The Safety And Validity Study Of LMA-Proseal And LMA-Supreme Using In The Operation Of Lateral Decubitus

[OBJECTIVE] To discuss the safety and validity of using LMA-proseal and LMA-supreme in the operation of lateral decubitus.【METHODS】60 patients (age 18-75 years old, Body Mass Index less than 30, ASAⅠ-Ⅱ, operation duration less than 3 hours) scheduled for surgery in lateral decubitus, were randomly allocated into LMA-proseal group(n=30) or LMA-supreme group(n=30). Anesthesia was induced and maintained with TCI of propofol(Cp=3-4.5μg/ml) and remifentanil (Ce=4-6ng/ml). After the Bispectr-al Index was≦ 60, gave rocuronium 0.6mg/kg intravenously, the LMA was inserted 90 seconds after gave rocuronium. The intracuff pressure was set at 60cmH2O. IF the mannual ventilation was well, used intermittent positive pressure ventilation(IPPV).Set the respiratory index,tidal volume 8ml/kg, ventilation rate 12/min. Observed if there was leakage from the drain tube, 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 ventilation was bad, or superosternal fossa test was positive or insertion of gastric tube was unsuccessful, inserted the LMA again. If the third insertion was unsuccessful, then excluded the patient. Let the Bispectral Index between 40-60, respired the mixed gas of air and oxygen(1.5L/1.5L), gave rocuronium to maintain the muscle relaxed.1.SBP, DBP, MAP, HR and BIS were recorded at the time 10mins after came into the OR (basic value) (T0), before insertion(T1), at the time of insertion(T2) and 1(T:3),3(T4),5min(T5) after insertion, at the time of changing position to lateral decubitus(T6) and 1 (T7), 3(T8),5min(T9) after changing position.2. After examined the LMA position with the branchofiberoscope(t1), recorded the MV, Vt, Paw, EtCO2, SpO2, airway seal pressure and Fiberoptic bronchoscope scores. Five minutes later, changed position to lateral decubitus (t2), measured the intracuff pressure, and recorded the parameters again. Then adjusted the intracuff pressure back to 60cmH2O(t:3), and recorded the parameters again.3. Recorded the Paw, EtCO2, airway seal pressure and intracuff pressure at 30 (t4,60(t5),90min(t6) after the beginning of the operation, then adjusted the intracuff pressure back to 60cmH2O.4. Recorded the duration of insertion, the times for successful insertion, the plasma concentration of propofol and remifentanil when successful insertion, the result of superosternal fossa test and gastric tube placing, recorded if there are drainage tube leakage, air leakage, bloodstain on LMA, trachyphonia and pharyngalgia.【RESULT】1. Between the two groups, there were no statistical differences in general situation and SBP, DBP, MAP, HR and BIS at T0 to T9(P>0.05). In both groups, compared with T0, the SBP, DBP, MAP, HR and BIS at T, to T9 all decreased (P<0.05). The level of decrease was±20%-30% of T0, it was acceptable in clinical study. In Supreme group, compared with T1, BIS at the time of T6, T7, T9 increased (P<0.05). There were no statistical differences in SBP, DBP, MAP, HR and BIS at other time in both groups.2. In Proseal group, airway seal pressure and fiberoptic bronchoscope scores were better than Supreme group at t1, t2, t3, airway seal pressure was better than Supreme group at t4, t5, t6 (P < 0.05).There were no statistical differences in other parameters at t1 to t6 (P>0.05).3. In both groups, compared with t2, airway seal pressure and intracuff pressure were higher in t1 (P<0.05),there were no statistical differences in other parameters between t1 and t2 (P>0.05).There were no statistical differences in all parameters between t1 and t3 (P>0.05).4. In both groups,there were no statistical differences in the duration of insertion, the times for successful insertion, the plasma concentration of propofol and remifentanil when successful insertion, the result of supero-sternal fossa test and gastric tube placing, drainage tube leakage, air leakage, bloodstain on LMA, trachyphonia and pharyngalgia.【RESULT】Both LMA-proseal and LMA-supreme could be used in the operation of lateral decubitus. In lateral decubitus, LMA-proseal had better airway seal pressure and fiberoptic bronchoscope scores. Both of them could be used in the operation of lateral decubitus safely and valid.