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Korean Journal of Anesthesiology 2003;44(4):440-445.
DOI: https://doi.org/10.4097/kjae.2003.44.4.440   
Efficacy of Positive Pressure Ventilation with the ProSeal Versus Classic Laryngeal Mask Airway during Gynecologic Laparoscopic Surgery.
Eun Sung Kim, Young Hun Kim
Department of Anesthesiology, College of Medicine, The Catholic University of Korea. euns1503@catholic.ac.kr
BACKGORUND: Previous studies have shown that the ProSeal laryngeal mask airway (PLMA) forms a more effective seal than the classic laryngeal mask airway (LMA) during a static oropharyngeal leak test and isolates the respiratory tract from the gastrointestinal tract when correctly positioned, but there is no evidence that it is a better ventilatory device. in the present study, we tested the hypothesis that the PLMA is a more effective ventilatory device than either the LMA or the endotracheal tube (ETT) in healthy anesthetized females undergoing gynecologic laparoscopic surgery at 120 ml/kg minute ventilation volume with the cuff fully inflated.
We studied 34 female patients (ASA physical status i, 22-46 yr) undergoing gynecologic laparoscopic surgery. Patients were randomized into three groups according to ventilatory devices; Group 1 (ETT, n = 11), Group 2 (LMA, n = 12) and Group 3 (PLMA, n = 11). After induction of anesthesia, patients were ventilated in the same mode in each group. We measured peak inspiratory pressure (PiP), PaO2, PaCO2, PETCO2 and arterial end-tidal PCO2 difference (PaCO2-PETCO2) at 10 min after induction of anesthesia (stage 1), 10 min after CO2 insufflation (stage 2), 10 min after Trendelenburg (T) position (stage 3) and 30 min after T position (stage 4).
There were no significant differences among the three groups in PaCO2, PETCO2, and PiP. PaCO2 , PETCO2 and PiP increased significantly at stages 2 through 4 compared to stage 1 (P<0.05). PaO2 decreased significantly at stage 4 compared to stage 1 (P<0.05). PaCO2-PETCO2 was maintained within normal range from stage 1 to stage 4.
This study demonstrates that pulmonary gas exchange is not affected by the choice of ventilatory devices during gynecologic laparoscopic surgery in young female patients under a Trendelenburg position and pneumoperitoneum.
Key Words: Gas exchange; laparoscopy; proSeal laryngeal mask airway


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