A comparison of the effect of two anaesthetic techniques on surgical conditions during gynaecological laparoscopy.
In a prospective, randomised, controlled trial, we compared the effects of two anaesthetic techniques on surgical conditions during day-case, gynaecological laparoscopic procedures in 40 female patients. Patients were allocated randomly to two groups, either to breathe spontaneously through a laryngeal mask airway or to receive a neuromuscular-blocking agent (NMB) and have the lungs ventilated via a tracheal tube. We then measured the number of attempts of Verres' needle insertion, initial intra-abdominal pressure, time to reach a steady 15 mmHg (1.97 kPa) of intra-abdominal pressure, adequacy of the pneumoperitoneum, operative view and duration of operation. We found that the initial intra-abdominal pressure was higher and the operation time shorter in the laryngeal mask group. The adequacy of the pneumoperitoneum for trocar placement was better in the NMB group. We conclude that the anaesthetic technique of spontaneously breathing through a laryngeal mask airway reduces total operation time. However surgeons should be aware of the different abdominal pressure patterns produced by each anaesthetic technique, and anaesthetists must consider the implications of the anaesthetic technique on surgical safety.
Williams
M T
MT
Queen Alexandra Hospital, Portsmouth, Hampshire, UK. Miketw@doctors.org.uk
Rice
I
I
Ewen
S P
SP
Elliott
S M
SM
D000556:Ambulatory Surgical Procedures; D000769:Anesthesia, Inhalation; D001279:Atracurium; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D010535:Laparoscopy; D017214:Laryngeal Masks; D019148:Neuromuscular Blockade; D003473:Neuromuscular Nondepolarizing Agents; D011028:Pneumoperitoneum, Artificial; D011446:Prospective Studies; D012121:Respiration, Artificial
D003473:Neuromuscular Nondepolarizing Agents; D001279:Atracurium