LMA-Classic and LMA-ProSeal are effective alternatives to endotracheal intubation for gynecologic laparoscopy.
OBJECTIVE
To compare the laryngeal mask airways (LMA), LMA-Classic(TM) (LMA-C) and LMA-ProSeal(TM) (PLMA) with the endotracheal tube (ETT) with respect to pulmonary ventilation and gastric distension during gynecologic laparoscopy.


METHODS
We stratified 209 women, aged > or = 18 yr, ASA physical status I-III, by body mass index as non-obese (< or = 30 kg x m(-2)) or obese (> 30 kg x m(-2)) and randomized them to LMA-C/PLMA or ETT groups for airway management. Anesthesia was induced with propofol, fentanyl and succinylcholine or rocuronium. In the LMA-C/PLMA group we used a size 4 LMA-C in non-obese patients and size 4 or 5 PLMA in obese patients. In the ETT group we used a cuffed 7.0 mm ETT in all patients. Anesthesia was maintained with isoflurane in nitrous oxide and 30-50% oxygen, fentanyl and neuromuscular blockade with mechanical ventilation (tidal volume 10 mL x kg(-1)). The staff surgeon, blinded to the type of airway, scored stomach size on an ordinal scale 0-10 at initial insertion of the laparoscope and immediately before the conclusion of the surgical procedure.


RESULTS
There were no crossovers and no statistically significant differences between LMA-C/PLMA and ETT groups for SpO(2,) P(ET)CO(2) or airway pressure before or during peritoneal insufflation in short (< or = 15 min) or long (> 15 min) periods of peritoneal inflation. Differences between groups with respect to stomach size changes during surgery were not statistically significant.


CONCLUSIONS
A correctly placed LMA-C or PLMA is as effective as an ETT for positive pressure ventilation without clinically important gastric distension in non-obese and obese patients.
Maltby
J Roger
JR
Department of Anesthesia, University of Calgary, Alberta, Canada. maltby@ucalgary.ca
Beriault
Michael T
MT
Watson
Neil C
NC
Liepert
David J
DJ
Fick
Gordon H
GH
D000328:Adult; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General; D000773:Anesthesia, Obstetrical; D015992:Body Mass Index; D005260:Female; D013271:Gastric Dilatation / Q000209:etiology; D013509:Gynecologic Surgical Procedures; D006801:Humans; D007442:Intubation, Intratracheal; D010535:Laparoscopy; D017214:Laryngeal Masks; D012123:Pulmonary Ventilation / Q000502:physiology; D013997:Time Factors