Effects of Peak Inspiratory Pressure-Guided Setting of Intracuff Pressure for Laryngeal Mask Airway Supreme (TM) Use during Laparoscopic Cholecystectomy: A Randomized Controlled Trial

Purpose: To determine the effects of peak inspiratory pressure (PIP)-guided intracuff pressure (ICP) modulation of laryngeal mask airway (LMA) Supreme (TM) during laparoscopic cholecystectomy. Methods: Totally 120 patients were randomly divided using computer-generated numbers into a control group (n = 60; ICP, 60 cmH(2)O) and a PIP group (n = 60), in which ICP was increased with 5 cmH(2)O each time from PIP level until no air leaks from the oropharynx. PIP, ICP, cuff volume (CV), oropharyngeal leak pressure (OLP) and leak fraction (LF) were recorded before and after pneumoperitoneum establishment. Postoperative pharyngolaryngeal complications (sore throat, dysphagia, pharyngeal hematoma, and dysphonia) were also recorded. Results: Demographic data were similar in the two groups. The CV and ICP before and after pneumoperitoneum were significantly lower in the PIP group (CV: 15.6 +/- 2.3 mL and 21.0 +/- 2.6 mL; ICP: 14.3 +/- 2.9 cmH(2)O and 20.5 +/- 3.4 cmH(2)O) than in the control group (CV: 33.0 +/- 2.8 mL and 32.8 +/- 1.9 mL; ICP: 60.0 +/- 0.1 cmH(2)O and 60.0 +/- 0.1 cmH(2)O) (P < 0.05). Although OLP was lower in the PIP group (P < 0.05), the LF was similar in the two groups (P > 0.05). There were fewer postoperative pharyngolaryngeal complications in the PIP group (P < 0.05). Conclusions: Compared with a fixed ICP of 60 cmH(2)O, PIP-guided ICP modulation during LMA Supreme (TM) use provided effective airway sealing at a lower CV and ICP, and produced fewer postoperative pharyngolaryngeal complications in patients undergoing laparoscopic cholecystectomy.