| Objective:This study aimed to explore the optimal volume of size 4 Supreme laryngeal mask airway?SLMA?to minimize the related complications of SLMA in laparoscopic cholecystectomy.Improve comfort,accelerate the recovery of patients.Methods:Ninety patients scheduled for elective laparoscopic cholecystectomy surgery under general anesthesia were randomly divided to 3 groups according to cuff inflatable volume as 10 ml air inflated group?group A?,20 ml air inflated group?group B?and 30 ml air inflated group?group C?with 30 patients in each group.Inclusion criteria were ASA physical status?or?,aged 18-65 yrs,weighing 50?70 kg,body mass index?BMI?of 1830 kg/m2,Mallampti grade??,Patients were excluded if they had a history of upper respiratory tract infection or predicted difficult airway,mouth opening of<2.5 cm,body mass index>35 kg/m2,or increased risk of regurgitation and aspiration.Ultrasonographic measurement of the antral CSA was performed for each patient to exclude whom was gastric flatulence before general anesthesia.The size 4 SLMA was inserted with freely inflated-deflated cuff method after general anesthesia.The card of the cuff exhaust valve was not removed during SLMA inserting process.Fiberoptic bronchoscope was inserted into the airway tube of SLMA to verify its position.The intercuff pressure?ICP?and oropharyngeal leak pressure?OLP?were measured preoperation,after pneumoperitoneum and postoperation respectively.Ultrasonographic measurement of the antral CSA was performed for each patient after SLMA placement?S1?and before SLMA withdrawal?S2?.Tidal volume,end tidal carbon dioxide pressure(PETCO2)and peak airway pressure?Ppeak?were monitored during operation.Duration of laryngeal mask airway placement,regurgitation,gas leakage during operation,bloodstain while extraction,sore throat after extraction were recorded.Results:In the 96 patients who passed the inclusion criteria,3 of them refused to participate in this study,1 of them failed to place laryngeal mask,and 2 of them were gastric flatulence before general anesthesia,which left 90 patients,37 males and 53females,were randomized into three groups to complete the trial.The ICPs of group A,B and C were 23±5 cmH2O,37±4 cmH2O and 60±6 cmH2O.Compared with group A,the ICP of and OLP in group B and group C was obviously increased?P<0.05?,the ICP in group C was obviously increased than group B?P<0.05?,the OLP in group C was lower than group B?P<0.05?.The number of cases of gas leakage during operation in the three groups was 16 cases in group A,1 case in group B,and 6 cases in group C.Compared with group A,the rate of gas leakage in group B and C was significantly reduced?P<0.05?,while the difference between group B and C was not statistically significant?P>0.05?.Compared with group B,the incidence of gastric flatulence and regurgitation was significantly increased in group A and group C?P<0.05?,while the difference between group A and group C was not statistically significant?P>0.05?.Compared with group A,effect of ventilation in group B and C was better?P<0.05?,while the difference between group B and group C was not statistically significant?P>0.05?.The throat complications after extraction in group A and group B were less than in group C?P<0.05?.The incidence of sore throat exceeds 30%in group C.Conclusion:The best ICP?3045 cmH2O?and the highest OLP?2636 cmH2O?were achieved when the inflatable volume of the 4th SLMA was 20 ml.Moreover,the incidence of gastric distension was low,the respiratory dynamics was stable,and the throat complications were few.Through accurate airway management,the comfort level of patients can be greatly improved and the recovery of patients can be accelerated. |
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