The Comparison Study Of Hemodynamic Effect Caused By Insertion And Insertion Difficulty Between LMA-Supreme And LMA-Proseal

Objective To study the difference of hemodynamic effect caused by insertion,insertion difficulty and the seal preasure between LMA-supreme and LMA-proseal.Methods 120 patients(age 18-75 years old,body weight less than 100kg,ASA^{â… -â…¡},operation duration less than 3 hours)scheduled for gynecology surgery or general surgery,were randomly allocated into 2 groups,LMA-supreme group or LMA-proseal group,each group contains 60 patients.Electrocardiograph,non-invasive blood pressure(NIBP) and pulse oximetry(SpO₂) monitoring commenced before the induction of anesthesia in all patients.Use the total intravenous anesthesia target control infusion for anesthesia induction,using plasma concentration for target control,target plasma concentration for propofol and remifentanil are 4.0μg/ml and 4.0ng/ml,infused at the same time.After the patient fall asleep(no response when the patients were asked and the eyelash reflex disappeared),gave the esmeron 0.6mg/kg into the patient intravenously.After the relaxation of mandibule,inserted the LMA.The LMA-proseal was inserted using digital technique with the use of the index finger to press,the LMA-supreme was inserted with the cuff fully deflated using a single-handed rotational technique,respectively.The intracuff pressure was set at 60cmH₂O then connected the device to the breathing circuit.Use the mannual ventilation to check the LMA for ventilation. IF the thorax fluctuation is well(the fluctuation of thorax is obvious, no leakage,effective CO₂ wave,SpO₂>95%),then fixed the LMA,to do intermittent positive-pressure ventilation(IPPV).Set the respiratory index,ventilation rate 10-12/min,tidal volume 8-12ml/kg.Put 1-2ml gel into the drain tube to see if there is leakage from the drain tube,press the superosternal fossa to see the fluctuation of the gel.Inserted the well lubricated gastric tube into the drain tube.If the thorax fluctuation is bad,or superosternal fossa test is positive or insertion of gastric tube is unsuccessful,inserted the LMA with cuff deflatted again.If the third insertion was unsuccessful,use the endotracheal intubation instead.Use the FOB(Fiberoptic Bronchoscope) to observe location of the LMA,and scored it.Tested the seal pressure 5min after LMA insertion.Then study end.â‘ Record the circulation system response during the insertion of the LMA-supreme or LMA-proseal,the SBP,DBP, MAP,HR and SpO₂ were recorded at the time before anesthetic induction, before insertion,at the time of insertion and 1,3,5mins after insertion.â‘¡Times for successful insertion.â‘¢Measured and recorded duration of insertion and the place of intergrated bite block.â‘£Recorded superosternal fossa test negative rate,the success rate of gastric tube placing.⑤Record the fibroptic score.â‘¥Record the oral pharyngeal seal pressure. Results There were no statistical differences in age,sex,weight, height,body index,ASA classification,Mallampati score and size of LMA(P＞0.05).â‘ Compare with the basic value,the SBP,DBP,MAP,HR before the insertion,at the time of insertion,and 1min,3min,5min after insertion all decreased(P＜0.05).The level of the decreasion was±20%-30%of basic value,was acceptable in clinical study.Compare with the time before insertion,in Supreme group DBP of 1min after insertion decrease(P＜0.05),5min after insertion SBP,MAP increased(P＜0.05),in Proseal group SBP 1min after insertion decreased.Compared with P group, in Supreme group,DBP at the time of insertion,SBP,DBP,MAP 5min after insertion were higher than Proseal group(P＜0.11).In the Supreme group SBP,DBP,MAP,HR basic value,before insertion,1,3,min after insertion had no statistical difference(P＞0.05).â‘¡The first insertion success rate in supreme group(90%) and proseal group(88%),had no statistical difference(P＞0.05).The total insertion success rate were both 100%.â‘¢The duration of insertion(7.9±3.5 s) was significantly shorter in the LMA-supreme group than the LMA-proseal group(10.4±4.7s)(P＞0.05).The fixation tab was 2.7±1.0cm above the superior incisor tooth in LMA-supreme,and the midpoint of LMA-proseal's internal bite block was 0.03±1cm below the superior incisor tooth.â‘£The superosternal fossa test negative rate and the success rate of gastric tbue placing in each group were all 100%.⑤The fibroptic score in Supreme group(0/1/2/3/4 percentage 0/0/8/33/59)and in Proseal group(0/1/2/3/4 percentage 0/3/7/27/63)had no statistical difference(P＜0.05).â‘¥The oral pharyngeal seal pressure in the LMA-supreme group(25.1±4.2cmH₂O) was significantly lower than the LMA-proseal group(31.4±5.7cmH₂O)(P＜0.05).Conclusionâ‘ The hemodynamic effects caused by insertion between LMA-supreme group and LMA-proseal group were lightly,circulatory system was stable.â‘¡Because of shorter duration of insertion and insertion without putting the finger into the patients mouth,the insertion of LMA-supreme was easier.