Rustagi Preeti, Patkar Geeta A, Ourasang Anil Kumar, Tendolkar Bharati A
Assistant Professor, Department of Anaesthesiology, Lokmanya Tilak Municipal Medical College and Lokmanya Tilak Municipal General Hospital , Sion, Mumbai, Maharashtra, India .
Professor, Department of Anaesthesiology, Lokmanya Tilak Municipal Medical College and Lokmanya Tilak Municipal General Hospital , Sion, Mumbai, Maharashtra, India .
J Clin Diagn Res. 2017 Feb;11(2):UC05-UC09. doi: 10.7860/JCDR/2017/22168.9422. Epub 2017 Feb 1.
A sustained and effective oropharyngeal sealing with supraglottic airway is required to maintain the ventilation during laparoscopic surgery. Previous studies have observed the Oropharyngeal Seal Pressure (OSP) for Proseal Laryngeal Mask Airway (PLMA) after pneumoperitoneum in supine and trendelenburg position, where PLMA was found to be an effective airway device. This study was conducted with ProSeal LMA, for laparoscopic Urologic procedures done in lateral position.
To measure OSP in supine and lateral position and to observe the effect of pneumoperitoneum in lateral position on OSP. Secondary objectives were to assess adequacy of ventilation and incidence of adverse events.
A total number of 25 patients of American Society of Anaesthesiologists (ASA) physical status II and I were enrolled. After induction of anaesthesia using a standardized protocol, PLMA was inserted. Ryle's tube was inserted through drain tube. The position of PLMA was confirmed with ease of insertion of Ryle's tube and fibreoptic grading of vocal cords. Patients were then put in lateral position. The OSP was measured in supine position. This value was baseline comparison for OSP in lateral position and that after pneumoperitoneum. We assessed the efficacy of PLMA for ventilation, after carboperitoneum in lateral position (peak airway pressure, End Tidal Carbon dioxide (EtCO), SPO). Incidence of adverse effects (displacement of device, gastric insufflation, regurgitation, coughing, sore throat, blood on device, trauma) was also noted.
The OSP was above Peak Airway Pressure (PAP) in supine (22.1±5.4 and 15.4±4.49cm of HO) and lateral position (22.6±5.3 and 16.1±4.6). After pneumoperitoneum, which was in lateral position, there was statistically significant (p-value <0.05) increase in both PAP (19.96±4.015) and OSP (24.32±4.98, p-value 0.03). There was no intraoperative displacement of PLMA. There was no event of suboptimal oxygenation. EtCO was always within normal limits. Gastric insufflation was present in one patient. One patient had coughing and blood was detected on device. Three patients had throat discomfort post-operatively.
In this study, Oropharyngeal seal pressures with PLMA were found to increase after pneumoperitoneum in lateral position. PLMA forms an effective seal around airway and is an efficient and safe alternative for airway management in urological laparoscopic surgeries done in lateral position.
在腹腔镜手术期间，需要通过声门上气道实现持续有效的口咽密封以维持通气。先前的研究观察了在仰卧位和气腹后处于头低脚高位时，喉罩气道（PLMA）的口咽密封压（OSP），发现PLMA是一种有效的气道装置。本研究使用PLMA对侧卧位进行的泌尿外科腹腔镜手术进行观察。
测量仰卧位和侧卧位的OSP，并观察侧卧位气腹对OSP的影响。次要目标是评估通气的充分性和不良事件的发生率。
共纳入25例美国麻醉医师协会（ASA）身体状况为Ⅰ级和Ⅱ级的患者。采用标准化方案诱导麻醉后，插入PLMA。通过引流管插入胃管。通过胃管插入的难易程度和声门的纤维光学分级确认PLMA的位置。然后将患者置于侧卧位。测量仰卧位的OSP。该值作为侧卧位和气腹后OSP的基线对照。我们评估了侧卧位气腹后PLMA的通气效果（气道峰值压力、呼气末二氧化碳分压（EtCO）、脉搏血氧饱和度（SPO））。还记录了不良反应的发生率（装置移位、胃充气、反流、咳嗽、咽痛、装置上有血、创伤）。
仰卧位（22.1±5.4和15.4±4.49cmH₂O）和侧卧位（22.6±5.3和16.1±4.6）的OSP均高于气道峰值压力（PAP）。侧卧位气腹后，PAP（19.96±4.015）和OSP（24.32±4.98，p值0.03）均有统计学意义的升高（p值<0.05）。术中PLMA无移位。无氧合不足事件。EtCO始终在正常范围内。1例患者出现胃充气。1例患者咳嗽，装置上发现有血。3例患者术后有咽痛。
在本研究中，发现侧卧位气腹后PLMA的口咽密封压升高。PLMA在气道周围形成有效的密封，是侧卧位泌尿外科腹腔镜手术气道管理的一种有效且安全的替代方法。
