Lu P P, Brimacombe J, Yang C, Shyr M
Department of Anesthesia, Chang Gung Memorial Hospital, 5 Fu-Hsin Street, Kuei-Shan Hsiang, 333 Taoyuan Hsien, Taiwan.
Br J Anaesth. 2002 Jun;88(6):824-7. doi: 10.1093/bja/88.6.824.
We tested the hypothesis that the ProSeal laryngeal mask airway (PLMA) is a more effective ventilatory device than the Classic laryngeal mask airway (LMA) for laparoscopic cholecystectomy.
Eighty anaesthetized, paralyzed patients (ASA 1-2, aged 18-80 yr) were randomly allocated for airway management with the PLMA or LMA. Ease of insertion and efficacy of seal were determined. Peak airway pressures were recorded immediately before and after carboperitoneum to 2.0 kPa. The inspired oxygen concentration and/or the ventilatory variable were adjusted according to a protocol to maintain SpO2 > or = 95% and E'CO2 < 6.0 kPa. Oxygenation was considered suboptimal if SpO2 fell to 94-90% and failed if SpO2 was < 90%. Ventilation was considered suboptimal if E'CO2 was > 6.0-7.3 kPa and failed if E'CO2 was > 7.3 kPa.
First-time insertion success rates were higher for the LMA (40/40 vs 33/40; P = 0.02). Seven patients required two attempts with the PLMA. Oropharyngeal leak pressure was higher for the PLMA [29 (SD 6) vs 19 (4) cm H2O; P < 0.001]. There was a similar, significant increase in peak airway pressure after carboperitoneum for both devices (P < 0.001). Before carboperitoneum, oxygenation and ventilation were optimal in all patients in both groups. After carboperitoneum, oxygenation was optimal in all patients in both groups, but ventilation was suboptimal more frequently with the LMA (8 vs 0; P = 0.01). In three of these eight patients, ventilation failed but was subsequently optimal with the PLMA.
The PLMA is a more effective ventilatory device for laparoscopic cholecystectomy than the LMA. We do not recommend the use of the LMA for laparoscopic cholecystectomy.
我们检验了以下假设：对于腹腔镜胆囊切除术，ProSeal喉罩气道（PLMA）是比经典喉罩气道（LMA）更有效的通气装置。
80例麻醉、肌松的患者（美国麻醉医师协会分级1 - 2级，年龄18 - 80岁）被随机分配接受PLMA或LMA气道管理。确定插入的难易程度和密封效果。在气腹至2.0 kPa之前和之后立即记录气道峰值压力。根据方案调整吸入氧浓度和/或通气变量，以维持脉搏血氧饱和度（SpO2）≥95%和呼气末二氧化碳分压（E'CO2）<6.0 kPa。如果SpO2降至94 - 90%，则认为氧合欠佳；如果SpO2<90%，则认为氧合失败。如果E'CO2>6.0 - 7.3 kPa，则认为通气欠佳；如果E'CO2>7.3 kPa，则认为通气失败。
LMA的首次插入成功率更高（40/40对33/40；P = 0.02）。7例患者使用PLMA需要尝试两次。PLMA的口咽漏气压更高[29（标准差6）对19（4）cmH2O；P<0.001]。两种装置在气腹后气道峰值压力均有相似的显著升高（P<0.001）。在气腹前，两组所有患者的氧合和通气均最佳。气腹后，两组所有患者的氧合均最佳，但LMA通气欠佳的情况更频繁（8例对0例；P = 0.01）。在这8例患者中的3例中，通气失败，但随后使用PLMA时通气最佳。
对于腹腔镜胆囊切除术，PLMA是比LMA更有效的通气装置。我们不推荐在腹腔镜胆囊切除术中使用LMA。
