Effect of pneumoperitoneum and Trendelenberg position on oropharyngeal sealing pressure of I-gel™and ProSeal LMA™ in laparoscopic gynecological surgery: A randomized controlled trial

Mishra, Sandeep Kumar; Sivaraman, Baskaran; Balachander, Hemavathy; Naggappa, Mahesh; Parida, Satyen; Bhat, Ramachandra V; Kotteeswaran, Yuvaraj

doi:10.4103/0259-1162.159771

Cited by 13 publications

(14 citation statements)

References 16 publications

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“…After the creation of a pneumoperitoneum, minute ventilation needs to be increased in order to maintain an acceptable level of arterial partial pressure of carbon dioxide. The abdominal splinting effect of the pnemonperitoneum reduces thoracic compliance and can lead to increase in airway pressures well in excess of 20 cmH 2 O [7]. The rise of airway pressure consequently inducing air leak from the SADs, might excessively insufflate the stomach and cause aspiration of regurgitated contents.…”

Section: Introductionmentioning

confidence: 99%

Comparison of gastric insufflation using LMA-supreme and I-gel versus tracheal intubation in laparoscopic gynecological surgery by ultrasound: a randomized observational trial

Fang

et al. 2020

BMC Anesthesiol

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Background: The application of bedside ultrasound to evaluate gastric content and volume can assist in determining aspiration risk. Applying positive pressure ventilation via supraglottic airway devices (SAD) can result in a degree of gastric insufflation. This study assessed and compared the antral cross-sectional area (CSA) in patients undergoing laparoscopic gynecological surgery when managed with different SAD. Methods: One hundred American Society of Anesthesiologists I or II female patients were assessed for inclusion in this study and divided into three groups of different ventilation devices. Patients were randomly allocated into three groups to receive LMA-Supreme (Group S), I-gel (Group I) or tracheal tube (Group T). The primary outcome was the antral cross-sectional area and secondary outcomes included haemodynamic parameters and postoperative morbidity such as sore throat, hoarseness, dry throat, nausea and vomiting. Results: The antral CSA was not significantly different among three groups before induction (P = 0.451), after induction (P = 0.456) and at the end of surgery (P = 0.195). The haemodynamic variables were significantly higher in the tracheal tube group than in the LMA-Supreme and I-gel groups after insertion (P < 0.0001) and after removal (P < 0.01). Sore throat was detected in none in the I-gel group compare to two patients (6.7%) in the LMA-Supreme group and fifteen patients (50%) in the tracheal tube group. Hoareness was detected in one (3.3%) in the I-gel group compare to two patients (6.7%) in the LMA-Supreme group and eleven patients (36.7%) in the tracheal tube group. Conclusions: The SADs do not cause obvious gastric insufflation. Thus, LMA-Supreme and I-gel can be widely used as alternative to endotracheal intubation for the short laparoscopic gynecological surgery. Trial registration: This trial was registered at the Chinese Clinical Trial Registry (ChiCTR1800018212, data of registration, September 2018).

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Section: Introductionmentioning

confidence: 99%

Comparison of gastric insufflation using LMA-supreme and I-gel versus tracheal intubation in laparoscopic gynecological surgery by ultrasound: a randomized observational trial

Fang

et al. 2020

BMC Anesthesiol

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“…They concluded that it may be because of the increase in intra-abdominal pressure leading to upward movement of trachea, in an LMA which is already placed and fixed. 10 In our study, of 30 cases in group PLMA, none had incidence of sore throat. Of 30 cases studied in group ETT, two cases (6.7%) had incidence of sore throat and blood staining of device way Pressures never crossed the sealing pressure.…”

Section: Discussionmentioning

confidence: 41%

Evaluation of the efficacy of proseal LMA versus endotracheal intubation for laparoscopic surgeries

Lawate¹,

Keniya²,

Swami³

2020

IJCA

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Background: Open surgeries which were done predominantly in previous days are progressing to minimally invasive keyhole laparoscopic surgeries. In same way, airway management has been also progressed from ETT to lesser invasive Laryngeal Mask Airway (LMA). Materials and Methods: This was a prospective observational study which was conducted in patients who came for lower abdominal laparoscopic surgeries during study period of 3 year. All patients were divided into 2 groups with 30 patients in each group (group A-PLMA, group B -ETT). Age, weight, type of surgery, time required for insertion of device, hemodynamic monitoring, ventilatory parameters, postoperative complications in the form of laryngopharyngeal morbidity were recorded. Results: In total 60 patients, between the age group of 18-65 year were included which were divided into 2 groups with 30 patients in each group. PLMA required 15.13 seconds as compared to ETT which required 13.33 seconds for insertion of device. The sealing pressure for PLMA was measured by leak test and the average was 32.2 cmH2O. The mean heart rate, systolic BP, Diastolic BP and MAP at various interval was significantly higher in group B as compared to group A (P-value<0.001 for all). The mean ± SD of ETCO2 among the cases studied in Group A and Group B was 36.53 ± 1.87% and 35.13 ± 2.51% respectively. Mean of Peak airway pressure (PAP) among the cases studied in PLMA (Group A) and ETT (Group B) was 22.53 mmHg and 18.97 mmHg respectively No complication or adverse event was noted during postoperative period in PLMA group but in Group ETT, 2 cases were found having blood staining of tube with sore throat in same 2 cases. Conclusion: PLMA is also proved to be an equally effective airway device in laparoscopic surgeries in the form of adequate oxygenation and ventilation. Also PLMA is associated with minimal intraoperative and postoperative complications. PLMA provided equally effective pulmonary ventilation despite of high airway pressures without significant gastric distension, aspiration and regurgitation.

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“…OPLP observed in our study was similar to the values noted in earlier studies. 5,9,[14][15][16] There have been many studies comparing PLMA with other SADs like LMA-Supreme and Igel 17,[18][19][20] They have found that both of these devices are suitable alternatives in laparoscopic surgeries, but PLMA has higher OPLP compared to other SADs. Therefore PLMA may be the most suited device for laparoscopic surgeries among SADs.…”

Section: Discussionmentioning

confidence: 99%

Comparison of oxygenation and ventilation parameters between proseal laryngeal mask airway and endotracheal tube in patients undergoing laparoscopic surgeries: a prospective observational study

Devendran¹,

M²,

K.S³

2020

IJCA

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Introduction: Use of endotracheal tube (ETT) has many limitations. There is a need for an airway device with similar safety and good side effect profile. In this prospective observational study, the oxygenation and ventilation parameters between patients who were inserted Proseal laryngeal mask airway (PLMA) or ETT for laparoscopic surgeries were compared. Materials and Methods: After ethical committee approval, informed consent was obtained from sixty patients (thirty in each group) posted for elective laparoscopic surgery. Following induction of general anaesthesia and paralysis, PLMA or ETT was inserted and pressure control mode was used for ventilation. The following parameters were measured: a. Oxygen saturation and changes in FiO2 needed to ensure a target SpO2> 95%, EtCO2 and changes in respiratory rate and inspiratory pressure needed to ensure a target EtCO2 between 35-45 mmHg. b. Insertion characteristics of airway device and gastric tube, hemodynamic responses, incidence of complications. Statistical Analysis: Chi-square test was used to analyze qualitative data. Independent t test was used to assess quantitative variables. Repeated measures ANOVA was used to compare the outcome measures over time adjusted for duration of surgery and anaesthesia. P values<0.05 considered significant. Results: Both groups were comparable with respect to age, gender and weight. Oxygenation and ventilation parameters achieved with both ETT and PLMA were comparable and satisfactory. Haemodynamic parameters increased significantly in ETT group compared to PLMA group during airway insertion and removal. Also, postoperative sore throat was comparatively less in the PLMA group. Conclusion:Hence we conclude that PLMA may be considered as an alternative to ETT in airway management of patients undergoing laparoscopic surgeries with comparable oxygenation and ventilation parameters and improved side effect profile.

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Effect of pneumoperitoneum and Trendelenberg position on oropharyngeal sealing pressure of I-gel™and ProSeal LMA™ in laparoscopic gynecological surgery: A randomized controlled trial

Cited by 13 publications

References 16 publications

Comparison of gastric insufflation using LMA-supreme and I-gel versus tracheal intubation in laparoscopic gynecological surgery by ultrasound: a randomized observational trial

Comparison of gastric insufflation using LMA-supreme and I-gel versus tracheal intubation in laparoscopic gynecological surgery by ultrasound: a randomized observational trial

Evaluation of the efficacy of proseal LMA versus endotracheal intubation for laparoscopic surgeries

Comparison of oxygenation and ventilation parameters between proseal laryngeal mask airway and endotracheal tube in patients undergoing laparoscopic surgeries: a prospective observational study

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