Proseal Laryngeal Mask Airway versus Endotracheal Intubation for Laparoscopic Surgery: A Randomized Controlled Study

Abstract

Context: Proseal LMA (laryngeal mask airway) is an useful modification of the classical LMA, which provides better hemodynamic stability and protection against intra operative as well as postoperative complications when used in laparoscopic procedures. Aims: To compare the efficacy of Proseal laryngeal mask airway (LMA) and endotracheal tube (ETT) in patients posted for laparoscopic surgery under general anaesthesia Settings and Design: This prospective randomized comparative study conducted in collaboration with a tertiary care level hospital. study was conducted on 100 ASA I-II class patients posted for laparoscopic surgery under general anaesthesia Methods and Material: A total of 100 patients posted for various laparoscopic surgeries were allocated into 2 groups of 50 each. After preoxygenation and induction, Proseal LMA was inserted in group A patients and patients in group B were intubated with ETT. Attempts for successful insertion, time taken for successful insertion, hemodynamic variations at various events and protection provided against both intra operative and postoperative complications were studied Statistical analysis used: Qualitative data was analysed using chi-square test or Fischer analysis and quantitative data analysed using paired or unpaired t test. Results: First attempt insertion success rate was 84% for PLMA insertion as compared to 76% for endotracheal intubation, Time for successful insertion was 15.54 sec in PLMA group and 20.20 sec in ETT group. Mean heart rate changes during PLMA insertion and removal were 5.52 and 7.10 respectively, and 9.56 and 11.46 at the same events with ETT. Mean systolic blood pressure changes during PLMA insertion and removal were 3.76 and 3.92 respectively and 13.92 and 23.20 at same events with ETT. No events of gastric regurgitation or pulmonary aspiration observed in both groups. PLMA provided better protection against postoperative complications like cough (6%) and sore throat (6%) as compared to ETT with 44% and 24% incidence respectively. Conclusions: Proseal LMA can be considered as a safe and effective alternative to endotracheal intubation in patients undergoing various laparoscopic procedures under general anesthesia. Key words: Proseal LMA, endotracheal tube, hemodynamic stability, pulmonary aspiration