Bhushan Deepak, Nandkumar Sunita, Butani Manju
Department of Anesthesiology, Global Hospital, Mumbai, India.
Department of Anesthesiology, P.D. Hinduja National Hospital and Medical Research Center, Mahim, Mumbai, Maharashtra, India.
Asian J Anesthesiol. 2022 Mar 1;60. doi: 10.6859/aja.202202/PP.0001.
Laparoscopic cholecystectomy is a commonly performed surgical procedure. Most anesthesiologists advocate tracheal intubation. Laparoscopic cholecystectomy is becoming a day care surgery, hence many anaesthesiologists have started using laryngeal masks to decrease airway manipulation seen with conventional laryngoscopy and endotracheal intubation and avoid hemodynamic pressor responses and postoperative sore throat. The Supreme laryngeal mask airway (LMA) is an innovative, sterile, single use, supraglottic airway management device which provides access to and functional separation of the respiratory and digestive tracts. In this study, there are two objectives-(1) primary objective: to assess the adequacy of ventilation when using LMA-Supreme^(TM) (LMA-S) and endotracheal tube (ETT), and (2) secondary objective: the first is to give the time for achieving effective airway and number of attempts for securing airway. The second is to assess haemodynamic parameters (heart rate and blood pressure). The last is to show the incidence of gastric distension, regurgitation and postoperative sore throat.
A total of 132 American Society of Anesthesiologists (ASA) I-II patients were randomly assigned to LMA-S and ETT for intraoperative ventilation. After induction of general anaesthesia, the device was inserted, correct placement was checked, and parameters were recorded. SPSS version 20.0 software (IBM Corp., Armonk, NY, USA) was used for statistical analysis. A P-value less than 0.05 is statistically significant.
Ventilatory parameters such as inspiratory and expiratory leak volumes, and peak airway pressure values were comparable between the groups throughout the entire time interval. The number of attempts for successful insertion were comparable, but the mean time required for achieving effective airway was significantly longer in ETT than LMA-S (25.2 ± 8.3 sec vs. 18.6 ± 5.1 sec, respectively [P ＜ 0.05]). There was no situation in which the patient from the LMA-S group had to be intubated. The haemodynamic responses to insertion, pneumoperitoneum inflation and deflation, and removal of the device were greater for the ETT than the LMA-S. There were no complications like gastric distension or regurgitation in either groups. The postoperative sore throat at 2 hours and 24 hours was significantly lower in group LMA-S than group ETT.
Positive pressure ventilation with a correctly placed LMA-S allows adequate pulmonary ventilation, without the untoward hemodynamic and postoperative adverse effects of endotracheal intubation, in laparoscopic cholecystectomy surgery.
腹腔镜胆囊切除术是一种常见的外科手术。大多数麻醉医生主张气管插管。腹腔镜胆囊切除术正逐渐成为日间手术，因此许多麻醉医生开始使用喉罩，以减少传统喉镜检查和气管插管时的气道操作，并避免血流动力学升压反应和术后咽痛。至尊喉罩气道（LMA）是一种创新的、无菌的、一次性使用的声门上气道管理设备，可实现呼吸道和消化道的通路及功能分离。本研究有两个目的：（1）主要目的：评估使用至尊喉罩（LMA-S）和气管内导管（ETT）时的通气充分性；（2）次要目的：一是给出实现有效气道的时间和确保气道安全的尝试次数；二是评估血流动力学参数（心率和血压）；三是显示胃扩张、反流和术后咽痛的发生率。
总共132例美国麻醉医师协会（ASA）I-II级患者被随机分配至LMA-S组和ETT组进行术中通气。全身麻醉诱导后，插入设备，检查正确放置情况，并记录参数。使用SPSS 20.0版软件（美国纽约州阿蒙克市IBM公司）进行统计分析。P值小于0.05具有统计学意义。
在整个时间段内，两组间的通气参数如吸气和呼气漏气量以及气道峰值压力值具有可比性。成功插入的尝试次数具有可比性，但ETT组实现有效气道所需的平均时间显著长于LMA-S组（分别为25.2±8.3秒和18.6±5.1秒[P＜0.05]）。LMA-S组的患者无需进行气管插管。ETT组对设备插入、气腹充气和放气以及设备移除的血流动力学反应大于LMA-S组。两组均未出现胃扩张或反流等并发症。LMA-S组术后2小时和24小时的咽痛明显低于ETT组。
在腹腔镜胆囊切除术中，正确放置的LMA-S进行正压通气可实现充分的肺通气，且无气管插管的不良血流动力学和术后不良反应。
