Comparison of Laryngeal Mask Supreme and Endotracheal Intubation without Neuromuscular Blockers in Laparoscopic Gynecological Surgery
Background and Goal of Study:New generation supraglottic airway devices (SGAD) are being used in a variety of laparoscopic surgeries (1). Our aim was to compare the effects on surgical view and ventilation parameters of laryngeal mask airway-supreme (LM-S) and endotracheal tube (ETT) applications, in cases undergoing laparoscopic gynecological surgery without using a neuromuscular blocker agent (NBA) in the Trendelenburg position with positive pressure ventilation.
Materials and Methods:After IRB approval and after written informed consent in this study was prospective, randomized and double blind, including 100 patients in ASA I-II class between 18 and 65 years old. Patients were divided into two groups; Group ETT (n=50) and Group LM-S (n=50). Standard anesthesia and ventilation protocols were administered to patients in all groups. Ventilation parameters were recorded in the peroperative period 2 minutes after airway device insertion (T1), after peritoneal insufflation and Trendelenburg position (T2), before desufflation (T3) and after removal of the airway device (T4) and laryngopharyngeal morbidity was recorded in the postoperative period. The surgeon, blind to the study, was asked to score pneumoperitoneum sufficiency (sufficient/insufficient), abdominal distension and surgical view (1-poor to 4-excellent).
Results and Discussion:The insertion time in Group LM-S (13.86±2.88 s) was significantly shorter than the time in Group ETT (21.62±9.0 s).In Group LM-S the oropharyngeal leak pressure (OLP) was 25.60±4.93 cmH2O. The OLP values in Group LM-S did not show significant change when measured during the peroperative period. Ppeak in Group ETT at T1 was found to be high compared to Group LM-S. Ppeak (p=0.041) and Pmean at T4 were found to be high in Group ETT. In terms of the attempt of Veress needle entries, sufficiency of pneumoperitoneum and surgical view quality, there was no significant differences found between the groups. At 1 hour postoperative laryngopharyngeal morbidity was found to be higher in Group ETT.
Conclusion: The results of this study showed that gynecological laparoscopies can be performed without using NBA without limitation the surgeon’s hand movements while maintaining a good surgical view. This study concludes that in special situations where NBA use should be avoided, like muscle diseases, myopathies and neurological disease, SGAD’s can be reliably used in anesthetic management. 
Key Words: laryngeal mask, neuromuscular blocker, laparoscopy, gynecology
References:1-Abdı W,et al.Sparing the larynx during gynecological laparoscopy: a randomized trial comparing the LMA Supreme and the ETT.Acta Anaesthesiol Scand 2010;54: 141–6.

Comparison of laryngeal mask supreme and endotracheal intubation without neuromuscular blockers in laparoscopic gynecological surgery