Successful Anesthetic Management Using Laryngeal Mask Airway during Laparoscopic Cholecystectomy under a Lower Intraabdominal Insufflation Pressure

• Published in: Nihon Rinshō Masui Gakkai shi Vol. 21; no. 5; pp. 247 - 253
• Main Authors: OSANAI, Hiroyuki, NAMIKI, Akiyoshi, HARADA, Yuzo, SHINOHARA, Yoshihumi
• Format: Journal Article
• Language: English
• Published: THE JAPAN SOCIETY FOR CLINICAL ANESTHESIA 2001
• Subjects: Anesthesia; Laparoscopic cholecystectomy; Laryngeal mask airway
• ISSN: 0285-4945; 1349-9149; 1349-9149
• DOI: 10.2199/jjsca.21.247

This study was designed to assess the safety and efficacy of anesthesia with the laryngeal mask airway (LM) during laparoscopic cholecystectomy under lower intraabdominal insufflation pressure (6mmHg). 260 patients were randomly (3 to 1) allocated to receive either LM (n=192) or tracheal tube (TT, n=68). After induction of anesthesia and paralysis, positive pressure ventilation was applied with 7-10ml•kg-1 tidal volume and 10-15 respiratory rate (RR) settings. Ventilatory parameters (PETCO2, airway pressure, RR, inspiratory minute volume) and leakage through the airway devices were measured before and during laparoscopy. PaO2 was measured before anesthesia and postoperatively (POD-1, 2). No ventilation trouble occurred in the LM group during laparoscopy. Maximum PETCO2 was not significantly different between the groups, whereas the maximum RR in the LM group was significantly higher (LM; 12.5±1.0 vs TT; 11.9±1.1 in females, and LM; 12.5±0.9 vs TT; 11.8±1.0 in males, p<0.01, respectively). Leakage (%) in the LM group was significantly greater (#3LM; 8.9±5.5 vs ID7.5TT; 4.7±2.8, and #4LM; 9.5±5.9 vs ID8.5TT; 4.9±3.2, p<0.001, respectively). No postoperative lung complications occurred in either group. Postoperative change in PaO2 was not significantly different between the two groups. We conclude that the laryngeal mask airway can be satisfactorily used for laparoscopic cholecystectomy under lower intraabdominal pressure.