The use of ProSeal laryngeal mask airway for mechanical ventilation during laparoscopic biliary tract surgery

Objective To investigate the possibility of using LMA-ProSeal (PLMA) instead of endotracheal intubation for mechanical ventilation during laparoscopic biliary tract operation. Methods Eighty ASA Ⅰ or Ⅱ patients aged 21-63 yr undergoing laparoscopic surgery were enrolled in the study. The extent of mouth opening and extension of the adanto-occipital joint as well as the visibility of facial pillars, uvula and soft palate (Mallampati class Ⅰ or Ⅱ) of these patients were normal. The patients were randomized to receive either PLMA (n = 40) or endotracheal tube (n = 40). Anesthesia was induced with propofol 2 mg·kg-1, sufentanil 0.6 μg·kg-1 and atracurium 0.6 mg·kg-1 . PLMA insertion and endotracheal intubation were performed by the same highly experienced anesthesiologist. The number of attempts at insertion and success rate, time of insertion, BP and HR before, during and after insertion and removal were recorded. The adequacy of ventilation was estimated by peak inspiratory airway pressure (Ppeak) , tidal volume (VT) and PETCO2 . The position of PLMA was examined by fiberoptic bronchoscopy.Results There was no significant difference in time of insertion, Ppeak, VT and PETCO2 at 15 min of IPPV or peritoneal insufflation between the two groups (P 0.05) . The success rate of insertion at first attempt was similar (95%) in both groups. PLMA was placed in the correct position in 87.5% of the patients. The changes in BP and HR and the extubation or PLMA removal response were less in the PLMA group. Significantly less patients in PLMA group complained about sore throat after operation (P 0.01) . Conclusion PLMA is superior to endotracheal intubation in terms of ease of insertion, intubation or insertion response and extubation or removal response, efficacy of mechanical ventilation and postoperative sore throat.