AutoFlow® versus volume-controlled ventilation for laparoscopic gynecological surgery using LMA® ProSeal™: a randomized controlled trial
| Autor: | Seishi Sakamoto, Toshiyuki Nakanishi, Takashi Toriumi, Manabu Yoshimura |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Adult
Time Factors medicine.medical_treatment Trendelenburg position Airway management Patient Positioning Head-Down Tilt Positive-Pressure Respiration 03 medical and health sciences 0302 clinical medicine Mechanical ventilation Gynecologic Surgical Procedures Pneumoperitoneum 030202 anesthesiology Anesthesiology medicine Tidal Volume Humans RD78.3-87.3 Single-Blind Method Prospective Studies Gynecological surgery Tidal volume Laryngeal masks business.industry Research Equipment Design Carbon Dioxide Middle Aged medicine.disease Respiration Artificial Anesthesiology and Pain Medicine Anesthesia Breathing 030211 gastroenterology & hepatology Female Laparoscopy Rocuronium Airway business |
| Zdroj: | BMC Anesthesiology BMC Anesthesiology, Vol 21, Iss 1, Pp 1-7 (2021) |
| ISSN: | 1471-2253 |
| Popis: | Background During laparoscopic gynecological surgery, increased peak airway pressure (PAWP) can cause airway leak upon ventilation with the LMA® ProSeal™. We hypothesized that compared with the use of volume-controlled ventilation (VCV), the use of the AutoFlow® mode would decrease PAWP and airway leak during laparoscopic gynecological surgery with LMA ProSeal. Methods This single-center, randomized, controlled trial allocated 80 adult women undergoing elective laparoscopic gynecological surgery to one of two groups, namely, the AutoFlow group or the VCV group. Ventilation settings for both groups were 8 ml/kg of tidal volume and 5 cmH2O of positive end-expiratory pressure, and respiratory rate was adjusted to maintain end-tidal carbon dioxide at 35–40 mmHg. Airway leak, PAWP, and other ventilatory parameters and vital signs were recorded at four timepoints (1, 1 min after insertion of the gastric tube; 2, 2 min after intravenous administration of rocuronium 0.6–0.8 mg/kg; 3, 1 min after initiation of pneumoperitoneum; and 4, 1 min after changing to the Trendelenburg position). The primary outcome was PAWP during pneumoperitoneum and in the Trendelenburg position, whereas the secondary outcomes included PAWP at other timepoints and airway leak development. We used the Mann–Whitney U test for PAWP and Fisher’s exact test for comparing airway leak among the groups. Results Data from 40 patients in the AutoFlow group and 39 in the VCV group were used for analysis. PAWP at pneumoperitoneum pressure and in the Trendelenburg position was significantly lower in the AutoFlow group than in the VCV group [median (interquartile range), 16 (15–18) cmH2O vs. 18 (17–19) cmH2O; P P = 0.68). Conclusions Even though AutoFlow ventilation decreased PAWP, it did not reduce the incidence of airway leak compared with VCV during laparoscopic gynecological surgery with the LMA ProSeal. Trial registration UMIN Clinical Trials Registry, identifier UMIN000023173. |
| Databáze: | OpenAIRE |
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