Comparison Of LMA ProSeal With LMA Supreme For The Airway Management In Patients Undergoing General Anesthesia

Objective:To evaluate the efficacy and safety of a new insertion technique of inserting the laryngeal mask airway ProSeal (LMAP) in patients with general anesthesia when compared with traditional method. We also compared LMAP with laryngeal mask airway Supreme (LMAS).Methods:A total of 180 patients (ASA Ⅰ-Ⅲ;age 20～78 yrs; weight 42～86 kg) undergoing elective laparoscopic cholecystectomy in First Hospital of Ningbo City from December 2013 to March 2014 were randomly divided into three groups:LMAP group, improved LMAP group and LMAS group (n=60 in each group). After anesthesia induction, LMAP was inserted with traditional digital manipulation in LMAP group, and with new tube core shaping technique in improved LMAP group. LMAS was inserted in LMAS group. Recorded the success rate, insertion time. Heart rate and mean arterial pressure were recorded 1 min before and after insertion. The success rate of inserting the gastric tube, score of fiberoptic bronchoscope (FOB) location, oropharyngeal leak pressure (OLP) and peak inspiratory pressure (PIP) before and after pneumoperitoneum were also recorded when the LMA was inserted successfully. Intraoperative complications such as air leakage, gastroesophageal regurgitation and pulmonary microaspiration and postoperative complications such as blood stains on the device, occurrence of sore throat and hoarseness were also recorded.Results:There were 45 (75.0%) cases inserted successfully at the first attempt in the LMAP group,56 (93.3%) cases in the improved LMAP group and 57 (95.0%) cases in the LMAS group. Compared with the LMAP group, the success rate of insertion at the first attempt was significantly higher (P<0.01) in the improved LMAP group and LMAS group. Three patients were failed to insert the LMAP in the LMAP group and endotracheal intubation were performed. The total success rate of insertion was 95% in the LMAP group and 100% in both LMAP group and LMAS group, there was no significant difference among these three groups (P>0.05). Compared with the LMAP group, the time taken for insertion was significantly shorter (P<0.01), mean arterial pressure 1 min after insertion was lower (P<0.05, P<0.01) in the improved LMAP group and LMAS group. There was no significant difference in heart rate 1 min before and after insertion and mean arterial pressure 1 min after insertion between these three groups (P>0.05). There was no significant difference in the success rate of insertion of gastric tube and numbers of FOB score>3 between these three groups (P>0.05). Compared with the LMAS group, the OLP was significantly higher (P<0.01) in the LMAP group and improved LMAP group, there was no significant difference in the PIP before and after pneumoperitoneum among these three groups (P>0.05). There was no significant difference in the numbers of air leakage after pneumoperitoneum among these three groups (P>0.05). In the LMAP group and improved LMAP group, the air leakage situation of LMAP was improved after adjusting the LMA location, but in the LMAS group, three patients were changed of endotracheal intubation who failed in LMA location adjustment. There was no significant difference between these three groups (P>0.05). There have no patient experienced gastroesophageal regurgitation and pulmonary microaspiration in the three groups. Compared with the LMAP group, the incidence of blood stains and sore throat after the operation was lower (P<0.05) in the improved LMAP group and LMAS group.Conclusion:Both LMAP and LMAS can safely and effectively used in patients with laparoscopic cholecystectomy undergoing general anesthesia. Just as LMAS, inserting LMAP by tube core shaping technique was more quickly and efficiently and also less postoperative complications when compared with LMAP of digital manipulation. Furthermore when compared with LMAS, LMAP provides better leak tightness and is more security in the airway management.