Elif GAYGUSUZ ATAR, Sema ÖNCÜL, Murat COŞKUN, Canan BALCI

LAPAROSKOPİK EKSTRAPERİTONEAL İNGUİNAL HERNİ AMELİYATLARINDA ENDOTRAKEAL ENTÜBASYON İLE PROSEAL LMA KULLANIMININ KARŞILAŞTIRILMASI

Amaç: Bu çalıflmada genel anestezi altında laparoskopik total ekstraperitoneal inguinal herni (TEP) operasyonu uygulanan hastalarda endotrakeal entübasyon ve proseal larengeal maske (LMA-P) kullanımının oksijenizasyon, ventilasyon ve hemodinamik yanıtlar üzerine etkilerini karflılafltırmayı amaçladık. Yöntem: 50 hasta çalıflmaya dahil edildi. Grup Eye endotrakeal entübasyon uygulandı, Grup Lye LMA-P yerlefltirildi. Anestezi indüksiyonu, entübasyon/LMA-P yerlefltirilmesi, cerrahi insizyon, insuflasyonun 1. dksında ve cerrahi süresince 15 dk aralıklarla tüm hemodinamik veriler ve Ppeak değerleri kaydedildi. Bulgular: Grup Ede cerrahi süre (p=0.032) ve gaz miktarı (p=0.019) Grup Lye göre yüksek bulundu. Her iki grupta da insuflasyon sonrası SpO2 ve ETCO2 değerlerindeki değiflim kontrol değerler ile karflılafltırıldığında benzer bulundu. nsuflasyon sonrası Ppeak değerindeki artıfl Grup Lde istatistiksel olarak yüksek bulundu (p=0.001). Her iki grupta da SpO2 (p=0.865), ETCO2 (p=0.812) ve Ppeak (p=0.570) ortalamalarının zaman içindeki değiflimi benzer bulundu. Sonuç: Bu çalıflma sonucunda TEP uygulanan laparoskopik inguinal herni onarımlarında LMA-P kullanımının endotrakeal entübasyona alternati f olabileceği sonucuna varılmıfltı

COMPARING THE EFFECTS OF THE USE OF ENDOTRACHEAL INTUBATION AND LMA PROSEAL ON LAPAROSCOPIC EXTRAPERITONEAL INGUINAL HERNIA OPERATION

Objective: In this study, we aimed to compare the effects of using endotracheal intubation and LMA-P on oxygenation,ventilation and hemodynamic responses on the patients whose laparoscopic total extraperitoneal inguinal hernia operation were applied under general anesthesia. Method: Fi fty patients were included in this study. Endotracheal intubation has been applied to group E. LMA-P was placed to group L. Anesthesia induction intubation/LMA-P placing, surgery incision, all of the hemodynamic datas in the first minutes of insuflation and with 15 minute intervals during surgery and Ppeak values were recorded. Results: It is observed that surgery time (p=0.032) and gas amount (p=0.019) in group E is higher compared to group L. Comparison of results on SpO2 and ETCO2 value changes with baseline values found as similar in both two groups. Increase of the Ppeak values after insuflation found as statistically high (p=0.001) in group L. Averages of SpO2 (p=0.865), ETCO2 (p=0.812) and Ppeak (p=0.570) changes in time found as similar in both two groups. Conclusion: As a result of this study, it is agreed that usage of LMA-P is an alternative to endotracheal intubation TEP applied in laparoscopic inguinal hernia repairs

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1. Salihoglu Z, Demiroluk S, Yavuz N. Minimally invasive preperitoneal inguinal hernia repair with epidural anaesthesia. Anaesth Intensive Care 2002; 30: 813-814. 2. Molinelli BM, Tagliavia A, Bernstein D. Total extraperitoneal preperitoneal laparoscopic hernia repair using spinal anesthesia. JSLS 2006; 10: 341-344. 3. Mullett CE1, Viale JP, Sagnard PE, et al. Pulmonary CO2 elimination during surgical procedures using intra or extraperitoneal CO2 insufflation. Anesth Analg 1993; 76: 622-626. 4. Saraswat N, Kumar A, Mishra A, Gupta A, Saurabh G, Srivastava U. The comparison of proseal laryngeal mask airway and endotracheal tube in patients undergoing laparoscopic surgeries under general anaesthesia. ndian J Anaesth. 2011; 55: 129-134. 5. Hoflten T, Yldz Tfi, Kufl A, Solak M, Toker K. Comparison of Supreme Laryngeal Mask Airway and ProSeal Laryngeal Mask Airway during Cholecystectomy. Balkan Med J 2012; 29: 314-319. 6. Natalini G, Lanza G, Rosano A, Dell'Agnolo P, Bernardini A. Standard Laryngeal Mask Airway and LMA-ProSeal during laparoscopic surgery. J Clin Anesth 2003; 15: 428-432. 7. Maltby JR, Beriault MT, Watson NC, Fick GH. Gastric distension and ventilation during laparoscopic cholecystectomy; LMA-Classic vs. Tracheal intubation. Can. J Anaesth 2000; 47: 622-626. 8. Keller C, Brimacombe J. Mucosal pressure and oropharyngeal leak pressure with the ProSeal versus laryngeal mask airway in anaesthetized paralysed patients. Br J Anaesth 2000; 85: 262-266. 9. Sharma B, Sahai C, Bhattacharya A, Kumar VP, Sood J. Proseal laryngeal mask airway: A study of 100 consecutive cases of laparoscopic surgery. Indian J Anaesth 2003; 47: 467-472. 10. Fujii Y, Tanak H, Toyooha H. Circulatory responses to laryngeal mask airway insertion or tracheal intubation in normotensive and hypertensive patients. Can J Anaesth 1995; 42: 32-36. 11. Ozdamar D, Güvenç BH, Toker K, Solak M, Ekingen G. Comparison of the effect of LMA and ETT on ventilation and intragastric pressure in pediatric laparoscopic procedures. Minerva Anestesiol 2010; 76: 592-599. 12. Kanthed P, Sharma B, Sood J, Kumra VP. Comparison of LMAProseal with LMA-Classic in anaesthetised paralysed children. Indian J Anaesth 2008; 52: 44-48. 13. Brimacombe J, Keller C. Aspiration of gastric contents during use of a ProSeal laryngeal mask airway secondary to unidentified foldover malposition. Anesth Analg 2003; 97: 1192-1194.