A comparison of the effect of two anaesthetic techniques on surgical conditions during gynaecological laparoscopy

TLDR

In a prospective, randomized controlled trial of 40 women undergoing day‑case gynaecological laparoscopy, patients were assigned to either spontaneous breathing via a laryngeal mask airway or neuromuscular blockade with tracheal intubation, and surgical conditions—including needle insertion attempts, intra‑abdominal pressure dynamics, pneumoperitoneum adequacy, operative view, and operative duration—were measured. The laryngeal mask airway group achieved higher initial intra‑abdominal pressure and shorter operation times, whereas the neuromuscular‑blocking group had superior pneumoperitoneum adequacy, indicating that spontaneous breathing reduces operative duration but alters abdominal pressure patterns that must be considered for surgical safety.

Abstract

Summary In a prospective, randomised, controlled trial, we compared the effects of two anaesthetic techniques on surgical conditions during day‐case, gynaecological laparoscopic procedures in 40 female patients. Patients were allocated randomly to two groups, either to breathe spontaneously through a laryngeal mask airway or to receive a neuromuscular‐blocking agent (NMB) and have the lungs ventilated via a tracheal tube. We then measured the number of attempts of Verres' needle insertion, initial intra‐abdominal pressure, time to reach a steady 15 mmHg (1.97 kPa) of intra‐abdominal pressure, adequacy of the pneumoperitoneum, operative view and duration of operation. We found that the initial intra‐abdominal pressure was higher and the operation time shorter in the laryngeal mask group. The adequacy of the pneumoperitoneum for trocar placement was better in the NMB group. We conclude that the anaesthetic technique of spontaneously breathing through a laryngeal mask airway reduces total operation time. However surgeons should be aware of the different abdominal pressure patterns produced by each anaesthetic technique, and anaesthetists must consider the implications of the anaesthetic technique on surgical safety.