Prostatic Neoplasms, Urinary Bladder Neoplasms
Conditions
Keywords
elderly, lithotomy position, PEEP, laryngeal mask airway
Brief summary
The purpose of the present study is to compare the effect of PEEP on arterial oxygen partial pressure in elderly patients undergoing urologic surgery using LMA supreme™ in a lithotomy position.
Detailed description
Positive end-expiratory pressure (PEEP) during general anesthesia with mechanical ventilation is routinely used as a standard lung protective strategy to prevent postoperative pulmonary complications including atelectasis. In urologic surgery, elderly patients are common. Since aging decreases the elasticity of lung tissues and allowing the collapse of small airways, old age is a risk factor for postoperative atelectasis. Lithotomy position is the preferred position in urologic surgery. However, it causes the abdominal viscera to displace the diaphragm cephalad, reducing lung compliance and resulting atelectasis. Therefore, in elderly patients undergoing urologic surgery with lithotomy position, PEEP may be essential to prevent postoperative atelectasis. Laryngeal mask airway (LMA) has been widely used in urologic surgery with lithotomy position because of short surgical time and no necessity of administration of muscle relaxant. However, application of PEEP when using LMA is still controversy. Therefore, in the present study, we aimed to compare the effect of PEEP on arterial oxygen partial pressure in elderly patients undergoing urologic surgery using LMA supreme™ in a lithotomy position.
Interventions
OTHERPEEP
After LMA Supreme™ insertion, it's proper position is confirmed. Then, PEEP of 7 cmH2O is applied during mechanical ventilation.
Sponsors
Asan Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
65 Years to 79 Years
Healthy volunteers
No
Inclusion criteria
* Patients undergoing urologic surgery with lithotomy position under general anesthesia * Elderly patients (65 ≤ Age \< 80) * American Society of Anesthesiologists (ASA) physical status: 1-3 * Patients who voluntarily agreed to participate in this clinical study
Exclusion criteria
* Heart failure (ejection fraction ≤ 40%) * Hemodynamic instability during perioperative period * Lung diseases (chronic obstructive pulmonary disease, asthma, bullae, pleural effusion) * Obesity (BMI ≥ 30 kg/m2) * Neck or upper respiratory tract pathologies * An increased risk of pulmonary aspiration * Anticipation of the difficult laryngeal mask fixation due to poor dentition
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The difference of arterial oxygen partial pressure (PaO2) between group P and group Z | 1 hour after LMA insertion | The difference of arterial oxygen partial pressure (PaO2) between group P and group Z 1 hour after LMA insertion by arterial blood gas analysis |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative pulmonary complications | Up to seven days | Postoperative pulmonary complications include atelectasis, pneumothorax, bronchospasm, pneumonia, pulmonary edema, pleural effusion, respiratory failure |
| Complications associated with LMA | 1 hour after end of surgery | Complications associated with LMA include oropharyngolaryngeal injury and sore throat. |
| Incidence of significant leak of LMA | At 5, 30, 60 mins after LMA insertion | Significant leak of LMA means that leak friction is more than 0.2. |
Countries
South Korea
Outcome results
None listed