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Gastric distension and ventilation during laparoscopic cholecystectomy: LMA-Classic vs. tracheal intubation

From the Departments of Anesthesia and Community Health Sciences,
^* University of Calgary, Alberta, Canada.

Address correspondence to: Dr. J. Roger Maltby, Department of Anesthesia, Foothills Medical Centre, 1403 - 29th Street NW, Calgary, Alberta, T2N 2T9 Canada. Phone: 403-670-1667; Fax: 403-670-1667; E-mail: maltby{at}ucalgary.ca

Purpose: The standard laryngeal mask airway LMA-Classic was designed as an alternative to the endotracheal tube (ETT) or the face mask for use with either spontaneous or positive pressure ventilation. Positive pressure ventilation may exploit leaks around the LMA cuff, leading to gastric distension and/or inadequate ventilation. We compared gastric distension and ventilation parameters with LMA vs ETT during laparoscopic cholecystectomy.

Methods: One hundred and one, ASA I-II adults scheduled for elective laparoscopic cholecystectomy were randomly assigned to LMA-Classic or ETT. Patients with BMI >30 kg•m^–2, hiatus hernia or gastroesophageal reflux were excluded. Following induction of anesthesia, an in-and-out orogastric tube was passed to decompress the stomach before insertion of the LMA (women size #4, men size #5) or ETT (women 7 mm, men 8 mm). Anesthesia was maintained with isoflurane in nitrous oxide and oxygen (FIO₂ 0.3–0.5), rocuronium and fentanyl. The surgeon, blinded to the type of airway, scored gastric distention 0–10 at insertion of the laparoscope and immediately before removal at the end of the surgical procedure.

Results: Incidence and degree of change in gastric distension were similar in both groups. Ventilation parameters during insufflation (mean ± SD) for LMA and ETT were: S_PO₂ 98 ± 1 vs 98 ± 1, P_ETCO₂ 38 ± 4 vs 36 ± 4 mm Hg and airway pressure 21 ± 4 vs 23 ± 3 cm water.

Conclusion: Positive pressure ventilation with a correctly placed LMA-Classic of appropriate size permits adequate pulmonary ventilation. Gastric distension occurs with equal frequency with either airway device.

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