Anaesthesia for gynaecological laparoscopy—a comparison between the laryngeal mask airway and tracheal intubation

Abstract

Forum 1bulbar blocks could lead to some passage of local anaesthetic across the optic chiasma and cause a contralateral block and blindness [I 1,121. This did not occur in our series. Theoretically, the use of a larger volume for retrobulbar block could lead to an increase in ocular tension and make the eye rather hard, but this effect is mitigated by the action of the local anaesthetic on the extra-ocular musculature [13]. In our study there was no increase in eye tension as assessed by the surgeon.In conclusion, local anaesthesia has a significant role in cataract surgery, particularly in the elderly and the chronically ill. This small study has established that good operating conditions can be achieved by a single retrobulbar block using a slightly higher volume of local anaesthetic solution than previously described. This method is satisfactory for both the surgeon and the patient.

A comparison of the effect of two anaesthetic techniques on surgical conditions during gynaecological laparoscopy

“…This is consistent with a study by Swann et al [2] Although the patient had to have resumed breathing before starting surgery, induction time for the laryngeal mask group was comparable. The NMB group also had a longer T3 due to the need for adequate reversal of neuromuscular blockade and extubation during these short procedures.…”

“…This technique has been shown to be safe, and there is a perception that as well as avoiding the morbidity of neuromuscular blocking agents and tracheal intubation, turnaround between cases is more rapid [2,3]. However, there has been little investigation of the effect of this technique on surgical access or surgical safety.…”

“…Rice, 1 S. P. Ewen, 2 and S. M. Elliott 3 1 Specialist Registrar in Anaesthesia, 2 Consultant Gynaecologist and 3 Consultant Anaesthetist., Queen Alexandra Hospital, Portsmouth, Hampshire, UK…”

Artificial ventilation during pneumoperitoneum

“…The latter observation raises an important issue, since it is generally accepted (90) that laparoscopy, especially in the Trendelenburg position, increases the risk of regurgitation and that LMA does not protect the airway against aspiration. Noteworthy, surgery with LMA results shorter than with tracheal tube (83,84).…”

“…However, this surgery can also be performed with supraglotic devices under spontaneous (83), assisted (84) or controlled ventilation (85)(86)(87)(88). Laryngeal mask airway (LMA) was proven efficient during cholecystectomy (85,87) and gynecological interventions (83,84,86,88). LMA's, particularly those with a conduit to allow the placement of a nasogastric tube, have a high oropharyngeal leak pressure and can, hence, provide adequate ventilation during laparoscopy (85,87,89).…”