Comparison of ProSeal laryngeal mask airway and intratracheal tube for ventilation under General Anesthesia during Laparoscopic Cholecystectomy<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />

史东平　封卫征　闻大翔　杭燕南

Dong-ping SHI,Wei-zheng FENG，Da-xiang WENG, Yan-nan HANG.

Department of Anesthesiology, Jiading Branch of Affiliated Renji Hospital, Shanghai Second Medical University,Shanghai 201800, China

Abstract

Objective：To compare ProSeal laryngeal mask airway with intratracheal tube for ventilation and investigate respiratory mechanics and hemodynamics during laparoscopic cholecystectomy.

Methods：80 ASA Ⅰ-Ⅱ adult patients undergoing elective Laparoscopic Cholecystectomy were randomly divided into two groups: ProSeal laryngeal mask airway group (PLMA, n=40) and intratracheal intubation group (TT n=40). In group PLMA, the patients were used the size 4 PLMA and in group TT the patients were used the size 7.5 tracheal tube. Anesthesia was induced with midazolam 0.05mg/kg, fentanyl 2-5ug/kg, propofol 1-1.5mg/kg and vecuronium 0.1-0.2mg/kg, maintained with inhalation of low concentration of isoflurane and intravenous fentanyl and vecuronium. ECG, SpO₂ , SBP, DBP , HR and PTEC0₂ were routinely monitored by PhillipsA₃ monitor. PIP, R, CL were measured by Bicore CP-100 respiratory monitor. Measurements were done at 5　distinct phases: before induction of anesthesia，1 min after insertion of PLMA or TT, 10 min after pneumoperitoneum, 5 min after the peritoneal deflation and extubation．

Results：Two groups were inserted successfully and gas leak did not occur in all patients. The time required for insertion of PLMA and TT were 24.2 sec and 22.7 sec average. In ProSeal laryngeal mask airway group the first time success rate was 87.5%, gastric tube was placed successfully, the airway seal pressure was 24.5±6.81 cmH₂O, hemodynamic had no change significantly during PLMA insertion or extubation. In intratacheal intubation group the first time success rate was 90% , hemodynamic had changed significantly during TT insertion or extubation. During pneumoperitoneum PETCO₂、PIP、R increased and CL decreased significantly　in two groups.

Conclusion：It is safety and convenient to use Proseal laryngeal mask airway with the result of effective ventilation, stable anesthesia and Less complication . So ProSeal laryngeal mask airway ventilation is suitable for laparoscopic cholecystectomy.

结　果<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />

两组病人平均年龄、身高、体重、手术时间无显著差异。PLMA插入一次成功率87.5%(34例)， 二次成功率10%(4例) ，三次成功率2.5%(2例)； TT组一次成功率90%（36例），二次成功率10%（4例），两组均无失败病例。操作时间 ：PLMA组最短7.1s，最长41.3s，平均24.2s；TT组最短6.1s，最长39.3s，平均22.7s。 PLMA充气量平均15.17±8.59ml，最大充气量30 ml；呼吸道密封压：<20cmH₂O, 2例；>20cmH₂O，38例；其中5例>40cmH₂O，平均24.5±6.81cmH₂O；在测量呼吸道密封压的过程中，无一例病人出现SPO₂ 降低和HR减慢；所有病人均成功放置胃管，平均放置长度51±4.70cm，手术结束时3例病人胃管内有引流液。术中无胃胀气，无返流、误吸的发生。；TT 组常规套囊充气，术中16例病人胃胀气。

插入和拔除PLMA和气管导管时血流动力学变化见表1，TT组血液动力学变化较PLMA组明显,有显著性差异( P<0.05)；气腹后较气腹前相比，血压明显升高，两组相比无显著差异。 呼吸力：学变化详见表2；气腹以后变化： ① ＰETCO₂、PIP、R明显升高，有显著性差异（P<0.05）；PLMA组分别平均增加7.15mmHg，6.70cmH₂O和2.91cmH₂O/L/s，TT组分别平均增加7.87mmHg，6.91 cmH₂O和2.30cmH₂O/L/s；两组间比较无显著性差异；② CL明显下降，有显著性差异（P<0.01），两组分别下降16.60 ml/cm/H₂O和17.55 ml/cm/H₂O。气腹10分钟后，PLMA组有3例病人,TT组有1例病人需调整呼吸频率至14次/分，使ＰETCO₂维持在设定范围内。 PLMA组和TT组术后各有1例病人述咽喉部不适，6小时后均消失。

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