveness and safety of ProSeal laryngeal mask(PLMA)used in posterior spinal surgery. Methods Forty ASA Ⅰ - Ⅱ patients of thoracic-lumbar fracture were randomly divided into PLMA group and tracheal intubation (TI) group by systematic sampling with 20 cases each. PLMA or TI was inserted after intravenous anesthesia induction. The number of intubation, intubation time and time to surgery were recorded, systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were recorded induction (To), during intubation (T1), at 1 min (T2),3 min(T3), 5 min (T4), 10 min after intubation (T5), during extubation (T6). The intubation, extubation, and the maintain ventilation process of the respiratory and respiratory damage were recorded. Results All patients in PLMA group and TI group achieved satisfactory lung ventilation at the first attempt. There were no significant difference in the number of intubation, intubation time and time to surgery between two groups (P ＞ 0.05 ).SBP,DBP,HR at T1,T2,T3,T6 in TI group were significandy higher than To and those in PLMA group (P＜0.05). The intubation, extubation, and the maintain ventilation process of the respiratory and respiratory damage in TI group (5,25,36 cases) were more than those in PLMA group (0,1,6 cases)(P ＜0.05).Conclusion PLMA for posterior spinal surgery is safe and effective.

Median effective dose of remifentanil for ProSeal laryngeal mask airway tolerance in adult / 临床麻醉学杂志

Objective To determine the median effective dose of remifentanil for maintaining the tolerance to ProSeal laryngeal mask airway in awake and spontaneously breathing patients.Methods Sixty ASA Ⅰ orⅡpatients aged 20-55 years old were recruited.Sixty patients was randomized into six groups with 10 case each Remifentanil was infused in a dose of 0.061,0.048,0.039,0.03,0.025 or 0.02μg·kg~(-1) 5 minutes after inserting PLMA.Single dose of remifentanil 0.25/μg/kg was given before continuous intravenous infusion.Respiratory response subscore of comfort scale(CSRR)and Ramsay sedation scale(RSS)were recorded after 25 minutes.ED50 was calculated.Results The ED50 of remifentanil for ProSeal laryngeal mask airway tolerance was 0.027μg·kg~(-1)(95%CI:0.023-0.030μg·kg~(-1)·min~(-1)in awake and spontaneously breathing patients.Conclusion The patients tolerate stimulus of laryngeal mask with a low dose continuous intravenous infusion of remifentanil in awake.and can maintain the hemodynamics stable.

A comparative study of the Cobra perilaryngeal airway and Proseal laryngeal mask airway during laparoscopic cholecystectomy / 대한마취과학회지

BACKGROUND: The Cobra Perilaryngeal Airway(TM) (Cobra PLA) and the Proseal Laryngeal Mask Airway(TM) (Proseal LMA) provide higher sealing pressures than the classic LMA. The authors compared the clinical effectiveness of these two airway types for controlled ventilation during laparoscopic cholecystectomy. METHODS: One hundred and twenty patients (ASA physical status I-II, aged 18-65 yrs) scheduled for laparoscopic cholecystectomy were randomly allocated for airway management with the Cobra PLA or the Proseal LMA. Anesthesia was induced and maintained with propofol and remifentanil using a target controlled infusion system. Insertion characteristics, anatomical positions, airway adequacies, ventilation efficacies, degrees of gastric distension, and postoperative adverse events (sore throat, dysphagia, and dysphonia) were noted. RESULTS: The number of insertion attempts, insertion times, airway sealing pressure, and airway positions were similar in the two groups. In one Cobra PLA patient, tracheal intubation was needed due to inadequate ventilation before pneumoperitoneum. During pneumoperitoneum, oxygenation and ventilation were optimal in all patients in both groups, and degrees of gastric distension were similar. Furthermore, no differences were found in terms of the incidences of adverse effects. CONCLUSIONS: Cobra PLA and Proseal LMA were found to have similar insertion characteristics and both provided adequate airways and effective ventilation during laparoscopic cholecystectomy.

Total Intravenous Anesthesia using Bispectral Index for Transvaginal Uterine Myomectomy in a Patient with Myotonic Dystrophy: A case report / 대한마취과학회지

We report a patient with myotonic dystrophy, who underwent a transvaginal uterine myomectomy. Anaesthesia was induced and maintained with remifentanil and the target-controlled infusion of propofol titrated according to the bispectral index (BIS). A ProSeal laryngeal mask airway (PLMA) was inserted, and mechanical ventilation was performed without a muscle relaxant. The time from the end of anaesthesia to the patient-awakening was approximately 8 minutes. The rapid offset of the action of remifentanil and low-dose propofol facilitated early recovery without respiratory complications. The total intravenous anaesthesia using the BIS and the PLMA without a muscle relaxant is a useful anaesthetic technique in myotonic dystrophy patients.

Effect of nitrous oxide on cuff pressure of ProSeal laryngeal mask airway during pediatric anesthesia / 上海第二医科大学学报

Objective To evaluate the effect of nitrous oxide(N2O) on the cuff pressure of ProSeal laryngeal mask airway(PLMA) in pediatric anesthesia. Methods Thirty-two pediatic patients were enrolled and divided into two groups randomly.PLMA cuffs were inflated with air(Group A) or 50% N2O/oxyen(Group N) to 20 mmHg as initial pressure.The intracuff pressure was monitored during anesthesia with 50% N2O in oxygen. Results Intracuff pressure increased to(40.6?9.3) mmHg in Group A and slightly decreased in Group N.Deflation volume in Group A was much more than that in Group N[(4.4?2.3) mL vs(2.6?1.0) mL,P

Effects of ProSeal Laryngeal Mask Airway Ventilation on the Hemodynamics and Respiratory Function in the Elderly Patients Undergoing Laparoscopic Surgery / 中国微创外科杂志

0.05).At T9,the Ppeak and PETCO2 in LMA group were significantly higher than those in ET group [(19.0?5.0) mm Hg and(44.7?3.1) mm Hg vs.(13.0?3.0) mm Hg and(34.1?1.9) mm Hg respectively,t=5.636,P=0.000 and t=15.968,P=0.000].In LMA group,5 patients developed adverse reaction,while in the ET group,13 patients showed the reaction(?2=3.774,P=0.052).Conclusions Ventilation with LMA is safe and reliable for elderly patients undergoing laparoscopic surgery with a low rate of adverse reaction.It has slight effect on the hemodynamics of the patients.

Application of ProSeal Laryngeal Mask Airway in Posterior Cervical Spine Surgery / 中国微创外科杂志

0.05).One minute after intubation(T3),MAP and HR in the ETT group increased to(12.13?1.37) mm Hg and(96.3?4.7)/min respectively,which were significantly higher than those in the PLMA group [(9.98?1.21) mm Hg,t=6.443,P=0.000;and(88.3?5.6)/min,t=5.947,P=0.000].Three minutes after intubation(T4),the MAP and HR of the two groups were significantly different(P0.05).Five patients in the PLMA group had adverse reaction,that was significantly fewer than that in the ETT group(12 cases)(?2=4.022,P=0.045).Conclusions PLMA is applicable for posterior cervical spine surgery,since it is associated with less stimulation and adverse reaction,and stable hemodynamics.The success rate of intubation is high by using the procedure.

Changes in Position and Intraabdominal Pressure do not Influence Oropharyngeal Leak Pressure in Laparoscopic Surgery Maintained with a ProSeal Laryngeal Mask Airway / 대한마취과학회지

BACKGROUND: It is known that pneumoperitoneum and changes of body position during laparoscopic surgery influenced peak inspiratory pressure (PIP). We asked the question whether oropharyngeal leak pressure (OLP) is changed by changes in intraabdominal pressure and position during laparoscopic surgery with a ProSeal laryngeal mask airway (PLMA). Since gynecological laparoscopic surgery (Lap-Gy) and laparoscopic cholecystectomy (Lap-C) require different surgical positions, we included both surgeries in this study so that we could investigate the effects of various positions on OLP. METHODS: Lap-Gy (n = 15) was performed in the trendelenburg position combined with the lithotomy position, whereas Lap-C (n = 10) was performed in the reverse trendelenburg position. The measured variables were PIP and OLP. We also marked the fiberoptic score to determine the intraoral position (FP) of the PLMA. OLP was measured using a manometric stability test. The variables were measured in a regular sequence as follows: S-0o-0, L-0o-0, L-0o-15, L-(-15o)-15, L-(-30o)-15 in Lap-Gy and S-0o-0, S-0o-15, S-(+15o)-15, S-(+30o)-15 in Lap-C. At each measured point, the capital S means supine and L lithotomy. Intermediate numbers with a 'o' superscript are table angles to the horizontal plane (degrees) , '-' means the trendelenburg position and '+', the reverse trendelenburg position, and the last number represents intraabdominal pressure (mmHg). RESULTS: PIP was significantly increased when L-0o-0 changed to L-0o-15, L-0o-15 to L-(-15o)-15 and L-(-15o)-15 to L-(-30o)-15 in Lap-G, and when S-0o-0 was changed to S-0o-15 in Lap-C (P < 0.05). But, OLP and FP were not significantly altered by changes in postion or intraabdominal pressure in both Lap-Gy and Lap-C. CONCLUSIONS: PIP was affected by pneumoperitoneum and positional changes. But, increases in intraabdominal pressure by pneumoperitoneum and changes in position during laparoscopic surgery had no effect on OLP and FP of PLMA.

Proseal Laryngeal Mask Airway for the Resection of a High Grade Upper Tracheal Stenosis: A case report / 대한마취과학회지

Laryngeal mask airways (LMAs) have several advantages compared with conventional endotracheal tube (ETT) in tracheal surgery. LMAs cannot penetrate the airway below the level of the glottis, but enable the access to the larynx and tracheobronchial tree while avoiding airflow impairment, tracheal stimulation, trauma, and the interference of tracheal mucosal blood flow. Moreover, LMAs have lower airway resistance than ETTs. We describe the use of a proseal laryngeal mask airway (PLMA) in patients with high grade upper tracheal stenosis. We suggest that PLMA might have advantages over the classic LMA by preventing aspiration and by allowing the evacuation of air from the stomach in high-grade upper tracheal stenosis.

Anesthetic Management of Tracheal Reconstruction Surgery with Laryngeal Mask Airway: A case report / 대한마취과학회지

Ventilatory management of tracheal reconstruction surgery may require sophisticated anesthetic techniques. Most airway problems that occurred during the tracheal surgery can be prevented by passing an endotracheal tube of small size through the tracheal narrowing or locating a normal endotracheal tube just above the stenotic lesion. However, in case of high tracheal stenosis sited near the vocal cord, it is difficult to manage airway using a cuffed endotracheal tube because of high possibility of injury of the vocal cord, shallow placement of the tube and inability to apply positive pressure ventilation. The laryngeal mask airway has been used as an efficient ventilatory device in this situation. We report one case of high tracheal stenosis requiring end to end anastomosis, where airway management was successful without any complications using the proseal laryngeal mask airway (PLMA).

Effects of ProSeal Laryngeal Mask Airway on Intraoperative Ventilation and Blood Pressure, and Postoperative Sore Throat in Laparoscopic Cholecystectomy / 대한마취과학회지

BACKGROUND: This study was performed to evaluate the effects of a ProSeal laryngeal mask airway (PLMA) on intraoperative ventilation and blood pressure, and postoperative sore throat in laparoscopic cholecystectomy (LC). METHODS: Sixty, ASA 1 or 2 adults scheduled for elective LC were randomly allocated into two groups; i.e., endotracheal tube (ETT) or PLMA groups. General anesthesia was administered in the usual fashion. Blood pressure and heart rate were measured before and after the induction of anesthesia. Blood pressure, heart rate, peak inspiratory pressure (PIP) and end-tidal CO2 (ETCO2) also were measured before and after intraabdominal CO2 insufflation (pneumoperitoneum) at 5 minutes intervals over 30 minutes. Sore throat, nausea and vomiting were evaluated at 6 and 24 hours postoperatively. RESULTS: Blood pressure and heart rate were higher in the ETT group than in the PLMA group after induction (P < 0.05), however, no differences were observed during pneumoperitoneum. Following the induction of pneumoperitoneum, ETCO2 increased significantly, but without the group differences. PIP was less increased in the PLMA group. No significant differences were observed in incidences of postoperative sore throat, nausea or vomiting in the two groups. CONCLUSIONS: We conclude that PLMA is a useful alternative to ETT in LC. Furthermore, PLMA seems to be more useful for hypertensive patients.

Efficacy of Positive Pressure Ventilation with the ProSeal Versus Classic Laryngeal Mask Airway during Gynecologic Laparoscopic Surgery / 대한마취과학회지

BACKGORUND: Previous studies have shown that the ProSeal laryngeal mask airway (PLMA) forms a more effective seal than the classic laryngeal mask airway (LMA) during a static oropharyngeal leak test and isolates the respiratory tract from the gastrointestinal tract when correctly positioned, but there is no evidence that it is a better ventilatory device. in the present study, we tested the hypothesis that the PLMA is a more effective ventilatory device than either the LMA or the endotracheal tube (ETT) in healthy anesthetized females undergoing gynecologic laparoscopic surgery at 120 ml/kg minute ventilation volume with the cuff fully inflated. METHODS: We studied 34 female patients (ASA physical status i, 22-46 yr) undergoing gynecologic laparoscopic surgery. Patients were randomized into three groups according to ventilatory devices; Group 1 (ETT, n = 11), Group 2 (LMA, n = 12) and Group 3 (PLMA, n = 11). After induction of anesthesia, patients were ventilated in the same mode in each group. We measured peak inspiratory pressure (PiP), PaO2, PaCO2, PETCO2 and arterial end-tidal PCO2 difference (PaCO2-PETCO2) at 10 min after induction of anesthesia (stage 1), 10 min after CO2 insufflation (stage 2), 10 min after Trendelenburg (T) position (stage 3) and 30 min after T position (stage 4). RESULTS: There were no significant differences among the three groups in PaCO2, PETCO2, and PiP. PaCO2 , PETCO2 and PiP increased significantly at stages 2 through 4 compared to stage 1 (P<0.05). PaO2 decreased significantly at stage 4 compared to stage 1 (P<0.05). PaCO2-PETCO2 was maintained within normal range from stage 1 to stage 4. CONCLUSiONS: This study demonstrates that pulmonary gas exchange is not affected by the choice of ventilatory devices during gynecologic laparoscopic surgery in young female patients under a Trendelenburg position and pneumoperitoneum.

A Comparison of the Laryngeal Tube, Laryngeal Mask Airway ClassicTM and Laryngeal Mask Airway ProsealTM during General Anesthesia / 대한마취과학회지

BACKGROUND: The laryngeal tube is a variant of the esophageal obturator airway. We compared laryngeal tube (LT), laryngeal mask airway classicTM (LMA) and laryngeal mask airway ProsealTM (PLMA) as a airway management device during general anesthesia. METHODS: Forty-five fasted healthy adult patients were enrolled in this study into one of three groups in a randomized, single-blinded protocol. Group 1 was to receive LT for airway management, LMA for Group 2, and PLMA for Group 3. General anesthesia was induced identically in three groups with thiopental sodium 5 mg/kg followed rocuronium 0.6 mg/kg. 90 seconds later, LT, LMA or PLMA was placed for airway management. Blood pressure and heart rate were measured immediately pre-induction control value, post-insertion of device 0 min, 1 min, 3 min and 5 min. We also compared times of insertion, the amounts of secretion, blood stain, and postoperative sore throat. RESULTS: There was no significant change of SBP, DBP and HR within three groups. All the groups showed stable hemodynamic results. The success rate on the first attempt was 93.6% (14/15, Group 1), 93.6% (14/15, Group 2) and 86.6% (13/15, Group 3). Minimum cuff volume to prevent gas leakage was 69.9+/-0.5 ml (Group 1), 11.1+/-4.3 ml (Group 2) and 11.9+/-3.2 ml (Group 3). The corresponding cuff pressure was 61.6+/-22.0 cmH2O (Group 1), 4.8+/-0.9 cmH2O (Group 2) and 4.6+/-1.5 cmH2O (Group 3). Moderate, severe sore throat was 20% (3/15, Group 1), 6.6% (1/15, Group 2) and 6.6% (1/15, Group 3). Moderate, profuse secretion was 40% (6/15, Group 1), 20% (3/15, Group 2) and 13.3% (2/15, Group 3). There was a 20% (3/15, Group 1) and 13.3% (2/15, Group 3) blood stain. But there was no blood stain for the Group 2. There was a 20% (3/15) gas leakage in Group 1, so we had to insert gas intermittently, but there were no gastric distension, regurgitation, aspiration, hypoxia, airway obstruction and laryngospasm in all three groups. CONCLUSIONS: All the groups revealed stable hemodynamics, no serious complications such as regurgitation, aspiration, hypoxia and airway obstruction during general anesthesia. But we did not find any evidence that LMA and PLMA have the remarkable advantages than laryngeal tube. So we suggested that laryngeal tube could be an alternative airway management device, even though further study will be needed.

Benefits of a ProSeal Laryngeal Mask Airway in a Laparoscopic Cholecystectomy / 대한마취과학회지

BACKGROUND: The ProSeal laryngeal mask airway (PLMA) is a new laryngeal mask device with a larger cuff and a drainage tube. This study was designed to assess the usefulness and the safety of the PLMA in a laparoscopic cholecystectomy. METHODS: Forty patients undergoing a laparoscopic cholecystectomy were randomly allocated to two groups; an endotracheal tube (ETT) group or a PLMA group. Anesthesia was induced with intravenous fentanyl and propofol and maintained with TCI-propofol. Blood pressure, heart rate, peak inspiratory pressure, peripheral O2 saturation (SpO2), end-tidal CO2 tension (PETCO2) and PaCO2 was measured during the operation. The incidence of gastric content regurgitation and gross pulmonary aspiration were evaluated. Postoperatively, SpO2, the visual analogue scale (VAS) of pain, nausea and vomiting (PONV), and sore throat were evaluated at 30 minutes intervals in post-anesthetic care unit (PACU) and at night. RESULTS: There were no significant differences in intraoperative PIP, SpO2, PETCO2, postoperative SpO2, VAS scores, PONV, and sore throat between the two groups. Gross pulmonary aspiration was not found in either group, but minimal gastric regurgitation occurred in 2 cases of the ETT group and 1 case of the PLMA group. CONCLUSIONS: We concluded that there were no differences in patient safety and adequate ventilation for a laparoscopic cholecystectomy between the ETT group and PLMA group. Moreover, there were no increases in blood pressure and heart rate in PLMA group during insertion/intubation.