Ventilatory performance of BASKA mask as an alternative to endotracheal intubation in short-term gynecologic laparoscopic procedures: a prospective randomized clinical trial.

BACKGROUND

Using laryngeal mask airways (LMAs) in laparoscopic surgery is still controversial because of the risk of insufficient ventilation and gastric overinflation. We investigated the use of BASKA LMA as an alternative to endotracheal intubation in low-risk females undergoing short-term gynecologic laparoscopic surgeries in Trendelenburg position under general anesthesia and positive pressure ventilation.

METHODS

Sixty-five females (19-43 years), ASA (I-II) were scheduled to receive endotracheal tube (ETT group, N.=32) or BASKA mask (BASKA group, N.=33) for airway management. Assessments included insertion time and score, intraoperative lung mechanics, oropharyngeal leak pressure (OLP), ventilatory score, leak fraction, perioperative lung spirometry, and adverse effects. Timepoints were after device insertion, pneumoperitoneum inflation, Trendelenburg position, at 15, 30, 45 minutes intraoperatively and at end of surgery.

RESULTS

The median insertion time was shorter in BASKA group (21.0 [18-38] s), compared with ETT group (27.0 [24-33] s, P=0.000). First-time success rate for insertion of BASKA mask was 87.9% (29 patients). The peak inflation pressure, calculated dynamic compliance, ventilatory score and lung spirometry data showed no significant difference between the two groups. The median leak fraction was higher in BASKA group after insertion (P=0.012) and after Trendelenburg position (P=0.032), with no significant differences afterwards. The median OLP after insertion was 32.0 (29-35) cmH2O which decreased after pneumoperitoneum inflation (31.0 [27-33] cmH2O, P=0.000), and after Trendelenburg position (30.0 [27-32] cmH2O, P=0.000) and remained stable at this range.

CONCLUSIONS

BASKA mask can be considered as a safe alternative to ETT with comparable ventilatory performance in low-risk females undergoing short-term gynecologic laparoscopic surgeries.