Open AccessSecond-generation laryngeal mask airway as an alternative to endotracheal tube in prolonged laparoscopic abdominal surgery: a comparative analysis of intraoperative gas exchanges
Author(s) -
Sukhee Park,
Ja Eun Lee,
Gyu Seong Choi,
Jong Man Kim,
Justin Sangwook Ko,
Duck Hwan Choi,
Gaab Soo Kim
Publication year - 2021
Publication title -
singapore medical journal/singapore medical journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.452
H-Index - 61
eISSN - 2737-5935
pISSN - 0037-5675
DOI - 10.11622/smedj.2021143
Subject(s) - medicine , anesthesia , tidal volume , surgery , pneumoperitoneum , laryngeal mask airway , airway , peak inspiratory pressure , laparoscopic surgery , ventilation (architecture) , laparoscopy , respiratory system , mechanical engineering , engineering
Introduction: Despite several advantages over endotracheal tube (ETT), laryngeal mask airway (LMA), which is used in emergencies under difficult airway maintenance conditions, is rarely utilized in prolonged surgery. We compared the variables representing intraoperative gas exchange with second-generation LMA and ETT during prolonged laparoscopic abdominal surgery. Methods: Prolonged surgery was defined as a surgery lasting more than 2 h. In total, 394 patients who underwent laparoscopic liver resection via either second-generation LMA or ETT were retrospectively analysed. Parameters including end-tidal pressure of carbon dioxide (ETCO2), tidal volume (TV), respiratory rate (RR), peak inspiratory pressure (PIP), arterial partial pressure of carbon dioxide (PaCO2), pH, and ratio of arterial partial pressure of oxygen to fractional inspired oxygen (PFR) during surgery were compared between the two groups. In addition, the incidence of postoperative pulmonary complications (PPC) including pulmonary aspiration was also compared. Results: The values of ETCO2, TV, RR and PIP during pneumoperitoneum were comparable between the two groups. Although PaCO2 at 2 h after induction was higher in patients with LMA (40.5 vs. 38.5 mmHg, p < 0.001), the pH and PFR values of the two groups were comparable. The incidence of PPC was not different. Conclusion: During prolonged laparoscopic abdominal surgery, the second-generation LMA facilitates adequate intraoperative gas exchange and represents an alternative to ETT.