LMA-classic™ and LMA-ProSeal™ are effective alternatives to endotracheal intubation for gynecologic laparoscopy

Abstract

Purpose: To compare the laryngeal mask airways (LMA), LMA-Classic™ (LMA-C) and LMA-ProSeal™ (PLMA) with the endotracheal tube (ETT) with respect to pulmonary ventilation and gastric distension during gynecologic laparoscopy. Methods: We stratified 209 women, aged ≥ 18 yr, ASA physical status I-III, by body mass index as non-obese (≤ 30 kg·m-2) or obese (> 30 kg·m-2) and randomized them to LMA-C/PLMA or ETT groups for airway management. Anesthesia was induced with propofol, fentanyl and succinylcholine or rocuronium. In the LMA-C/PLMA group we used a size 4 LMA-C in non-obese patients and size 4 or 5 PLMA in obese patients. In the ETT group we used a cuffed 7.0 mm ETT in all patients. Anesthesia was maintained with isoflurane in nitrous oxide and 30-50% oxygen, fentanyl and neuromuscular blockade with mechanical ventilation (tidal volume 10 mL·kg-1). The staff surgeon, blinded to the type of airway, scored stomach size on an ordinal scale 0-10 at initial insertion of the laparoscope and immediately before the conclusion of the surgical procedure. Results: There were no crossovers and no statistically significant differences between LMA-C/PLMA and ETT groups for SpO2, PETCO2 or airway pressure before or during peritoneal insufflation in short (≤ 15 min) or long (> 15 min) periods of peritoneal inflation. Differences between groups with respect to stomach size changes during surgery were not statistically significant. Conclusion: A correctly placed LMA-C or PLMA is as effective as an ETT for positive pressure ventilation without clinically important gastric distension in non-obese and obese patients.