Effects Of Proseal Laryngeal Mask Airway And Endotracheal Intubation In Patients Undergoing Fast-track Gynecological Laparoscopic Operation During General Anesthesia

Objective:To compare the clinical effects of the ProSeal laryngeal mask airway and Endotracheal Intubation on hemodynamic and respiratory function in patients undergoing fast-track gynecological laparoscopic operation during general anesthesia; To explore the feasibility and safety of the ProSeal laryngeal mask airway used for the fast-track gynecological laparoscopic operation.Methods:Sixty patients received fast-track gynecological laparoscopic operation during general anesthesia were randomly allocated into two equal groups:PLMA group (treated by Proseal laryngeal mask) and TT group (treated by endotracheal intubation).The hemodynamic changes were continuously monitored by the Bioz.com system in all patients. The Proseal laryngeal mask/endotracheal intubation were inserted after general anesthesia induction. Anesthesia was maintained with Intravenous inhalation combined anesthesia.The pressure of CO2pneumoperitoneum were restricted under15mmHg during the operation. Hemodynamic and Respiratory parameters, including heart rate (HR), stroke volume(SV), mean arterial pressure(MAP), cardiac output(CO), systemic vascular resistance(SVR), thoracic fluid content(TFC), acceleration index(ACI), left ventricular ejection time(LVET), PETCO2, PPeak and Pplat were recorded before anesthesia induction(T1), after intubation(T2), retroperitoneal insufflation of CO2, at0min(T3),5min(T4),30min(T5),60min(T6),5min before extubation (T7) and extubation (T8). Meanwhile, record the incidence of regurgitation, aspiration, gastric distension, leakage, nausea/vomiting, irritability during extubation, blood traces on the airway device, laryngopharynx complications in both groups. After operation, the time of the diet progression, foley catheter removal, length of stay were also recorded in both groups. All the data were analysed after collection.Results:No significant changes of SPO2、ACI、LVET、STR and TFC were observed in both intra-and between two groups (P>0.05). In both groups, MAP、PETCO2、 Ppeak、Pplat at T4-T7were significantly increased compared with those at T3 (P<0.05); CO、SV were decreased at at T1-T6(p>0.05)and increased at T6-T8(in TT group, p<0.05, in PLMA group, p>0.05), while the SVR were increased at T1-T6(p>0.05)and decreased at T6-T8(p>0.05); At T2-T7, the PETCO2、Ppeak. Pplat of the TT group were higher than those of the PLMA group(p>0.05); while compare with the PLMA group, the MAP、HR、CO、SV、SVR at the T7-T8were significantly higher in the TT group。In TT group, MAP、HR、CO、SV、SVR at T7-T8were significantly increased compared with those at T1(P<0.05);No significant changes of the time interval for the diet progression, foley catheter removal, length of stay were observed in both groups (P>0.05).No occurance of regurgitation and aspiration were found in all patients,and the incidence of gastric distension,leakage, nausea/vomiting, blood traces on the airway device were similar in both groups (p>0.05). The incidence of irritability during extubation and the laryngopharynx complications were significantly higher in TT group(p<0.05).Conclusions:The ProSeal laryngeal mask airway is a useful alternative to the Endotracheal Intubation and have comparable efficacy and less complication rates in patients undergoing Fast-Track Gynecological laparoscopic operation. The PLMA is a more effective ventilatory device for Fast-Track Gynecological laparoscopic operation during general anesthesia.