Introduction
Laparoscopic cholecystectomy is widely performed as a day case. Although Laryngeal Mask Airway(LMA) is common in day surgery, concerns exist regarding the potential for increased reflux of gastric contents and bile during gall bladder surgery. Our goal was to explore the safety and efficacy of using LMA in these surgeries including obese patients with BMI>30.
Methods-A Retrospective, non-randomised observational study using EPR data from Barnet and Chase Farm Hospital for 6 months in 2023-24.
Inclusion: All ASA 1 to 3 patients posted for Elective Laparoscopic Cholecystectomy.
Exclusion criteria:
Patients with limited mouth opening, oropharyngeal pathology, or at risk of aspiration (non-fasted, severe gastroesophageal reflux disease, or hiatus hernia) were excluded. Data recorded included LMA type, intraoperative adverse events (regurgitation, desaturation), peak airway pressure, and immediate postoperative airway complications in recovery.
Results:
A total of 82 patients underwent laparoscopic cholecystectomy with LMA (I-Gel, LMA Supreme, ProSeal LMA). No intra-operative complications were observed in any cases. The mean airway pressure was 20.7 (ranging from 16 to 37). One patient experienced desaturation post-operatively attributed to opioids, and one patient had stridor diagnosed as a panic attack. Twelve patients (14.4%) were monitored overnight as level 1 in the ward due to their comorbidities. No patient required HDU or ITU care.
Conclusions:
Despite high BMI and ASA 3 status, all patients performed well with LMA. No Level 2 care was required, reducing financial impact. While most cases met day case discharge criteria, twelve patients were monitored in the ward due to comorbidities for safety.
Authors
Vivek Kumar
Royal free London NHS trust, London, United Kingdom
Muthiah Balasubramanian
Royal free London NHS trust, London, United Kingdom
Amalia Priovolou
Royal free London NHS trust, London, United Kingdom