Othman, Marini
(2007)
Proseal laryngeal mask airway versus endotracheal tube for delivering positive pressure ventilation during laparoscopic surgery.
Masters thesis, Universiti Sains Malaysia.
Abstract
The purpose of our study is to assess whether the new Proseal Laryngeal Mask airway
(PLMA) can be a suitable alternative to the standard use of Endotracheal Tube (ETT) as
an airway adjunct to deliver positive pressure ventilation during laparoscopic surgeries.
We compared haemodynamic changes (by measuring heart rates, systolic blood
pressures, diastolic blood pressures and mean arterial pressures at different time intervals)
throughout the surgery, the quality of airway maintenance by measuring Sp02 and
ETC02 and recorded intra operative as well as post operative complications related to use
of both airway devices. We performed a prospective single blinded study on 64 patients
undergoing laparoscopic surgical procedures. These patients were randomized using
block randomization and divided into two groups; PLMA and ETT group. Both groups
have 32 patients. After standardized induction of anaesthesia, PLMA or ETT was inserted
and the patient was connected to ventilator that delivered positive pressure ventilation at
set tidal volume and rate. Anaesthesia was maintained with Nitrous oxide, Oxygen and
Isoflurane. Both airway devices were removed at the end of surgery with the patients
fully awake. The haemodynamic changes were recorded at different time intervals,
together with Sp02 and ETC02 changes. The incidences of intra operative complications
(coughing, regurgitation, bronchospasm, desaturation and gas leaking) were recorded if
present. The presence of blood upon airway device removal that indicates airway trauma
was also recorded. Then we recorded post operative complications if present (persistent
cough, vomiting and sore throat). We found that there were no statistical differences in HR changes measured at different
time intervals between PLMA and ETT. However there were statistically significant
decrease in systolic blood pressures and mean arterial pressures for PLMA group at 1
minute, 5 minute, 10 minute and 15 minute post intubation. For diastolic blood pressures,
the lower values in PLMA group were only significant at 10 and 15 minutes post
intubations. Comparing Sp02 and ETC02 monitoring, generally there were no significant
statistical differences for both groups studied.
Our findings on intra operative complications were that both groups have no statistical
difference in the incidence of coughing, regurgitation, desaturation, bronchospasm and
gas leaking. For presence of blood upon airway devices removal, we found no statistical
difference between PLMA and ETT groups. The incidence of post operative persistent
coughing and vomiting were also found to be statistically insignificant for both groups,
however incidence of post operative sore throat was significantly higher in ETT group
compared to PLMA with p value ofO.OOl.
Therefore we concluded that for laparoscopic surgery with positive pressure ventilation,
PLMA is a suitable alternative to standard ETI use and may offer advantages in terms of
haemodynamic changes, with lower incidences or no statistically significant peri
operative complications related to its use.
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