Use of the laryngeal mask is not contraindicated for laparoscopic cholecystectomy
Notice bibliographique
Résumé
We question the premises on which Asai bases his opinion that use of the laryngeal mask airway is contraindicated during laparoscopic cholecystectomy (Asai. Anaesthesia 2001; 56: 187). His opinion that tracheal intubation is mandatory for laparoscopic surgery, or that the laryngeal mask airway is contraindicated, could equally be applied to gynaecological laparoscopy. The popularity of the laryngeal mask airway in gynaecological laparoscopy, despite the head-down position that might be expected to facilitate passive regurgitation, stands in sharp contrast to the rarity of reported pulmonary aspiration [1, 2]. This suggests that the danger is more apparent than real. Asai quoted one case report from 10 years ago to justify his concern of ‘high risk’ of pulmonary aspiration [3]. No large-scale randomised study has compared the incidence of clinically significant pulmonary aspiration between tracheal intubation and laryngeal mask, but the incidence appears to be similar (1 in 5–10 000) in the general population of healthy patients undergoing elective surgery [1, 4, 5]. Pulmonary aspiration has not been reported in studies that compare efficacy and safety of these methods of airway management for laparoscopic cholecystectomy [6, 7]. Active vomiting under inadequate depth of anaesthesia can force gastric contents past and into the laryngeal mask airway to reach the pharynx and lungs. However, passive regurgitation occurs at baseline intragastric pressure of 9–15 mmHg [8], which is less than the pressure needed to bypass a correctly placed laryngeal mask airway [9]. Distension of the abdomen by gas insufflation does not increase the risk of regurgitation unless the patient has an incompetent lower oesophageal sphincter. Rather, it causes a reflex increase in the tone and therefore the barrier pressure of the lower oesophageal sphincter [10]. Cholangiogram dye is emetogenic and, unless gastric suction is used following intra-operative cholangiography, ‘regurgitation’ (active vomiting) of bile-stained gastric fluid is common during emergence from anaesthesia when anaesthesia is light. We have not seen vomiting during the surgical procedure for which we maintain anaesthesia at 1.0–1.5 MAC. Georgiou's concern in his case report [11] about inflation of the stomach is relevant if the laryngeal mask airway is not the correct size, or if it is incorrectly positioned and causes airway obstruction. We found that gastric distension was not a problem when we used the laryngeal mask airway for airway management with positive pressure ventilation during laparoscopic cholecystectomy [7]. We randomised 104 healthy, non-obese patients with no history of gastro-oesophageal reflux to tracheal intubation or laryngeal mask airway. The surgeons, who were blinded to the airway device, scored the size of the stomach 0–10 at entry of the laparoscope and before its removal at the end of surgery. The degree of change in stomach size was similar in both groups, and the surgeon only requested deflation of the stomach in one patient – in the intubation group!
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».