P Pu ur rp po os se e: : To compare LMA-ProSeal™ (LMA-PS) with endotracheal tube (ETT) with respect to pulmonary ventilation and gastric distension during laparoscopic cholecystectomy.
M Me et th ho od ds s: :We randomized 109 ASA I-III adults to LMA-PS or ETT after stratifying them as non-obese or obese (body mass index > 30 kg·m -2 ). After preoxygenation, anesthesia was induced with propofol, fentanyl and rocuronium. An LMA-PS (women #4, men #5) or ETT (women 7 mm, men 8 mm) was inserted and the cuff inflated. A #14 gastric tube was passed into the stomach in every patient and connected to continuous suction. Anesthesia was maintained with nitrous oxide, oxygen and isoflurane. Ventilation was set at 10 mL·kg -1 and 10 breaths·min -1 . The surgeon, blinded to the airway device, scored stomach size on an ordinal scale of 0-10 at insertion of the laparoscope and upon decompression of the pneumoperitoneum.R Re es su ul lt ts s: : There were no statistically significant differences in SpO 2 or P ET CO 2 between the two groups before or during peritoneal insufflation in either non-obese or obese patients. Median (range) airway pressure at which oropharyngeal leak occurred during a leak test with LMA-PS was 34 (18-45) cm water. Change in gastric distension during surgery was similar in both groups. Four of 16 obese LMA-PS patients crossed over to ETT because of respiratory obstruction or airway leak.C Co on nc cl lu us si io on ns s: : A correctly seated LMA-PS or ETT provided equally effective pulmonary ventilation without clinically significant gastric distension in all non-obese patients. Further studies are required to determine the acceptability of the LMA-PS for laparoscopic cholecystectomy in obese patients.
Objectif : Comparer le LMA-ProSeal™ (LMA-PS) et le tube endotrachéal (TET) quant à la ventilation pulmonaire et à la distension gastrique pendant la cholécystectomie laparoscopique.
Méthode : Le tirage au sort de 109 adultes d'état physique ASA I-III, répartis en deux groupes, LMA-PS ou ETT, a été stratifié sur les facteurs non obèses ou obèses (indice de masse corporelle > 30 kg·m -2 ). Après la préoxygénation, l'anesthésie a été induite avec du propofol, du fentanyl et du rocuronium. Un LMA-PS (no 4 : femmes et no 5 : hommes) ou un TET (7 mm : femmes et 8 mm : hommes) a été inséré, et le ballonnet gonflé. Un tube gastrique no 14 a été poussé dans l'estomac et relié à une aspiration continue. L'anesthésie a été maintenue avec du protoxyde d'azote, de l'oxygène et de l'isoflurane. La ventilation a été instaurée à 10 mL·kg -
P Pu ur rp po os se e: : To compare the laryngeal mask airways (LMA), LMAClassic™ (LMA-C) and LMA-ProSeal™ (PLMA) with the endotracheal tube (ETT) with respect to pulmonary ventilation and gastric distension during gynecologic laparoscopy.
M Me et th ho od ds s: :We stratified 209 women, aged $ 18 yr, ASA physical status I-III, by body mass index as non-obese (# 30 kg·m -2 ) or obese (> 30 kg·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·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.R Re es su ul lt ts s: : 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 (# 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. C Co on nc cl lu us si io on n: : 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.
Objectif : Comparer les masques laryngés (ML), ML Classique™ (MLC) et le ML ProSeal™ (MLP), au tube endotrachéal (TET) quant à la ventilation pulmonaire et à la distension gastrique pendant la laparoscopie gynécologique.
Méthode : Nous avons réparti 209 femmes, $ 18 ans, d'état physique ASA I-III, selon l'indice de masse corporelle, comme non obèses (# 30 kg·m -2 ) ou obèses (> 30 kg·m -2 ) et leur avons assigné au hasard le MLC/MLP ou le TET pour maintenir la perméabilité des voies aériennes. L'anesthésie a été induite avec du propofol, du fen-
P Pu ur rp po os se e: : To determine whether, in obese [body mass index (BMI) > 30 kg·m 2 ] patients, oral intake of 300 mL clear liquid two hours before elective surgery affects the volume and pH of gastric contents at induction of anesthesia.
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