TITLE: PULMONARY COMPLIANCE OF LARYNGEAL MASK AIRWAY DURING LAPAROSCOPIC CHOLECYSTECTOMY

AUTHORS: Toru Iizuka, MD, PhD¹, Kohdai Kinoshita, MD, PhD², Hidekimi Fukui, MD²
AFFILIATION: ¹Natl. Ohkura Hospital, Tokyo Medical Univ., Komae-shi, Japan; ²Natl. Ohkura Hospital, Tokyo Medical Univ., Setagaya, Japan.

INTRODUCTION: Laparoscopic cholecystectomy have some adverse effects mainly related to the inflation of the peritoneal cavity, the use of CO2 gas. Peritoneal insufflation decrease the pulmonary compliance and increase the inspiratory pressure and the incidence of a leak with positive pressure ventilation, using the laryngeal mask airway (LMA). In this study, we studied the changes in pulmonary function during laparoscopic cholecystectomy anesthetized with epidural-propofol using the LMA.
METHODS: After obtained informed concent and approval, we studied 24 patients (ASA physical status 1 or 2) undergoing laparoscopic cholecystectomy. After inserted the epidural catheter, (Th11-12, cranially directed for 5 cm and 10 ml 0.5% bupivacaine was administered), anesthesia was induced with 2mg/kg propofol and LMA was inserted. Maintenance consisted of 7-10mg/kg/hr propofol and vecronium was given. At present times during the lapaloscopic operation, pulmonary compliance, peak inspiratory pressure and an audible leak were monitored. Measurements were made with before and during the pneumoperitoneum.
RESULTS:

*p<0.05 when compared with the before pneumoperitoneal values., Figures are Mean±S.D.

DISCUSSION: Our results indicate that the degree of the pulmonary mechanical changes caused by the pneumo- peritoneum were significant. But epidural-propofol anesthesia using the LMA is suitable for laparoscopic cholecystectomy because the incidence of the leak were slightly and O2 desaturation and passive gastric regurgitation were not occur.