Comparison of intragastric pressure between endotracheal tube and supraglottic airway devices in laparoscopic hepatectomy

Abstract

Background: Supraglottic airway (SGA) devices do not definitively protect the airway from regurgitation of gastric contents. Increased gastric pressure and long operation time are associated with development of complications such as aspiration pneumonia. The aim of this study was to compare intragastric pressure between second-generation SGA and endotracheal tube (ETT) devices during long-duration laparoscopic hepatectomy. Methods: A total of 66 patients was randomly assigned to 2 groups; 33 patients each in the ETT and SGA groups. Intragastric pressure was continuously measured via a gastric drainage tube with a three-way stopcock connected to the pressure monitoring device. Normal saline was added to the end of the gastric drainage tube at each operation time point. Results: Intragastric pressure during pneumoperitoneum was no different between the 2 groups ( P = .146) or over time ( P = .094). The mean (standard deviation [SD]) pH of the SGA tip measured after operation was 6.7 (0.4), and a pH <4 was not observed. Relative risk of postoperative complications was significantly higher in the ETT group relative to the SGA group (sore throat, 5.5; cough,13.0). Conclusions: Use of SGA devices does not further increase intragastric pressure, even during prolonged upper abdominal laparoscopic surgery. Also, the frequency of postoperative sore throat and cough was significantly lower when the second-generation SGA device was used.

Supraglottic airway devices versus endotracheal intubation for laparoscopic surgeries: An updated systematic review and meta-analysis of randomised controlled trials

“…There were five studies that contributed to the analysis of cough with SAD or tracheal intubation. [ 15 – 17 , 20 , 25 ] We observed 11% reduction of cough in SAD group as compared to ET intubation group (RR 0.11, P < 0.00001 [0.06, 0.20], i 2 = 42%) [ Figure 3f ]. In our study, three out of five studies were conducted by the same author which may led to bias.…”

“…Hoarseness was reported in eight studies. [ 4 , 8 - 11 , 18 , 21 , 25 ] Analysis of pooled data showed 38% reduction in incidence of hoarseness in SAD group as compared to ET intubation group (RR 0.38, P < 0.01 [0.21, 0.69], i 2 = 72%) [ Figure 3b ].…”

“…[ 33 ] There was high statistical heterogeneity of 72% in this group. We conducted subgroup analysis with different types of supraglottic devices and found that LMA Classic[ 10 , 25 ] yielded the most consistent result with i 2 of 0%. Other studies with LMA Supreme[ 11 , 18 ] and LMA ProSeal[ 8 , 9 ] yielded i 2 of 49% and 42%, respectively [ Figure 4b ].…”