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GYNECOLOGIC LAPAROSCOPY: LARYNGEAL MASK VS. TRACHEAL TUBE

Department of Anesthesia, Foothills Medical Centre
^* Community Health Sciences, University of Calgary, Alberta

INTRODUCTION

The LMA-Classic is used for gynecological laparoscopy in non-obese patients.^1,2 The ProSeal LMA³ incorporates a posterior inflatable cuff that permits higher airway pressure without oropharyngeal leak. We compared the LMA-Classic (BMI 30 kg.m^-2) or ProSeal LMA (BMI >30 kg.m^-2) with endotracheal tube (ETT) for elective gynecologic laparoscopy.

METHODS

Patients aged 18 yr, ASA I - III were randomized to LMA or ETT. Following preoxygenation, anesthesia was induced using propofol, fentanyl and rocuronium. A size 4 LMA (Classic or ProSeal) or ETT 7.0 mm was inserted. Anesthesia was maintained with isoflurane and nitrous oxide in 30-50% oxygen, V_T 10 mL.kg^-1 and rate 10.min^-1. Ventilation parameters were recorded before peritoneal insufflation (baseline) and with head down tilt during peritoneal insufflation (insufflation). The surgeon, blinded to the type of airway, assessed gastric size laparoscopically on a 0-10 scale at insertion of the laparoscope and at the end of the procedure.

RESULTS

Demographic data, anesthetic time, insufflation time, and changes in gastric distension were similar in both groups. Ventilation measurements are shown in the Table.

The LMA-Classic in non-obese patients and the ProSeal LMA in obese patients permitted effective ventilation during gynecological laparoscopy. Changes in gastric distension scores were not clinically significant and no surgeon requested passage of a gastric tube to deflate the stomach.

REFERENCES

1 Anesth Analg 1996; 82: 129–33.[Abstract]

2 Anesth Analg 1997; 85: 139–43.[Abstract]

3 Anaesthesia 1995; 50: 42–8.[Medline]

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