Proseal Laryngeal Mask Airway versus Endotracheal Tubes for Intraoperative Airway Management during Laparoscopic Biliary Tract Surgery: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

ZHANG Yanju , LIU Xinzhu ,  LIU Bin

Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

LIU Bin, Email: benbinliu@hotmail.com

Keywords：

ProSeal laryngeal mask airway; Endotracheal tube; Laparoscopic biliary tract surgery; Randomized controlled trial; Systematic review

DOI：

10.7507/1672-2531.20090101

Video：

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Objective 　To systematically assess the effectiveness and safety of ProSeal laryngeal mask (PLMA) compared to endotracheal tube (TT) for airway management in the patients undergoing laparoscopic biliary tract surgery.
Methods 　Using the Cochrane systematic review methods, we searched the Cochrane Controlled Trial Registers (CCTR) of The Cochrane Library, MEDLINE, VIP, and CNKI databases through May 2008. We also handsearched relevant journals and conference proceedings. Two reviewers independently selected studies and assessed the quality of the trials. Disagreements were resolved by discussion, in consultation with a third reviewer. RevMan 4.2 software provided by the Cochrane Collaboration was used for meta-analysis which was performed for combining the results of homogeneity
studies.
Results 　Seven studies involving 493 patients undergoing laparoscopic biliary tract surgery were included. Meta analysis results showed that: ① Side effects: none of the patients experienced regurgitation or hypoventilation. ② PLMA was superior to TT in terms of less postoperative sore throat (OR=0.27, 95%CI 0.13 to 0.53, P=0.0002) and response during extubation (OR=0.01, 95%CI 0.00 to 0.03, P lt;0.00001). ③ PLMA was similar to TT in terms of effective ventilation during peritoneal insufflation (Ppeak: WMD=0.01, 95%CI -0.66 to 0.68, P=0.98; PetCO2: WMD=0.01, 95%CI -0.58 to 0.59, P=0.99) and ease of insertion (OR=0.58, 95%CI 0.23 to 1.47, P=0.25). ④ Hemodymatics changed during the procedure: PLMA was more stable than TT.
Conclusion 　It is safe to use PLMA for ventilation in laparoscopic biliary tract surgery. However, up to now, we still cannot draw a definite conclusion due to the low quality of the included studies, and more high quality trials of PLMA airway management for laporoscopic surgery are needed.

Citation： ZHANG Yanju,LIU Xinzhu,LIU Bin. Proseal Laryngeal Mask Airway versus Endotracheal Tubes for Intraoperative Airway Management during Laparoscopic Biliary Tract Surgery: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2009, 09(5): 552-557. doi: 10.7507/1672-2531.20090101 Copy

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2.	Gadacz TR. Update on laparoscopic cholecystectomy, including a clinical pathway. The Surgical Clinics of North America, 2000, 80(4): 1127–1149.
3.	Leonard IE, Cunningham AJ. Anaesthetic considerations for laparoscopic cholecystectomy. Best Practice & Research. Clinical Anaesthesiology, 2002, 16(1): 1–20.
4.	Joshi, GP. Anesthesia for laparoscopic surgery. Can J Anesth, 2002, 49(6): R1–5.
5.	Klimek M, Klein J. Can the laryngeal mask airway replace endotracheal tubation for airway control? The argument against the laryngeal mask airway. The Israel Medical Association Journal, 2004, 6(4): 242–244.
6.	Brain AI, Verghese C, Strube PJ. The LMA‘Proseal’--a laryngeal mask with an oesophageal vent. Br J Anaesth, 2000, 84(5): 650-654.
7.	Lim Y, Goel S, Brimacombe JB. The Proseal laryngeal mask airway is an effective alternative to laryngoscope-guided tracheal intubation for gynaecological laparoscopy. Anaesth Intensive Care, 2007, 35(1): 52-56.
8.	Roth H, Genzwuerker HV, Rothhaas A, et al. The ProSeal laryngeal mask airway and the laryngeal tube suction for ventilation in gynaecological patients undergoing laparoscopic surgery. Eur J Anaesthesiol, 2005, 22(2): l17-122.
9.	Asai T. Use of the laryngeal mask is contraindicated during cholecystectomy. Anaesthesia, 2001, 56(2): 187-188.
10.	Maltby JR. Beriault MT. Watson NC. Use of the laryngeal mask is not contraindicated for laparoscopic cholecystectomy. Anaesthesia, 2001, 56(8): 800-802.
11.	董庆龙, 叶靖, 庄小雪, 等. 腹腔镜胆道手术患者双管型喉罩通气的可行性. 中华麻醉学杂志, 2005, 25（7）: 493-496.
12.	史东平, 祝义军, 封卫征, 等. 食管引流型喉罩在腹腔镜胆囊手术麻醉中的应用. 临床麻醉学杂志, 2006, 22(7): 511-513.
13.	华震, 周淑珍, 王杨, 等. ProSeal 喉罩在腹腔镜胆囊切除手术中的应用. 中国临床医生杂志, 2007, 35(1): 43-44.
14.	朱志兵, 郑吉卫, 雷菊红, 等. 第三代喉罩在腹腔镜胆囊手术中的应用. 中国医疗前沿, 2007, 2(17): 117-118.
15.	陈锋, 王成夭, 王焱林. 双管型喉罩通气在腹腔镜胆道手术中对血流动力学和通气的影响. 武汉大学学报(医学版), 2007, 28(1): 99-102.
16.	夏瑞, 程智刚, 毛庆军, 等. Proseal喉罩对腹腔镜胆囊切除术患者心钠素和皮质醇的影响. 中国内镜杂志, 2008, 14(2): 202-207.
17.	Maltby JR, Beriault MT, Watson NC. The LMA-ProSeal? is an effective alternative to tracheal intubation for laparoscopic cholecystectomy. Can J Anesth, 2002, 49(8): 857–862.
18.	华震, 周淑珍, 左明章. 双管喉罩在老年患者腹腔镜胆囊切除手术中的应用. 临床麻醉学杂志, 2007, 23(12): 1002-1003.
19.	夏瑞, 朱志兵, 毛庆军. Proseal 喉罩对腹腔镜胆囊切除术病人心钠素和皮质醇的影响. 实用医学杂志, 2007, 23(10): 1482-1484.
20.	黄文. 第三代喉罩全麻在腹腔镜手术中的应用. 右江民族医学院学报, 2002, 4: 567-569.

1. Bittner R. The standard of laparoscopic cholecystectomy. Langenbeck’s Archives of Surgery, 2004, 389(3): 157–163.
2. Gadacz TR. Update on laparoscopic cholecystectomy, including a clinical pathway. The Surgical Clinics of North America, 2000, 80(4): 1127–1149.
3. Leonard IE, Cunningham AJ. Anaesthetic considerations for laparoscopic cholecystectomy. Best Practice & Research. Clinical Anaesthesiology, 2002, 16(1): 1–20.
4. Joshi, GP. Anesthesia for laparoscopic surgery. Can J Anesth, 2002, 49(6): R1–5.
5. Klimek M, Klein J. Can the laryngeal mask airway replace endotracheal tubation for airway control? The argument against the laryngeal mask airway. The Israel Medical Association Journal, 2004, 6(4): 242–244.
6. Brain AI, Verghese C, Strube PJ. The LMA‘Proseal’--a laryngeal mask with an oesophageal vent. Br J Anaesth, 2000, 84(5): 650-654.
7. Lim Y, Goel S, Brimacombe JB. The Proseal laryngeal mask airway is an effective alternative to laryngoscope-guided tracheal intubation for gynaecological laparoscopy. Anaesth Intensive Care, 2007, 35(1): 52-56.
8. Roth H, Genzwuerker HV, Rothhaas A, et al. The ProSeal laryngeal mask airway and the laryngeal tube suction for ventilation in gynaecological patients undergoing laparoscopic surgery. Eur J Anaesthesiol, 2005, 22(2): l17-122.
9. Asai T. Use of the laryngeal mask is contraindicated during cholecystectomy. Anaesthesia, 2001, 56(2): 187-188.
10. Maltby JR. Beriault MT. Watson NC. Use of the laryngeal mask is not contraindicated for laparoscopic cholecystectomy. Anaesthesia, 2001, 56(8): 800-802.
11. 董庆龙, 叶靖, 庄小雪, 等. 腹腔镜胆道手术患者双管型喉罩通气的可行性. 中华麻醉学杂志, 2005, 25（7）: 493-496.
12. 史东平, 祝义军, 封卫征, 等. 食管引流型喉罩在腹腔镜胆囊手术麻醉中的应用. 临床麻醉学杂志, 2006, 22(7): 511-513.
13. 华震, 周淑珍, 王杨, 等. ProSeal 喉罩在腹腔镜胆囊切除手术中的应用. 中国临床医生杂志, 2007, 35(1): 43-44.
14. 朱志兵, 郑吉卫, 雷菊红, 等. 第三代喉罩在腹腔镜胆囊手术中的应用. 中国医疗前沿, 2007, 2(17): 117-118.
15. 陈锋, 王成夭, 王焱林. 双管型喉罩通气在腹腔镜胆道手术中对血流动力学和通气的影响. 武汉大学学报(医学版), 2007, 28(1): 99-102.
16. 夏瑞, 程智刚, 毛庆军, 等. Proseal喉罩对腹腔镜胆囊切除术患者心钠素和皮质醇的影响. 中国内镜杂志, 2008, 14(2): 202-207.
17. Maltby JR, Beriault MT, Watson NC. The LMA-ProSeal? is an effective alternative to tracheal intubation for laparoscopic cholecystectomy. Can J Anesth, 2002, 49(8): 857–862.
18. 华震, 周淑珍, 左明章. 双管喉罩在老年患者腹腔镜胆囊切除手术中的应用. 临床麻醉学杂志, 2007, 23(12): 1002-1003.
19. 夏瑞, 朱志兵, 毛庆军. Proseal 喉罩对腹腔镜胆囊切除术病人心钠素和皮质醇的影响. 实用医学杂志, 2007, 23(10): 1482-1484.
20. 黄文. 第三代喉罩全麻在腹腔镜手术中的应用. 右江民族医学院学报, 2002, 4: 567-569.

Chinese Journal of Evidence-Based Medicine

Proseal Laryngeal Mask Airway versus Endotracheal Tubes for Intraoperative Airway Management during Laparoscopic Biliary Tract Surgery: A Systematic Review

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