Comparison of lm-supreme and endotracheal tube in patients undergoing laparoscopic cholecystectomy

SUMMARYComparison of LM-SUPREME and Endotracheal TubeIn Patients Undergoing Laparoscopic CholecystectomyAim of the study : Although in some countries Laryngeal Mask Airway (LMA) is used for laparoscopic surgeries Endotracheal Tube (ETT) is still preferred for such operations because of the fear of pulmonary aspiration and inadequate ventilation. Laryngeal mask Supreme (LM-S) is a single use device and the presence of a drain tube allows to separate the gastrointestinal tract from the respiratroy tract. We planned to compare ventilation parameters and gastric distension with LM-S vs ETT during laparoscopic cholecystectomy.Methods: ASA I-II one hundred patients, aged between 18-70 years, were included to this double blind, randomised, controlled study. Patients were decided into two groups: ETT group (n=50) and LM-S group (n=50). All patients received total intravenous general anesthesia and a standart ventilation protocol has been carried out. Peroperative ventilation parameteres (peak airway pressure, mean airway pressure, end tidal carbon dioxide, tidal volume and oropharyngeal leak pressure) were recorded before, during and after peritoneal insufflation. At the same times the gastric distention was scored by a blinded surgeon. Perioperative laryngopharyngeal morbidity was also recorded.Results: Insertion time of the airway device was significantly shorter in Group LM-S (12 sec) than Group ETT (17 sec) (p=0.000). Insertion of the gastric tube was significantly easier in Group LM-S (p=0.000). The degree of gastric distention after the entry of the laparoscope was significantly higher in Group ETT (p=0.036). The mean and peak airway presure values were significantly higher in Group ETT (p<0.05) two minutes after the insertion of the airway device. Mean oropharyngeal leak pressure in the LM-S group was 29,8 cmH2O and this preesure increased significantly during the insuflation period (p=0.000). Postoperative laryngopharyngeal adverse events were similar in both groups.Conclusion: Our study demonstrated that LM-S may be safe and superior to ETT for positive pressure ventilation during laparoscopic cholecystectomy in ASA I-II patients.Key words: Laryngeal mask Supreme, endotracheal tube, laparoscopic cholecystectomy