MONITORING CHANGES IN OROPHARYNGEAL SEAL PRESSURE OF PROSEAL LARYNGEAL MASK AIRWAY AND IT'S CORRELATION WITH CUFF PRESSURE, PEAK AIRWAY PRESSURE AND INTRAABDOMINAL PRESSURE IN LAPAROSCOPIC CHOLECYSTECTOMY.

Dr Shruti Malik, Dr Chirag Madaan, Dr Divya Gautam, Dr Suniti Kale

Abstract


INTRODUCTION: Supraglottic airway devices have become a fixture in airway management due to the increased reliability of placement, improved hemodynamic stability at induction, reduced anaesthesia requirement, lower frequency of sore throat. We conducted a prospective observational study to measure changes in peak airway pressure, cuff pressure, intra-abdominal pressure during laparoscopic cholecystectomy and to correlate changes in Oropharyngeal seal pressure (OPSP) of the P-LMA.

MATERIALS & METHODS: This study was conducted in 70 ASA grade I-II patients in the age group of 18-60 years scheduled for laparoscopic cholecystectomy surgery after approval from the institutional ethical committee of safdarjung hospital. After taking informed consent, providing pre-anaesthetic medications, patients were taken to the operation theater, standard monitors attached and baseline parameters were recorded. Patients were administered balanced general anaesthesia and appropriate size Proseal LMA (PLMA) was inserted and proper placement was ensured and cuff of the LMA was inflated to a pressure of 60 cm H2O. The oropharyngeal seal pressure of PLMA was measured and the site of the gas leak was also noted and after noting the baseline OPSP,the patient was put on ventilation and baseline peak airway pressure (PAP) was noted. The surgeon was then asked to proceed with the surgery with a targeted intra abdominal pressure of 12 mm of Hg, which was taken as the baseline IAP. Thereafter OPSP, PP, IAP and Cuff pressures were noted at various intervals throughout the surgery.The BMI of the patients, Mallampatti grading to assess the airway of the patients, volume required to inflate the cuff to 60 cm of H2O, total volume and colour of ryle’s tube aspirate were also noted for all patients.

RESULTS:It was found that, OPSP decreased at all intervals except T1( 15 minutes after final surgical position) which was statistically significant. Cuff pressure increased at all time intervals in comparison to baseline reading and was found to be statistically significant. Peak airway pressure increased at the time of pneumoperitoneum which is statistically as well as clinically significant. PAP kept on increasing from the time of surgical positioning till desufflation. IAP raised from a value of 0 at the baseline to 12 at the time of pneumoperitoneum creation, and throughout the duration of surgery, and then decreased to zero at the time of desufflation.No statistical or clinical correlation was found between any of these parameters

CONCLUSION: We conclude that inspite of fall in OPSP of P-LMA during laparoscopic cholecystectomy, an adequate laryngeal seal is maintained throughout the surgical period, thereby maintaining adequate ventilation and protection against aspiration inspite of pneumoperitoneum, surgical manipulation and in patient population, prone to GERD.


Keywords


Oropharyngeal seal pressure (OPSP), hemodynamic, anaesthesia

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