Canadian Journal of Anaesthesia

, Volume 47, Issue 7, pp 622–626 | Cite as

Gastric distension and ventilation during laparoscopic cholecystectomy: LMA-classic vs. tracheal intubation

  • J. Roger Maltby
  • Michael T. Beriault
  • Neil. C. Watson
  • Gordon H. Fick
Reports of Investigation


Purpose: The standard laryngeal mask airway LMA-Classic was designed as an alternative to the endotracheal tube (ETT) or the face mask for use with either spontaneous or positive pressure ventilation. Positive pressure ventilation may exploit leaks around the LMA cuff, leading to gastric distension and/or inadequate ventilation. We compared gastric distension and ventilation parameters with LMAvs ETT during laparoscopic cholecystectomy.

Methods: One hundred and one, ASA 1–11 adults scheduled for elective laparoscopic cholecystectomy were randomly assigned to LMA-Classic or ETT. Patients with BMI >30 kg·m−2, hiatus hernia or gastroesophageal reflux were excluded. Following induction of anesthesia, an in-and-out orogastric tube was passed to decompress the stomach before insertion of the LMA (women size #4, men size #5) or ETT (women 7 mm, men 8 mm). Anesthesia was maintained with isoflurane in nitrous oxide and oxygen (FIO2 0.3–0.5), rocuronium and fentanyl. The surgeon, blinded to the type of airway, scored gastric distention 0–10 at insertion of the laparoscope and immediately before removal at the end of the surgical procedure.

Results: Incidence and degree of change in gastric distension were similar in both groups. Ventilation parameters during insufflation (mean±Sd) for LMA and ETT were: SpO2 98±1vs 98±1, PETCO2 38±4vs 36±4 mm Hg and airway pressure 21±4vs 23±3 cm water.

Conclusion: Positive pressure ventilation with a correctly placed LMA-Classic of appropriate size permits adequate pulmonary ventilation. Gastric distension occurs with equal frequency with either airway device.


Laparoscopic Cholecystectomy Rocuronium Laryngeal Mask Airway Positive Pressure Ventilation Gastric Distension 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Objectif: Le masque laryngé classique (ML) a été conçu comme une solution de remplacement au tube endotrachéal (TET) ou au masque lors de ventilation à pression positive ou de ventilation spontanée. La ventilation à pression positive accentue les fuites autour du ballonnet du ML. Nous avons comparé la distension gastrique et les paramètres de la ventilation avec le MLvs le TET pendant la cholécystectomie laparoscopique.

Méthode: Cent un patients d’état physique ASA 1–11, dont la cholécystectomie laparoscopique avait été planifiée, ont été répartis au hasard en deux groupes: ML et TET. Les patients dont l’IMC était >30kg·m−2, ou qui présentaient une hernie hiatale ou du reflux gastro-œsophagien ont été exclus de l’étude. Après l’induction de l’anesthésie, un cathéter orogastrique (placé et enlevé) a été introduit pour décompresser l’estomac avant l’insertion du ML (modèle 4 pour les femmes, 5 pour les hommes) ou un TET (7 mm pour les femmes, 8 mm pour les hommes). L’anesthésie a été maintenue avec de l’isoflurane dans un mélange de protoxyde l’azote et d’oxygène (FIO2 0,3–0,5), du rocuronium et du fentanyl. Le chirurgien, qui ne connaît pas le type de canule utilisée, a coté la distension gastrique de 0 à 10 à l’insertion du laparoscope et immédiatement avant son retrait à la fin de l’intervention chirurgicale.

Résultats: L’incidence et le degré de changement de distension gastrique ont été similaires dans les deux groupes. Les paramètres de ventilation notés pendant l’insufflation (moyenne±écart type) pour le ML et le TET ont été de: SpO2 98±1vs 98±1, PETCO238±4vs 36±4 mm Hg et la pression des voies aériennes de 21 ±4vs 23±3 cm d’eau.

Conclusion: La ventilation à pression positive avec un ML bien placé et de grandeur appropriée permet une ventilation pulmonaire adéquate. La distension gastrique survient selon la même fréquence avec le ML ou le TET.


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Copyright information

© Canadian Anesthesiologists 2000

Authors and Affiliations

  • J. Roger Maltby
    • 1
  • Michael T. Beriault
  • Neil. C. Watson
  • Gordon H. Fick
    • 1
  1. 1.From the Departments of Anesthesia and Community Health SciencesUniversity of CalgaryAlbertaCanada

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