Second-generation laryngeal mask airway as an alternative to endotracheal tube in prolonged laparoscopic abdominal surgery: a comparative analysis of intraoperative gas exchanges

Abstract

Introduction: Despite several advantages over endotracheal tube (ETT), laryngeal mask airway (LMA), which is used in emergencies under difficult airway maintenance conditions, is rarely utilized in prolonged surgery. We compared the variables representing intraoperative gas exchange with second-generation LMA and ETT during prolonged laparoscopic abdominal surgery. Methods: Prolonged surgery was defined as a surgery lasting more than 2 h. In total, 394 patients who underwent laparoscopic liver resection via either second-generation LMA or ETT were retrospectively analysed. Parameters including end-tidal pressure of carbon dioxide (ETCO2), tidal volume (TV), respiratory rate (RR), peak inspiratory pressure (PIP), arterial partial pressure of carbon dioxide (PaCO2), pH, and ratio of arterial partial pressure of oxygen to fractional inspired oxygen (PFR) during surgery were compared between the two groups. In addition, the incidence of postoperative pulmonary complications (PPC) including pulmonary aspiration was also compared. Results: The values of ETCO2, TV, RR and PIP during pneumoperitoneum were comparable between the two groups. Although PaCO2 at 2 h after induction was higher in patients with LMA (40.5 vs. 38.5 mmHg, p < 0.001), the pH and PFR values of the two groups were comparable. The incidence of PPC was not different. Conclusion: During prolonged laparoscopic abdominal surgery, the second-generation LMA facilitates adequate intraoperative gas exchange and represents an alternative to ETT.

Is Laryngeal Mask a Good Alternative in Children Undergoing Laparoscopic Inguinal Hernia Repair with Percutaneous Internal Ring Suturing Under and Over Two Years Old?

“…LMA is frequently used in short procedures in which general anesthesia is applied due to its ease of insertion and use without muscle relaxants, less hemodynamic instability during insertion, less metabolic stress response, and a lower risk of tracheal trauma. [9][10][11] Despite all these, a laryngeal mask is not always suitable for all laparoscopic surgeries, but it can be a good alternative to ETT for short procedures. In appropriate patients and surgical procedures, LMA prevents intubation risks and the adverse effects of residual block due to muscle relaxants.…”

“…Common airway complications were observed less in using LMA. 11,17,[21][22][23][24] A laryngeal mask may also provide an advantage in patients with an upper respiratory tract infection (URTI) and who require emergency surgery because of an incarcerated or strangulated inguinal hernia. Also, some children have a frequency of URTI of 6-8 episodes per year, so it may be challenging to schedule the child during a symptom-free interval for elective surgery; LMA will be a better alternative for appropriate surgical procedures in children who are at high risk of airway complications.…”

Laryngeal mask airway devices are a safe and effective method for anesthesia of laparoscopic extraperitoneal hernia repair surgery. A double blinded randomized prospective study.

“…It has been reported that there was no difference in the duration of surgery and anesthesia between the LMA and ETT groups when performed with the TAPP technique in adults [15]. In studies of laparoscopic surgeries in which LMA and ETT were compared, no difference was found in surgical times, while anesthesia times were found to be statistically signi cantly longer in the ETT group [31,32]. In their prospective randomized clinical study, Ye et al reported that no signi cant difference was found between the LMA and ETT groups in terms of anesthesia duration [33].…”

Is Laryngeal Mask a Good Alternative in Children Undergoing Laparoscopic Inguinal Hernia Repair with Percutaneous Internal Ring Suturing Under and Over Two Years Old?

“…LMA is frequently used in short procedures where general anaesthesia is applied due to its ease of insertion and use without muscle relaxants, less hemodynamic instability during insertion, less metabolic stress response, and a lower risk of tracheal trauma. [9][10][11] Despite all these, a laryngeal mask is not always suitable for all laparoscopic surgeries, but it can be a good alternative to ETT for short procedures. In appropriate patients and surgical procedures, LMA prevents intubation risks and the adverse effects of residual block due to muscle relaxants.…”

“…Recently, LMA has been used in some laparoscopic surgeries in adults; however, its use in pediatric patients is limited in laparoscopic surgeries. [9][10][11][12][13][14][15][16][17] Small working spaces in children may even become smaller due to gastrointestinal distention because LMA ventilation may be the major limitation of its use. To the best of our knowledge, the effect of LMA on laparoscopic surgery in different ages of pediatric patients is not compared with ETT.…”