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

Abstract

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.