Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Nov 27, 2015; 7(11): 319-325
Published online Nov 27, 2015. doi: 10.4240/wjgs.v7.i11.319
Role of laryngeal mask airway in laparoscopic cholecystectomy
José M Beleña, Ernesto Josué Ochoa, Mónica Núñez, Carlos Gilsanz, Alfonso Vidal
José M Beleña, Department of Anesthesiology and Critical Care, Sureste University Hospital, 28500 Arganda del Rey, Madrid, Spain
José M Beleña, Ernesto Josué Ochoa, Mónica Núñez, Alfonso Vidal, Department of Anesthesiology and Critical Care, Hospital Sur, Alcorcón, 28929 Madrid, Spain
Mónica Núñez, Department of Anesthesiology and Critical Care, Ramón y Cajal University Hospital, 28034 Madrid, Spain
Carlos Gilsanz, Department of General and Gastrointestinal Surgery, Sureste University Hospital, 28500 Arganda del Rey, Madrid, Spain
Author contributions: Beleña JM performed the majority of the writing and prepared the tables; Ochoa EJ performed part of the writing and data accusation; Núñez M performed part of the writing and language review; Gilsanz C provided the input in writing the paper; Vidal A coordinated the writing of the paper.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors contributed their efforts in this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: José M Beleña, MD, PhD, Assistant Professor, Department of Anesthesiology and Critical Care, Sureste University Hospital, C/Ronda del Sur, 10, 28500 Arganda del Rey, Madrid, Spain.
Telephone: +34-91-8394184 Fax: +34-91-8394378
Received: April 27, 2015
Peer-review started: April 29, 2015
First decision: July 25, 2015
Revised: August 26, 2015
Accepted: September 25, 2015
Article in press: September 28, 2015
Published online: November 27, 2015

Laparoscopic cholecystectomy is one of the most commonly performed surgical procedures and the laryngeal mask airway (LMA) is the most common supraglottic airway device used by the anesthesiologists to manage airway during general anesthesia. Use of LMA has some advantages when compared to endotracheal intubation, such as quick and ease of placement, a lesser requirement for neuromuscular blockade and a lower incidence of postoperative morbididy. However, the use of the LMA in laparoscopy is controversial, based on a concern about increased risk of regurgitation and pulmonary aspiration. The ability of these devices to provide optimal ventilation during laparoscopic procedures has been also questioned. The most important parameter to secure an adequate ventilation and oxygenation for the LMA under pneumoperitoneum condition is its seal pressure of airway. A good sealing pressure, not only state correct patient ventilation, but it reduces the potential risk of aspiration due to the better seal of airway. In addition, the LMAs incorporating a gastric access, permitting a safe anesthesia based on these commented points. We did a literature search to clarify if the use of LMA in preference to intubation provides inadequate ventilation or increase the risk of aspiration in patients undergoing laparoscopic cholecystectomy. We found evidence stating that LMA with drain channel achieves adequate ventilation for these procedures. Limited evidence was found to consider these devices completely safe against aspiration. However, we observed that the incidence of regurgitation and aspiration associated with the use of the LMA in laparoscopic surgery is very low.

Keywords: Laryngeal mask airway, Laryngeal mask airway Proseal, Laryngeal mask airway Supreme, I-gel, Laparoscopic cholecystectomy, Oropharyngeal leak pressure, Ventilation

Core tip: Use of the laryngeal mask airway (LMA) in laparoscopy is controversial, largely because of a concern about increased risk of regurgitation and aspiration, also due to an inadequate or suboptimal ventilation of the patient during these procedures. We performed the first review of this topic and we found evidence to recommend the LMA with gastric access in laparoscopy for selected patients based on its ability for optimal ventilation. A potential risk of aspiration cannot be totally rejected, however, clinical performance using these devices has reported a very low incidence of aspiration-related morbidity, so future research may provide some evidence about this topic.