Randomised Comparative Study of Efficacy of Proseal Laryngeal Mask Airway, Laryngeal Tube and Endotracheal Tube in Mechanically Ventilated Gynaecological Laproscopic Surgeries

Introduction In spite of tremendous advances in contemporary anaesthetic practice, airway management continues to be of paramount importance to anaesthesiologists. Till date, the cuffed tracheal tube was considered as the gold standard for providing a safe glottic seal. To overcome the disadvantages of tracheal intubation, supraglottic airway devices were introduced. This study was therefore undertaken to compare PLMA and laryngeal tube with standard tracheal tube for the number of attempts and time taken for insertion, haemodynamic changes, oxygenation, ventilation and intraoperative and postoperative laryngopharyngeal morbidity (LPM) occurring during general anaesthesia in young healthy adult patients undergoing laparoscopic surgeries. Methods After attaining ethical committee approval a prospective randomised comparative study was conducted on 90 patients, 30 each in each group, of ASA I-II who were posted for gynaecological laproscopic procedures under general anaesthesia. After preoxygenation, anaesthesia was induced with propofol, fentanyl and atracurium. PLMA, laryngeal tube or ETT was inserted and cuff inflated. Nasogastric tube (NGT) was passed in all patients. Anaesthesia was maintained with N2 O, O2, sevoflurane and atracurium. Ventilation was set at 8 ml/kg and respiratory rate of 12/min-14/ min to maintain end tidal carbon dioxide of 35-45 mmhg. The attempts and time taken for insertion of devices, haemodynamic changes, oxygenation, ventilation and intraoperative and postoperative laryngopharyngeal morbidity (LPM) were noted. Results In our study time taken for insertion of Proseal laryngeal mask airway (18.432.89) sec was found to be less than that taken for insertion of Laryngeal tube suction (26.262.93) sec which was less than the insertion time for securing airway with endotracheal tube (27.732.47) sec, (P0.05). Conclusion Supraglottic airway devices were easier to insert, did not cause hemodynamic changes, were associated with less post op morbidity and regurgitation was not found to be significant. Therefore they can be used in laproscopic procedures safely. References Saraswat N etal The comparison of Proseal Laryngeal mask airway and endotracheal tube in patients undergoing laproscopic surgeries under general anaesthesia. Indian J Anaesth 2011; 55: 129-34 Roth H etal The proseal LMA and the laryngeal tube suction for ventilation in gynaecological patients undergoing laproscopic surgery. European J anaesthesiology 2005; 22: 117-122