Application Of Proseal Laryngeal Mask In Lateral Laparoscopic Surgery

Objective:Laryngeal mask there are few reports about LMA in Laparoscopic operation,especially in lateral decubitus.The main reason is that CO₂ pneumoperitoneum and lateral decubitus may cause the diaphragm to move upward.It leads to higher intra-abdominal pressure level,lower lung compliance,LMA prone to air leakage,and may increase complications.Compared with the ordinary laryngeal mask,Proseal LMA is more tightness to the throat,and it has an independent esophagus drainage tube,which can reduce the risk of reflux mistaken aspiration and gastric distention.The purpose of this study was to investigate the feasibility and safety of Proseal LMA in laparoscopic lateral decubitus surgery by observing the effects of Proseal laryngeal mask on hemodynamics,inflammation index,airway resistance,oropharyngeal pressure（OLP）and fiberoptic bronchoscope rating.Methods:Sixty patients undergoing laparoscopic lateral decubitus surgery under general anesthesia were randomly divided into Proseal LMA group（group A,n=30 cases）and tracheal intubation group（group B,n=30 cases）.Methylene blue capsules 5mg was given orally to all patients 60 minutes before anesthesia.Both groups were induced by midazolam 0.06⁰.08mg/kg,Sufentanil 0.3⁰.4μg/kg,Cisatracurium Besilate0.3⁰.4 mg/kg,propofol 1.5²mg/kg.After successful induction,group A was implanted with appropriate LMA and group B was intubated.Observation and record:（1）The values of SBP,DBP,HR,PaO₂/FiO₂,PaCO₂,PH before induction of anesthesia（T0）,immediately after insertion of LMA/ETT（T1）,immediately after pneumoperitoneum（T2）,30 minutes after pneumoperitoneum（T3）,60 minutes after establishment of pneumoperitoneum（T4）,immediately before removal of LMA/ETT（T5）,and immediately after removal of LMA/ETT（T6）;（2）The PetCO₂,Pa-etCO₂,P_peak,P_mean at T1-T5 in the two groups;（3）The levels of FBG,Cor,IL-6 at T0,T1,T3and T6 in the two groups;（4）OLP at T1-T3 and FOB at T1 and T2 in group A were performed to evaluate the alignment of LMA;（5）The complications of reflux,aspiration and so on in the two groups.Results:（1）SBP,DBP and HR in group A were significantly lower than those in group T0 at T1-T6（P<0.05）;SBP,DBP and HR in group B were significantly higher than those in group A at T1,T5 and T6（P<0.05）.（2）There was no significant difference in PaO₂/FiO₂ at each time point between the two groups（P<0.05）.In the same group,PaO₂/FiO₂ at T4-T6 was significantly lower than that at T0（P<0.05）;PaCO₂at T2-T6was higher than that at T0,especially at T4（P<0.05）;PH at T1-T6 was lower than that at T0（P<0.05）,but there was no difference between the two groups at the same time（P>0.05）.（3）Compared with T1 and T2,the levels of PetCO₂,Pa-etCO₂,P_peakeak and P_mean at T3,T4 and T5 were significantly higher in both groups（P<0.05）;compared with group A,the levels of PetCO₂,Pa-etCO₂,P_peak and P_mean at each time point of T1-T5 were significantly higher in group B（P<0.05）.（4）Compared with T0,the levels of FBG,Cor and IL-6 at T1,T3 and T6 were significantly higher in both groups（P<0.05）,and the levels of FBG,Cor and IL-6 at T1,T3 and T6 in group A were significantly lower than those in group B（P<0.05）.（5）Compared with T1 time point,OLP in group A decreased significantly at T2 to T4 time points（P<0.05）,while OLP did not decrease further at T3 and T4 time points（P>0.05）;FOB rating at T1time point in group A had no statistical difference compared with T3 time point（P>0.05）.（6）There was no reflux aspiration in both groups.The incidence of cough and agitation during extubation in group A was significantly lower than that in group B（χ²=4.593,4.686,P=0.032,0.030<0.05）;There was no significant difference in the incidence of gastrointestinal distention,air leakage,nausea and vomiting between the two groups（χ²=0.218,0.517,0.218,P=0.640,0.472,0.640>0.05）.Conclusion:Proseal LMA can be safely used in lateral position laparoscopic general anesthesia because of its better airway sealing,the same ventilation effect as ETT,low airway resistance and fewer complications.