The Application Of ProSeal Laryngeal Mask In Laparoscopic Hysterectomy During General Anesthesia

Objective: To compare the application of Pro Seal laryngeal mask airway(PLMA) with endotracheal intubation in laparoscopic hysterectomy during general anesthesia.Method: 66 patients(ASA I-II), who were operated with laparoscopic total hysterectomy during general anesthesia in Yihe department of Cangzhou People’s Hospital during January 2014 to February 2015,were selected and divided into two groups randomly.The LMA group: adopt ProSeal laryngeal mask airway(PLMA) under intravenous combined anesthesia(33 cases). The intubation group: apply intubation airway under intravenous combined anesthesia(33 cases). Moreover, this experiment was conducted by the researcher himself. The premedication and operative conditions were completely the same. Indicators like ECG, BP and SpO2 of patients were tested after entering the operating room, and the invasive arterial blood pressure(MAP) under local anesthesia was monitored. The anesthesia method of both groups were total intravenous anesthetics. Three minutes after the induction, the cases in LMA group were placed with PLMA while those of the intubation group were endotracheal intubated. Subsequently, monitored the change of HR and MAP in the next 3 steps: before anesthesia induction(T0),during anesthesia induction for PLMA or intubation(T1), 30 minutes after pneumoperitoneum(T2) and after extubation(T3), and the airway pressure was continuously measured. The arterial blood gas at T0, T1, T2 and T3 were analyzed respectively and the PaO2 and PaCO2 were measured. The peripheral blood at T0, T1, T2 and T3 was extracted and centrifuged respectively and the supernatant was collected to store in the refrigerator for standby application.Besides, the concentration changes of epinephrine(E), norepinephrine(NE)and cortisol in blood were tested. Follow-up visits with patients after 24 hourssince the operation were conducted to check if they suffering anesthetic complications, laryngeal discomfort, pharyngalgia, hoarseness or others.Results: the group difference on basic values of HR and MAP of patients in two groups was no statistical significance(P>0.05). Compared within the same group, the difference of HR and MAP of LMA between T1 and T0 was of no statistical significance(P>0.05). However, in intubation group, the HR and MAP both increased at T1, and thus it was of statistical significance(P<0.05). Compared with the intubation group, the HR and MAP of LMA group at T1 were obviously lower(P < 0.01), and thus the difference was of statistical significance as well. Compared with the two groups, the differences of PaCO2 and PetCO2 at different time were of no statistical significance(P>0.05). Compared within the groups, the concentrations of E, NE and cortisol of patients in both groups at T1, T2 and T3 after intubation all increased compared those at T0; while compared between groups, the increase amplitude of the above hormones in PLMA was small(P < 0.05) with statistical significance in differences. In addition, the incidence rate of adverse reactions(such as body movement and laryngeal discomfort) in PLMA group is much lower than that in intubation group(P<0.05).Conclusions: the airway effects of PLMA and intubation for patients undergoing laparoscopic hysterectomy during general anesthesia are similar,both with high security and stable haemodynamics. However, the stress responses, complications and secretions in PLMA are less and the postoperative recovery is more stable.