title: ProSeal versus the Classic laryngeal mask airway for positive pressure ventilation during laparoscopic cholecystectomy.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Anesthesia, Chang Gung Memorial Hospital, 5 Fu-Hsin Street, Kuei-Shan Hsiang, 333 Taoyuan Hsien, Taiwan.
authors.forename: P P
authors.initials: PP
authors.lastname: Lu
authors.forename: J
authors.initials: J
authors.lastname: Brimacombe
authors.forename: C
authors.initials: C
authors.lastname: Yang
authors.forename: M
authors.initials: M
authors.lastname: Shyr
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000399:Air Pressure; D017081:Cholecystectomy, Laparoscopic; D004867:Equipment Design; D005260:Female; D006801:Humans; D017214:Laryngeal Masks; D008297:Male; D008875:Middle Aged; D011028:Pneumoperitoneum, Artificial; D011175:Positive-Pressure Respiration / Q000295:instrumentation*