Ramkumar DHANASEKARAN, Gautam Dilip MEHTA, Aruna PARAMESWARI

A Prospective Randomized Comparative Study between Baska Mask, Proseal LMA and I Gel During Positive Pressure Ventilation in Laparoscopic Cholecystectomy

Objective: Supraglottic airway devices with facility for gastric suction such as Proseal LMA and I gel have been successfully used for positive pressure ventilation in laparoscopic surgeries. Baska mask, a novel device with many unique features such as self-sealing membranous cuff and effective sump drainage system was designed in such a way that the perilaryngeal seal increases incrementally with increasing airway pressures. But Baska mask was not extensively evaluated to validate its use in laparoscopic surgeries. The efficiency of Baska mask (B), Proseal LMA (P) and I Gel (I) are compared during positive pressure ventilation in laparoscopic cholecystectomy. Methods: Ninety patients of ASA physical status I-II planned for laparoscopic cholecystectomy were randomized into three groups (B, I, P) of 30 each. The study was proceeded with 88 (B-30, I-29, P-29) patients. Oropharyngeal leak pressure, insertion time, effective airway time and airway morbidity were assessed and compared between the three groups. Mean, standard deviation, paired sample t-test, one way ANOVA with Tukey’s Post-Hoc test was used. Results: The oropharyngeal leak pressure at insertion time was 38.33±4.353 cm of H2 O for group B, 30.57±2.174 cm of H2 O for group I, 29.36±2.706 cm of H2O for group P. The leak pressure was statistically significant between group B and other groups. Conclusions: Baska mask provided higher oropharyngeal leak pressure in comparison to other two supraglottic devices.

Laparoskopik Kolesistektomide Pozitif Basınçlı Ventilasyon Sırasında Baska Mask, Proseal LMA ve I Gel ile Prospektif Randomize Karşılaştırmalı Bir Çalışma

Amaç: Proseal LMA ve I gel gibi gastrik aspirasyon avantajı olan supraglottik hava yolu araçları, laparoskopik ameliyatlarda pozitif basınçlı ventilasyonda başarıyla kullanılmaktadır. Kendiliğinden yerleşen membranöz cuff ve etkin sıvı drenaj sistemi gibi pek çok benzersiz özelliğe sahip yeni bir cihaz olan Baska mask, perilarengeal yerleşme basıncının, artan hava yolu basınçları ile aşamalı olarak artacağı şekilde tasarlanmıştır. Ancak, Baska maskın, laparoskopik ameliyatlarda kullanımı kapsamlı olarak araştırılmamıştır. Laparoskopik kolesistektomide pozitif basınçlı ventilasyon sırasında Baska mask (B), Proseal LMA (P) ve I Gel (I)’in etkinliği karşılaştırıldı. Yöntem: Laparoskopik kolesistektomi planlanan ASA I-II 90 hasta, üç gruba (B, I, P) randomize edildi. Çalışma 88 (B-30, I-29, P-29) hasta ile sürdürüldü. Orofarengeal kaçak basıncı, yerleştirme zamanı, etkin hava yolu zamanı ve hava yolu morbiditesi değerlendirildi ve üç grup karşılaştırıldı. İstatistiksel analizde; ortalama, standart sapma, paired sample t-testi, Tukey Post-Hoc testi ile tek yönlü ANOVA kullanıldı. Bulgular: Yerleştirme sırasında orofarengeal kaçak basıncı, B grubunda 38.33±4.353 cmH2 0, I grubunda 30.57±2.174 cmH2 0, P grubunda 29.36±2.706 cmH2 0 idi. Kaçak basıncı, B grubu ve diğer gruplar arasında istatistiksel olarak anlamlıydı. Sonuç: Baska mask, diğer iki supraglottik araç ile karşılaştırıldığında daha yüksek orofaringeal kaçak basıncı sağladı. Bu çalışmada kullanılan üç farklı ikinci kuşak supraglottik hava yolu aracı arasında, Baska mask, yüksek orofarengeal kaçak basıncı ile yeterli ventilasyonun sağlanmasında daha etkin bulunmuştur.

PDF

___

Medeiros AC, Araújo-Filho I, Carvalho MD, de Paiva Medeiros VF, de Azevedo ÍM, Dantas Filho AM. Laparoscopic versus open cholecystectomy: complications and cost. Journal of Surgical and Clinical Research. 2013;3:49-58. https://doi.org/10.20398/jscr.v3i2.3567

Sharma KC, Brandstetter RD, Brensilver JM, Jung LD. Cardiopulmonary physiology and pathophysiology as a consequence of laparoscopic surgery. Chest. 1996;110:810-5. https://doi.org/10.1378/chest.110.3.810

Diebel LN, Wilson RF, Dulchavsky SA, Saxe J. Effect of increased intra-abdominal pressure on hepatic arterial, portal venous, and hepatic microcirculatory blood flow. The Journal of Trauma. 1992;33:279-82. https://doi.org/10.1097/00005373-199208000-00019

Hashikura Y, Kawasaki S, Munakata Y, Hashimoto S, Hayashi K, Makuuchi M. Effects of peritoneal insufflation on hepatic and renal blood flow. Surgical Endoscopy. 1994;8:759-61. https://doi.org/10.1007/BF00593435

Hong JY, Chung KH, Lee YJ. The changes of ventilatory parameters in laparoscopic cholecystectomy. Yonsei Medical Journal. 1999;40:307-12. https://doi.org/10.3349/ymj.1999.40.4.307

Meininger D, Byhahn C, Mierdl S, Westphal K, Zwissler B. Positive end‐expiratory pressure improves arterial oxygenation during prolonged pneumoperitoneum. Acta Anaesthesiologica Scandinavica. 2005;49:778-83. https://doi.org/10.1111/j.1399-6576.2005.00713.x

Hazebroek EJ, Haitsma JJ, Lachmann B, Bonjer HJ. Mechanical ventilation with positive end-expiratory pressure preserves arterial oxygenation during prolonged pneumoperitoneum. Surgical Endoscopy. 2002;16:685-9. https://doi.org/10.1007/s00464-001-8174-y

Ogunnaike BO, Jones SB, Jones DB, Provost D, Whitten CW. Anesthetic considerations for bariatric surgery. Anesthesia & Analgesia. 2002;95:1793-805. https://doi.org/10.1097/00000539-200212000-00061

Mercat A, Graïni L, Teboul JL, Lenique F, Richard C. Cardiorespiratory effects of pressure-controlled ventilation with and without inverse ratio in the adult respiratory distress syndrome. Chest. 1993;104:871-5. https://doi.org/10.1378/chest.104.3.871

Park SY, Rim JC, Kim H, Lee JH, Chung CJ. Comparison of I-gel and LMA Supreme during laparoscopic cholecystectomy. Korean Journal of Anesthesiology. 2015;68:455-61. https://doi.org/10.4097/kjae.2015.68.5.455

Howes B, Cook T. Supraglottic airway devices: recent advances. Contin Educ Anaesth Crit Care Pain. 2010;11:56-61. https://doi.org/10.1093/bjaceaccp/mkq058

Ramachandran SK, Kumar AM. Supraglottic Airway Devices Discussion. Respiratory Care. 2014;59:920-32. https://doi.org/10.4187/respcare.02976

Cook TM. Novel airway devices: spoilt for choice? Anaesthesia. 2003;58:107-10. https://doi.org/10.1046/j.1365-2044.2003.03047.x

Maltby JR, Beriault MT, Watson NC, Liepert D, Fick GH. The LMA-ProSeal™ is an effective alternative to tracheal intubation for laparoscopic cholecystectomy. Canadian Journal of Anesthesia. 2002;49:857-62. https://doi.org/10.1007/BF03017420

Badheka JP, Jadliwala RM, Chhaya VA, Parmar VS, Vasani A, Rajyaguru AM. I-gel as an alternative to endotracheal tube in adult laparoscopic surgeries: A comparative study. Journal of Minimal Access Surgery. 2015;11:251. https://doi.org/10.4103/0972-9941.140210

Chaudhary UK, Mahajan SR, Mahajan M, Sharma C, Sharma M. A comparative analysis of the baska mask versus I-gel for general anesthesia in surgical patients undergoing laparoscopic cholecystectomy. Acta Medica International. 2018;5:69-73. https://doi.org/10.4103/ami.ami_41_18

Baska K, Baska M. Baska Mask- The new generation supraglottic airway with high volume suction clearance; Instructions for use. Available on http://www.baskamask.com.au/baskamasksizes.html

Van Zundert T, Gatt S. The Baska Mask - A new concept in self-sealing membrane cuff extraglottic airway devices using a sump and two gastric drains: A critical evaluation. J Obstet Anaesth Crit Care. 2012;2:23-30. https://doi.org/10.4103/2249-4472.99313

Sharma B, Sehgal R, Sahai C, Sood J. PLMA vs. I-gel: A comparative evaluation of respiratory mechanics in laparoscopic cholecystectomy. J Anaesthesiol Clin Pharmacol. 2010;26:451-7.

Teoh WHL, Lee KM, Suhitharan T, Yahaya Z, Teo MM, Sia ATH. Comparison of the LMA Supreme vs the i‐gel™ in paralysed patients undergoing gynaecological laparoscopic surgery with controlled ventilation. Anaesthesia. 2010;65:1173-9. https://doi.org/10.1111/j.1365-2044.2010.06534.x

Singh A, Bhalotra AR, Anand R. A comparative evaluation of ProSeal laryngeal mask airway, I-gel and Supreme laryngeal mask airway in adult patients undergoing elective surgery: A randomised trial. Indian Journal of Anaesthesia. 2018;62:858-64. https://doi.org/10.4103/ija.IJA_153_18

Liew GH, Yu ED, Shah SS, Kothandan H. Comparison of the clinical performance of i-gel, LMA Supreme and LMA ProSeal in elective surgery. Singapore Medical Journal 2016;57:432-7. https://doi.org/10.11622/smedj.2016133

Henlin T, Sotak M, Kovaricek P, Tyll T, Balcarek L, Michalek P. Comparison of five 2nd-generation supraglottic airway devices for airway management performed by novice military operators. BioMed Research International 2015;2015. https://doi.org/10.1155/2015/201898

Verma S, Sharma SP. Effectiveness of Proseal laryngeal mask airway and laryngeal tube suction in elective non-laparoscopic surgeries of up to ninety minutes duration: A prospective, randomized study. Journal of Anaesthesiology, Clinical Pharmacology. 2018;34:58-61.

Gill RK, Tarat A, Pathak D, Dutta S. Comparative study of two laryngeal mask airways: Proseal laryngeal mask airway and supreme laryngeal mask airway in anesthetized paralyzed adults undergoing elective surgery. Anesthesia, Essays and Researches. 2017;11:23-7. https://doi.org/10.4103/0259-1162.177184

Al-Rawahi SA, Aziz H, Malik AM, Khan RM, Kaul N. A comparative analysis of the Baska mask vs Proseal laryngeal mask for general anesthesia with IPPV. Anaesth Pain & Intensive Care. 2013;17:233-6.

Alexiev V, Salim A, Kevin LG, Laffey JG. An observational study of the Baska® mask: a novel supraglottic airway. Anaesthesia. 2012;67:640-5. https://doi.org/10.1111/j.1365-2044.2012.07140.x

López AM, Mu-oz-Rojas G, Fontanals M, de San José I, Hermoso A, Valero R. Clinical evaluation of the Baska Mask® laryngeal mask in adult patients in ambulatory surgery. Revista Espa-ola de Anestesiología y Reanimación (English Edition). 2015;62:551-6. https://doi.org/10.1016/j.redare.2015.07.002

Font MC, García-Aguado R, Pascual JÚ. Funduplicatura de Nissen Laparoscópica con mascarilla laríngea Baska Mask®. Revista Espa-ola de Anestesiología y Reanimación. 2016;63:599-603. https://doi.org/10.1016/j.redar.2016.03.010

Aziz RA, Osman YM. Comparison of I-gel with Baska Mask Airway for Controlled Ventilation in Obese Patients Undergoing Ambulatory Surgery: A Prospective Randomized Trial. Journal of Anesthesiology. 2017;5:29- 35. https://doi.org/10.11648/j.ja.20170504.12

Almeida G, Costa AC, Machado HS. Supraglottic airway devices: a review in a new era of airway management. J Anesth Clin Res. 2016;7:2. https://doi.org/10.4172/2155-6148.1000647

Lai CJ, Liu CM, Wu CY, Tsai FF, Tseng PH, Fan SZ. I-Gel is a suitable alternative to endotracheal tubes in the laparoscopic pneumoperitoneum and trendelenburg position. BMC Anesthesiology. 2017;17:3. https://doi.org/10.1186/s12871-016-0291-1

Maharjan SK. I-gel for positive pressure ventilation. Journal of the Nepal Medical Association 2013;52:255-9. https://doi.org/10.31729/jnma.571