Derya ÖZKAN, Alp ALPTEKİN, Haluk GÜMÜŞ, Emine ARIK, Yasemin DAYICAN, Sumru ŞEKERCİ

Laparoskopik kolesistektomilerde proseal LMA ve endotrakeal entübasyonun ventilasyon ve regürjitasyon açısından karşılaştırılması

Amaç: ProSeal laringeal mask airway (PLMA), LMA’ya göre hava yolunu daha iyi izole eden ve mide direnajını sağlayan bir aygıttır. Gastrik içeriğin regürjitasyonu PLMA ile tamamen önlenememekle birlikte, doğru yerleştirildiğinde glottisi hipofarinksten izole edebilmektedir. Çalışmamızın amacı ventilasyon parametreleri ve regürjitasyon riski açısından PLMA ile endotrakeal entübasyonu karşılaştırmaktır. Yöntem: Laparoskopik kolesistektomi uygulanacak 87 erişkin hasta çalışmaya alındı. Hastalara operasyondan 20 dk önce metilen mavisi kaşesi verildi. Her iki gruptaki hastalara standart anestezi yöntemi uygulandı. Grup I’deki (n=47) hastalara PLMA yerleştirilerek pilot balon, gaz kaçağı olmayacak şekilde şişirildi. PLMA içerisinden fiberoptik laringoskopla girilerek yerleşim yeri izlendi. Gastrik direnaj tüpünün içinden nazogastrik sonda yerleştirildi, aspire edilerek geri çekildi. Grup II’deki hastalara (n=40) ise endotrakeal entübasyon uygulandı. Periferik oksijen saturasyonu (SpO2), endtidal karbondioksit (ETCO2), peritoneal insüflasyon öncesi ve sonrası; ortalama hava yolu basınçları, nazogastrik sonda yerleştirme süresi, PLMA ve entübasyon tüpü pasajında yerleştirmeden hemen sonra ve operasyon sonunda metilen mavisi olup olmadığı kaydedildi. Bulgular: Gruplar arasında SpO2, ETCO2, insuflasyon öncesi ve sonrası ortalama hava yolu basınçları arasında anlamlı fark yoktu. Endotrakeal entübasyon grubunda hiçbir hastada metilen mavisi tespit edilmezken PLMA grubunda iki hastada maske çıkarılmadan hemen önce PLMA haznesinde metilen mavisi olduğu tespit edildi. Entübasyon grubundaki üç hastada, ekstübasyon sonrası laringospazm gelişti. Sonuç: Laparoskopik kolesistektomilerde doğru yerleştirilen PLMA’nın uygun ventilasyon koşulları sağlaması ve gastrik distansiyonu giderebilmesi nedeniyle endotrakeal entübasyona alternatif olabileceği ve PLMA’nın doğru yerleşiminin fiberoptik laringoskopla tespitinin regürjitasyon riskini azaltabileceği kanısındayız.

A comparison of proseal LMA and endotracheal entubation for ventilation and regurgilation in laparoscopic cholecystectomies

Objective: Even though PLMA cannot prevent gastric regurgitation completely, it is effective in isolating the glottis from the hypopharynx. ProSeal LMA (PLMA) has a superior design when compared to standard LMA in isolating the airway and allowing drainage of gastric contents. In this study, we compared PLMA with standard intubation with regard to ventilation parameters and the risk of regurgitation. Method: Eighty-seven patients undergoing laparoscopic cholecystectomy were included in this study. All patients received methylene blue orally 20 minutes before the induction. Standard general anaesthesia was performed to both groups. Group I (n =47) received PLMA and the pilot balloon was inflated to stop gas leakage. Fiberoptic laryngoscopy was performed to check the correct placement of PLMA. Nasogastric tube was placed through the drainage tube and suctioned, then removed. Group II (n= 40) patients had endotracheal entubation. SpO2 and ETCO2 were checked before and after peritoneal insufflation. The average airway pressure, the time for nasogastric tube placement and whether methylene blue was present on the PLMA and intubation tube at the end of the operation were recorded. Results: There was no statistically significant difference between SpO2, ETCO2 and average airway pressures. Two patients had methylene blue on their PLMA just before removal of the laryngeal mask. Three patients in Group II had laryngospazm after extubation. Conclusion: The appropiate use of PLMA is an effective means of obtaining ventilation and decreasing gastric distantion in laparoscopic cholecystectomy. We also think that controlling PLMA placement with a fiberoptic laryngoscope will be effective in decreasing the risk of regurgitation.

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