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British Journal of Anaesthesia, 2002, Vol. 88, No. 6 824-827
© 2002 The Board of Management and Trustees of the British Journal of Anaesthesia

Clinical Investigations

ProSeal versus the Classic laryngeal mask airway for positive pressure ventilation during laparoscopic cholecystectomy{dagger}

P. P. Lu1, J. Brimacombe*,2, C. Yang1 and M. Shyr1

1Department of Anesthesia, Chang Gung Memorial Hospital, 5 Fu-Hsin Street, Kuei-Shan Hsiang, 333 Taoyuan Hsien, Taiwan. 2University of Queensland and James Cook University, Department of Anaesthesia and Intensive Care, Cairns Base Hospital, The Esplanade, Cairns 4870, Australia*Corresponding author

{dagger}Declaration of interest: Professor Brimacombe has intermittently received funds for research and lecturing overseas from Intavent Ltd, which manufactures both the devices used in this study. This study was not sponsored by Intavent Ltd.
{ddagger}LMA® is the property of Intavent Ltd.

Background. We tested the hypothesis that the ProSeal laryngeal mask airway (PLMA) is a more effective ventilatory device than the Classic laryngeal mask airway (LMA{ddagger}) for laparoscopic cholecystectomy.

Methods. Eighty anaesthetized, paralysed patients (ASA 1–2, aged 18–80 yr) were randomly allocated for airway management with the PLMA or LMA. Ease of insertion and efficacy of seal were determined. Peak airway pressures were recorded immediately before and after carboperitoneum to 2.0 kPa. The inspired oxygen concentration and/or the ventilatory variable were adjusted according to a protocol to maintain SpO2 >=95% and E'CO2 <6.0 kPa. Oxygenation was considered suboptimal if SpO2 fell to 94–90% and failed if SpO2 was <90%. Ventilation was considered suboptimal if E'CO2 was >6.0–7.3 kPa and failed if E'CO2 was >7.3 kPa.

Results. First-time insertion success rates were higher for the LMA (40/40 vs 33/40; P=0.02). Seven patients required two attempts with the PLMA. Oropharyngeal leak pressure was higher for the PLMA [29 (SD 6) vs 19 (4) cm H2O; P<0.001]. There was a similar, significant increase in peak airway pressure after carboperitoneum for both devices (P<0.001). Before carboperitoneum, oxygenation and ventilation were optimal in all patients in both groups. After carboperitoneum, oxygenation was optimal in all patients in both groups, but ventilation was suboptimal more frequently with the LMA (8 vs 0; P=0.01). In three of these eight patients, ventilation failed but was subsequently optimal with the PLMA.

Conclusion. The PLMA is a more effective ventilatory device for laparoscopic cholecystectomy than the LMA. We do not recommend the use of the LMA for laparoscopic cholecystectomy.

Br J Anaesth 2002; 88: 824–7


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