The application of PEEP when PCV is used with the PLMA results in improved oxygenation in obese patients with a BMI ≥30 and <36 kg/m(2) but not in normal weight patients. Alveolar recruitment produced by seal pressure measurements below 30 cm H(2)O was sufficient to produce a clinically significant improvement in oxygenation in most obese patients and there was a significant improvement of oxygenation with PEEP=5 cmH(2)O. Both findings are in contrast to findings of studies using an ETT which suggests that higher pressures (40 cmH(2)O) are needed for recruitment of collapsed alveoli and higher PEEP (10 cmH(2)O) is needed to produce a clinically significant improvement in oxygenation in obese patients. The results of this study support data showing that the consequences of bronchopulmonary airway reactions known to occur with an ETT are less pronounced or absent when an LMA is used.

Planned PLMA removal in the recovery room after BIS-guided balanced anesthesia did not enable the anesthetist to be available earlier for induction of anesthesia in the following patient. Hence the anesthetist could not contribute to a faster turnover of cases. Obviously, with the type of close communication between surgeon and anesthetist dictated by the study protocol (announcement of expected end of surgery by the surgeon 20 min before end of surgery) it is possible for the patient to regain consciousness within a very small time window following the end of surgery. Following this kind of protocol, postponement of removal of the LMA in the recovery room does not seem to be attractive neither from a clinical nor an economic point of view. In contrast, removal of LMA in the recovery room should be restricted to occasional cases with an abrupt end of the operation or prolonged emergence from anesthesia. The obvious risk of hypoxemia necessitates continuous O(2) application and S(p)O(2) monitoring during transport to the recovery room.