Abstract
BackgroundThe application of bedside ultrasound to evaluate gastric content and volume can assist in determining aspiration risk. Applying positive pressure ventilation via supraglottic airway devices (SAD) can result in a degree of gastric insufflation. This study assessed and compared the antral cross-sectional area (CSA) in patients undergoing laparoscopic gynecological surgery when managed with different SAD.MethodsOne hundred American Society of Anesthesiologists I or II female patients were assessed for inclusion in this study and divided into three groups of different ventilation devices. Patients were randomly allocated into three groups to receive LMA-Supreme (Group S), I-gel (Group I) or tracheal tube (Group T). The primary outcome was the antral cross-sectional area and secondary outcomes included haemodynamic parameters and postoperative morbidity such as sore throat, hoarseness, dry throat, nausea and vomiting.ResultsThe antral CSA was not significantly different among three groups before induction (P = 0.451), after induction (P = 0.456) and at the end of surgery (P = 0.195). The haemodynamic variables were significantly higher in the tracheal tube group than in the LMA-Supreme and I-gel groups after insertion (P < 0.0001) and after removal (P < 0.01). Sore throat was detected in none in the I-gel group compare to two patients (6.7%) in the LMA-Supreme group and fifteen patients (50%) in the tracheal tube group. Hoareness was detected in one (3.3%) in the I-gel group compare to two patients (6.7%) in the LMA-Supreme group and eleven patients (36.7%) in the tracheal tube group.ConclusionsThe SADs do not cause obvious gastric insufflation. Thus, LMA-Supreme and I-gel can be widely used as alternative to endotracheal intubation for the short laparoscopic gynecological surgery.Trial registrationThis trial was registered at the Chinese Clinical Trial Registry (ChiCTR1800018212, data of registration, September 2018).
Highlights
The application of bedside ultrasound to evaluate gastric content and volume can assist in determining aspiration risk
Informed consent was obtained from 100 American Society of Anesthesiologists (ASA) physical status I and II female patients patients aged 18 years or more scheduled to undergo elective laparoscopic gynecological surgery lasting less than 3 h were recruited with ninety patients completing the protocol
There were allocated as follows: 33 patients included in the I-gel group, 33 in the LMA Supreme group and 33 in the tracheal intubation group
Summary
The application of bedside ultrasound to evaluate gastric content and volume can assist in determining aspiration risk. Applying positive pressure ventilation via supraglottic airway devices (SAD) can result in a degree of gastric insufflation. Second-generation SADs with gastric channels enables the insertion of a nasogastric tube to either actively or passively vent the stomach. This can potentially minimize gastic insufflation associated with positive pressure ventilation through a suboptimally fitting SAD. For this reason and because of their versatility and ease of insertion, SADs are increasingly replacing endotracheal tubes [4,5,6]. The degree to which this occurs when compared with endotracheal intubation, or the gastric venting potential of the second generation SADs, have not been quantitatively assessed
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