Abstract
BackgroundDuring laparoscopic gynecological surgery, increased peak airway pressure (PAWP) can cause airway leak upon ventilation with the LMA® ProSeal™. We hypothesized that compared with the use of volume-controlled ventilation (VCV), the use of the AutoFlow® mode would decrease PAWP and airway leak during laparoscopic gynecological surgery with LMA ProSeal.MethodsThis single-center, randomized, controlled trial allocated 80 adult women undergoing elective laparoscopic gynecological surgery to one of two groups, namely, the AutoFlow group or the VCV group. Ventilation settings for both groups were 8 ml/kg of tidal volume and 5 cmH2O of positive end-expiratory pressure, and respiratory rate was adjusted to maintain end-tidal carbon dioxide at 35–40 mmHg. Airway leak, PAWP, and other ventilatory parameters and vital signs were recorded at four timepoints (1, 1 min after insertion of the gastric tube; 2, 2 min after intravenous administration of rocuronium 0.6–0.8 mg/kg; 3, 1 min after initiation of pneumoperitoneum; and 4, 1 min after changing to the Trendelenburg position). The primary outcome was PAWP during pneumoperitoneum and in the Trendelenburg position, whereas the secondary outcomes included PAWP at other timepoints and airway leak development. We used the Mann–Whitney U test for PAWP and Fisher’s exact test for comparing airway leak among the groups.ResultsData from 40 patients in the AutoFlow group and 39 in the VCV group were used for analysis. PAWP at pneumoperitoneum pressure and in the Trendelenburg position was significantly lower in the AutoFlow group than in the VCV group [median (interquartile range), 16 (15–18) cmH2O vs. 18 (17–19) cmH2O; P < 0.001]. Similarly, patients in the AutoFlow group showed lower PAWP at the other three timepoints measured. Airway leak occurred in four patients in the AutoFlow group and in two patients in the VCV group; however, this incidence was not significantly different (P = 0.68).ConclusionsEven though AutoFlow ventilation decreased PAWP, it did not reduce the incidence of airway leak compared with VCV during laparoscopic gynecological surgery with the LMA ProSeal.Trial registrationUMIN Clinical Trials Registry, identifier UMIN000023173.
Highlights
LMA® ProSealTM is the oldest second-generation supraglottic airway device with a gastric tube channel
peak airway pressure (PAWP) at pneumoperitoneum and in the Trendelenburg position was significantly lower in the AutoFlow group compared with that in the volume-controlled ventilation (VCV) group (16 [15– 18] cmH2O vs. 18 [17–19] cmH2O; P < 0.001) (Fig. 2)
Airway leak was found in four patients in the AutoFlow group and in two patients in the VCV group; this difference was not significant (P = 0.68)
Summary
LMA® ProSealTM (pLMA) is the oldest second-generation supraglottic airway device with a gastric tube channel. Endotracheal tubes have been used most commonly, but the use of pLMA has been reported as a useful alternative [1,2,3] During such procedures, the need for pneumoperitoneum and the placement of the patient in the Trendelenburg position raise patients’ diaphragms, which results in decreased lung compliance and elevated peak airway pressure (PAWP). Whether DCV can effectively regulate PAWP, avoid airway leak, and maintain adequate tidal volume during laparoscopic surgery with supraglottic airway devices is unknown. We hypothesized that, compared with VCV, AutoFlow would decrease PAWP and airway leak during laparoscopic gynecological surgery with pLMA. We hypothesized that compared with the use of volume-controlled ventilation (VCV), the use of the AutoFlow® mode would decrease PAWP and airway leak during laparoscopic gynecological surgery with LMA ProSeal
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