ProSeal as an alternative to endotracheal intubation in pediatric laparoscopy

The increasing use of laparoscopic surgery in children mandates a leak-free airway device during carboperitoneum for which tracheal tubes (TT) have been traditionally used. The pediatric ProSeal is a recent introduction to the laryngeal mask airway (LMA) family. The ProSeal LMA (PLMA) has been successfully used in adult laparoscopic procedures. We hypothesized that the ProSeal can be equally effective in achieving adequate oropharyngeal seal and pulmonary ventilation during elective laparoscopic procedures in children.

Sixty ASA I and II children, 6 months to 8 years, scheduled for elective laparoscopic surgeries (duration of carboperitoneum <60 min) were randomly assigned to two groups of 30 each (TT and ProSeal(TM)). Patients at risk of aspiration, difficult airway and upper respiratory tract infection were excluded. Anesthesia technique included 8% of sevoflurane/O(2)/N(2)O and neuromuscular blockade. Ventilation was set to 10 ml.kg(-1) with positive endexpiratory pressure of 5 cmH(2)O. Respiratory rate was adjusted to maintain endtidal CO(2) (P(E)CO(2)) between 4.6 and 5.8 kPa (35-45 mmHg). Carboperitoneum was achieved at 10 mmHg. Hemodynamic parameters, peak inspiratory pressure (PIP) and P(E)CO(2) were noted at different time points. Chi-squared test, Mann-Whitney U-test and Wilcoxan W-test were applied; P < 0.05 was considered significant.

There were no statistically significant differences in SpO(2) and P(E)CO(2) between PLMA and TT groups before and after peritoneal insufflation. Significant change was seen in PIP (cmH(2)O) from induction to carboperitoneum in both groups (14.3 +/- 1.48 in PLMA, 14.2 +/- 1.46 in TT to 23.36 +/- 1.7 in PLMA, and 23.73 +/- 1.9 in TT); and in P(E)CO(2) (mmHg), from 32 +/- 2.2 to 48 +/- 3.6 in PLMA and 30 +/- 3.1 to 47 +/- 2.8 in the TT group. The changes were not significant; P > 0.05 between the groups. The first-time success rate for PLMA was 88%, mean oropharyngeal leak pressure was 29 +/- 3 cmH(2)O.

The pediatric PLMA and TT have comparable ventilatory efficacy for elective short laparoscopic procedures.