Title: Comparison of hemodynamic and Ventilator parameters with i-gel vs endotracheal tube in patients for laparoscopic cholecystectomy
Authors: Dr Bhawna Ahluwalia, Dr Manjit Singh Kanwar, Dr Ankita Chandel, Dr Nisha Sharma, Dr Naresh Anand
DOI: https://dx.doi.org/10.18535/jmscr/v9i2.02
Abstract
Laparoscopic surgery or minimal invasive surgery is an evolving surgical specialty in view of number of advantages like minimal bleeding, small incision, less surgical scar and short recovery time. It is done with insufflation of carbondioxide in the peritoneal cavity leading to increased abdominal pressure, raised carbon-dioxide levels, hemodynamic changes or lung aspiration.(1) Till date cuffed endotracheal tubes are used to secure the airway and adequate control of airway pressures but the airway manipulation during laryngoscopy and ventilation leads to sympatho-adrenal axis stimulation that can cause increase in heart rate, blood pressure, increased myocardial contractility, increased myocardial oxygen demand, myocardial ischemia or infarction, increased intracranial pressures or bronchospasm. To combat these effects we used laryngeal mask airway to secure the airway and control of ventilation during laparoscopic cholecystectomy.
Methodology: A total of 80 patients of ASA-1 &2 selected for this double blind, prospective, randomised study. They were divided into two groups; group I and group E, of 40 each. Group-I was managed by LMA (i-gel) and Group-E by endotracheal cuffed tube. A detailed pre-anesthesia check up done for all the patients and informed consent taken. All patients who fulfilled the inclusion criteria were kept nil orally for six hours before the surgery and anaesthesia. Pre-medication given with cap pantoprazole 40mg night before the surgery and at 6.0am on the day of surgery. In the operation theatre after recording the baseline vital parameters all patients induced and airway device was used as per their group. Any changes in the heart rate, blood pressure, airway pressures recorded and compared. Incidence of post-operative throat discomfort or Sore throat also noted down.
Results: The number of attempts taken to place the i-gel or endotracheal tube was not significant but the duration of time to place the i-gel v/s ETT was quite less…..14.98 v/s 19.23 sec ( p-value =< 0.05).A significant increase in the heart rate and blood pressure at the time of endotracheal intubation in group- E patients from a baseline of 74.10 to 82.30 compare to group-I that varied from 74.10 to 75.15 maximum(p-value <0.05). The mean blood pressure was 123.33 mmhg in group I and 124.10mmhg in group E.A significant rise in Sysolic and diastolic Blood Pressure is seen at at 1 and 5 minutes in group E and a similar trends seen in extubation. (p --0.05). No significant differences recorded in the mean airway pressure in both the groups before, during and after the pneumoperitoneum (p-- >0.05).
Conclusion: Use of i gel-LMA is better tolerated by the patient in terms of hemodynamic stability, airway pressures and post-operative comfort.
Keywords: Laparoscopy, laryngeal mask airway, cholecystectomy.
References
- Sharma B, Sahai C, Bhattacharya A, Kumar VP, Sood J. Pro Seallaryngealmask airway: A study of 100 consecutive cases of laparoscopic surgery. Indian J Anaesth 2003;47:467-72.
- Badheka JP, Jadliwala RM, Chhaya VA, Parmar VS, Vasani A, Rajyaguru AM. I-gel as an alternative to endotracheal tube in adult laparoscopic surgeries: A comparative study. J Min Access Surg 2015;11:251-6
- Richez B, Saltel L, Banchereau F, Torrielli R, Cros AM. A new single use supraglottic airway device with a noninflatable cuff and an esophageal vent: An observational study of the I-gel. Anesth Analg 2008;106:1137-9.
- Beylacq L, Bordes M, Semjen F, Cros AM. The I-gel, a single-use supraglottic airway device with a non-inflatable cuff and an esophageal vent: An observational study in children. Acta Anaesthesiol Scand 2009;53:376-9.
- Teoh WH, Lee KM, Suhitharan T, Yahaya Z, Teo MM, Sia AT. Comparison of the LMA Supreme vs the I-gel in paralysed patients undergoing gynaecological laparoscopic surgery with controlled ventilation. Anaesthesia 2010; 65:1173-9.
- Higgins PP, Chung F, Mezei G. Postoperative sore throat after ambulatory surgery. Br J Anaesth 2002;88:582-4.
- Dyer RA, Llewellyn RL, James MF Totali. v. anaesthesia with propofoland the laryngeal mask for orthopaedic surgery. Br J Anaesth 1995;74:123-8
- Cork RC, Depa RM, Standen JR. Prospective comparison of use of the laryngeal mask and endotracheal tube for ambulatory surgery. Anesth Analg 1994; 79:719-27.
- Ekinci O, Abitagaoglu S, Turan G, Sivrikaya Z, Bosna G, Özgultekin A. The comparison of ProSeal and I-gel laryngeal mask airways in anesthetized adult patients under controlled ventilation. Saudi Medical Journal 2015;36(4):432-436.
- Jadhav PA, Dalvi NP, Tendolkar BA. I-gel versus laryngeal mask airway-Proseal: Comparison of two supraglottic airway devices in short surgical procedures. J Anaesthesiol Clin Pharmacol 2015;31:221
- Helmy AM, Atef HM, El-Taher EM, Henidak AM. Comparative study between I-gel, a new supraglottic airway device, and classical laryngeal mask airway in anesthetized spontaneously ventilated patients. Saudi J Anaesth2010;4:131-6. [PUBMED]
- Kini G, Devanna GM, Mukkapati KR, Chaudhuri S, Thomas D. Comparison Of I-gel with proseal LMA in adult patients undergoing elective surgical procedures under general anesthesia without paralysis: A prospective randomized study. J Anaesthesiol Clin Pharmacol 2014;30:183-7.
- Jeon WJ, Cho SY, Baek SJ, Kim KH. Comparison of the Proseal LMA and intersurgical I-gel during gynecological laparoscopy. Korean Journal of Anesthesiology. 2012;63(6):510-514. doi:10.4097/kjae.2012.63.6.510.
- Gardy DM, Mchardy F, Wong J et al. Pharyngolaryangeal morbidity with laryngeal mask airway in spontaneous breathing patients. Anesthesiology 2001;94:760-6
- Singh I, Gupta M, Tandon M. Comparison of clinical performance of I-Gel with LMA-proseal in elective surgeries. Indian J Anaesth 2009; 53:302-5.
- Gatward JJ, Cook TM, Seller C, et al. Evaluation of the size 4 i-gel airway in one hundred non-paralysed patients. Anaesthesia 2008; 63: 1124–30.