Effects of Peak Inspiratory Pressure-Guided Setting of Intracuff Pressure for Laryngeal Mask Airway Supreme™ Use during Laparoscopic Cholecystectomy: A Randomized Controlled Trial

Abstract

Purpose

To determine the effects of peak inspiratory pressure (PIP)-guided intracuff pressure (ICP) modulation of laryngeal mask airway (LMA) Supreme™ during laparoscopic cholecystectomy.

Methods

Totally 120 patients were randomly divided using computer-generated numbers into a control group (n = 60; ICP, 60 cmH₂O) and a PIP group (n = 60), in which ICP was increased with 5 cmH₂O each time from PIP level until no air leaks from the oropharynx. PIP, ICP, cuff volume (CV), oropharyngeal leak pressure (OLP) and leak fraction (LF) were recorded before and after pneumoperitoneum establishment. Postoperative pharyngolaryngeal complications (sore throat, dysphagia, pharyngeal hematoma, and dysphonia) were also recorded.

Results

Demographic data were similar in the two groups. The CV and ICP before and after pneumoperitoneum were significantly lower in the PIP group (CV: 15.6 ± 2.3 mL and 21.0 ± 2.6 mL; ICP: 14.3 ± 2.9 cmH₂O and 20.5 ± 3.4 cmH₂O) than in the control group (CV: 33.0 ± 2.8 mL and 32.8 ± 1.9 mL; ICP: 60.0 ± 0.1 cmH₂O and 60.0 ± 0.1 cmH₂O) (P < 0.05). Although OLP was lower in the PIP group (P < 0.05), the LF was similar in the two groups (P > 0.05). There were fewer postoperative pharyngolaryngeal complications in the PIP group (P < 0.05).

Conclusions

Compared with a fixed ICP of 60 cmH₂O, PIP-guided ICP modulation during LMA Supreme™ use provided effective airway sealing at a lower CV and ICP, and produced fewer postoperative pharyngolaryngeal complications in patients undergoing laparoscopic cholecystectomy.

CLINICAL TRIAL REGISTRATION:

• ClinicalTrials.gov (NCT03365557)

Keywords:

• Laryngeal mask
• Pressure
• Airway management
• Laparoscopy

View correction statement:

Optimal Use of LMA SupremeTM for Laparoscopy

Acknowledgements

We sincerely appreciate the nursing staff and surgical team for their patience and enthusiastic support.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The datasets generated and analyzed in this study are available from the corresponding author upon reasonable request.

Additional information

Funding

Financial support and sponsorship: This work was supported by the General Project of Jiangsu Provincial Health and Wellness Committee Fund (H2018049); the Medical Key Talents Training Project of Yangzhou City Health and Family Planning Commission (ZDRC201815); and the Key Program of The Affiliated Hospital of Yangzhou University Research Grant (YZYY2017-07).