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Papel de la ML en colecistectomía laparoscópica
Role of laryngeal mask airway in laparoscopic cholecystectomy.
Abstract
Laparoscopic cholecystectomy is one of the most commonly performed surgical procedures and the laryngeal mask airway (LMA) is the most common supraglottic airway device used by the anesthesiologists to manage airway during general anesthesia. Use of LMA has some advantages when compared to endotracheal intubation, such as quick and ease of placement, a lesser requirement for neuromuscular blockade and a lower incidence of postoperative morbididy. However, the use of the LMA in laparoscopy is controversial, based on a concern about increased risk of regurgitation and pulmonary aspiration. The ability of these devices to provide optimal ventilation during laparoscopic procedures has been also questioned. The most important parameter to secure an adequate ventilation and oxygenation for the LMA under pneumoperitoneum condition is its seal pressure of airway. A good sealing pressure, not only state correct patient ventilation, but it reduces the potential risk of aspiration due to the better seal of airway. In addition, the LMAs incorporating a gastric access, permitting a safe anesthesia based on these commented points. We did a literature search to clarify if the use of LMA in preference to intubation provides inadequate ventilation or increase the risk of aspiration in patients undergoing laparoscopic cholecystectomy. We found evidence stating that LMA with drain channel achieves adequate ventilation for these procedures. Limited evidence was found to consider these devices completely safe against aspiration. However, we observed that the incidence of regurgitation and aspiration associated with the use of the LMA in laparoscopic surgery is very low.
KEYWORDS: I-gel; Laparoscopic cholecystectomy; Laryngeal mask airway; Laryngeal mask airway Proseal; Laryngeal mask airway Supreme; Oropharyngeal leak pressure; Ventilation
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Comparación de ML Supreme y ProSeal en pacientes programados para colecistectomía laparoscópica. Estudio controlado randomizado
Comparison of the Supreme and the ProSeal laryngeal mask airway in patients undergoing laparoscopic cholecystectomy: A randomized controlled trial.
Abstract
OBJECTIVE: The single-use LMA Supreme (Teleflex, Inc., Wayne, PA, USA) and the LMA ProSeal (Teleflex, Inc., Wayne, PA, USA) laryngeal mask airway (LMA) have similar characteristics. To date, studies have not achieved a consensus regarding the oropharyngeal leak pressure (OLP) of the LMA Supreme and LMA ProSeal, and there is little information on their efficacy in laparoscopic cholecystectomy. This study compared the safety and efficacy of the LMA Supreme and LMA ProSeal devices in patients undergoing laparoscopic cholecystectomy. METHOD: Eighty-four eligible consenting patients were randomly allocated to the LMA Supreme group or the LMA ProSeal group. Both groups received the standard anesthesia technique. The Supreme or ProSeal LMA was inserted, the cuff was inflated to 60 cmH2O, and the LMA position was confirmed. Anesthesia was maintained using propofol and 50% oxygen in air. A gastric tube was inserted through the drain tube of the LMA to deflate the stomach, and the first attempt success rate and insertion time were recorded. During surgery, the intra-abdominal pressure was maintained at 12 mmHg. The fiberoptic view of the larynx was determined by passing a flexible fiberoptic bronchoscope. The OLPs, success rate, insertion time, hemodynamic and respiratory parameters, and complications were recorded at different time points. RESULTS: The mean OLP was significantly lower in the LMA Supreme group than in the LMA ProSeal group (24.9 ± 5.3 cmH2O vs. 28.4 ± 5.8 cmH2O; p < 0.01). The first attempt success rate and ease of insertion grading for LMA were higher in the Supreme group. The insertion time was lower in the Supreme group than in the ProSeal group (p < 0.01). The fiberoptic view was better with the ProSeal LMA. The hemodynamic and ventilatory parameters and postoperative sore throat were comparable in both groups. CONCLUSION:
The LMA ProSeal has a higher OLP than the LMA Supreme. The success rate of first attempt insertion and ease of insertion were better for the LMA Supreme group and the insertion time was lower in the LMA Supreme group. The Supreme and ProSeal LMAs were both effective for positive pressure ventilation in laparoscopic cholecystectomy.
KEYWORDS: ProSeal; Supreme; laparoscopic cholecystectomy; laryngeal mask airway; oropharyngeal leak pressure
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Comparación de ML i-gel®y ML Supreme® durante colecistectomía laparoscópica
Comparison of i-gel® and LMA Supreme® during laparoscopic cholecystectomy.
2015 Oct;68(5):455-61. doi: 10.4097/kjae.2015.68.5.455. Epub 2015 Sep 30.
Abstract
BACKGROUND: In laparoscopic surgical procedures, many clinicians recommend supraglottic airway devices as good alternatives to intubation. We compared the i-gel® (i-gel) and LMA Supreme® (Supreme Laryngeal Mask Airway, SLMA) airway devices during laparoscopic cholecystectomy regarding sealing pressure and respiratory parameters before, during, and after pneumoperitoneum. METHODS: Following Institutional Review Board approval and written informed consent, 93 patients were randomly allocated into the i-gel (n = 47) or SLMA group (n = 46). Insertion time, number of insertion attempts, and fiberoptic view of glottis were recorded. Oropharyngeal leak pressure (OLP), the use of airway manipulation, peak inspiratory pressure, lung compliance, and hemodynamic parameters were measured before, during, and after pneumoperitoneum. RESULTS: There were no significant differences between the two groups regarding demographic data, insertion time, fiberoptic view of glottis, and the use of airway manipulation. The gastric tube insertion time was longer in the i-gel group (20.4 ± 3.9 s) than in the SLMA group (16.7 ± 1.6 s) (P < 0.001). All devices were inserted on the first attempt, excluding one case in each group. Peak inspiratory pressure, lung compliance, and OLP changed following carbon dioxide pneumoperitoneum in each group, but there were no significant differences between the groups. CONCLUSIONS: Both the i-gel and SLMA airway devices can be comparably used in patients who undergo laparoscopic cholecystectomy, and they offer similar performance including OLP.
KEYWORDS: I-gel; Laparoscopic cholecystectomy; Supreme laryngeal mask airway
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Curso sobre Anestesia en Trasplantes, Cirugía abdominal, Plástica, Oftalmología y Otorrinolaringología.
Committee for European Education in Anaesthesiology (CEEA)
y el Colegio de Anestesiólogos de León A.C.
Abril 7-9, 2017, León Guanajuato, México
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4° Congreso Internacional de Control Total de la Vía Aérea
Asociación Mexicana de Vía Aérea Difícil, AC
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Regional Anesthesiology and Acute Pain Medicine Meeting
April 6-8, 2017, San Francisco, California, USA
ASRA American Society of Regional Anesthesia and Pain Medicine
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