Pressure versus volume-controlled ventilation with BASKA mask airway in laparoscopic cholecystectomy: A randomized clinical study

The best ventilation mode that suits with LMAs is still unclear. In this study, we investigated the ventilatory performance of Baska masks in patients who underwent elective laparoscopic cholecystectomy under general anaesthesia and pneumoperitoneum with either volume-controlled ventilation (VCV) or pressure-controlled ventilation (PCV) mode. Fifty-Six patients with ASA I – II, who underwent laparoscopic cholecystectomy, were randomly classified into VCV (n = 28) and PCV (n = 28) groups. The lung was ventilated with a tidal volume of 8 ml/kg in the VCV group. It was ventilated initially using an inflating pressure that delivered a tidal volume of 8 ml/kg with a maximum of 35 cmH2O in the PCV group. The primary outcome was the intraoperative oropharyngeal leak pressure (OLP) of the Baska mask. Secondary outcomes were intraoperative lung mechanics, arterial carbon dioxide levels, and perioperative adverse effects. After pneumoperitoneum inflation, the OLP, peak inflation pressure (PIP), mean pressure (Pmean), PaCO2, and end-tidal CO2 significantly increased, and the calculated dynamic compliance significantly decreased in both ventilation modes. All variables partially returned to baseline after pneumoperitoneum deflation. Patients ventilated with PCV mode demonstrated significantly lower PIP and PaCO2 levels but higher dynamic compliance with statistically comparable OLP-PIP difference and higher leak fraction. In this study, Patients ventilated with PCV mode showed lower PIP and PaCO2 but higher dynamic compliance, and higher leak fraction. However, both modes investigated provided effective Baska mask ventilation and maintained the OLP throughout the procedure with a statistically comparable OLP-PIP difference.

目前适配喉罩气道（Laryngeal Mask Airways, LMAs）的最优通气模式仍未明确。本研究针对全身麻醉联合气腹下接受择期腹腔镜胆囊切除术的患者，对比了容量控制通气（Volume-Controlled Ventilation, VCV）与压力控制通气（Pressure-Controlled Ventilation, PCV）模式下巴斯卡面罩（Baska mask）的通气效能。本研究纳入56例美国麻醉医师协会（American Society of Anesthesiologists, ASA）分级I~II级的择期腹腔镜胆囊切除术患者，采用随机分组法分为VCV组（n=28）与PCV组（n=28）。VCV组设置潮气量为8ml/kg实施肺通气；PCV组初始采用可产生8ml/kg潮气量的充气压力，且最高充气压力不超过35cmH₂O。本研究的主要结局指标为巴斯卡面罩的术中口咽部漏气压力（Oropharyngeal Leak Pressure, OLP）；次要结局指标包括术中肺力学参数、动脉二氧化碳水平及围手术期不良事件。气腹建立后，两种通气模式下的OLP、气道峰压（Peak Inflation Pressure, PIP）、平均气道压（Mean Pressure, Pmean）、动脉血二氧化碳分压（Partial Pressure of Carbon Dioxide in Arterial Blood, PaCO₂）及呼气末二氧化碳（End-Tidal CO₂）均显著升高，而计算所得的动态肺顺应性则显著下降。气腹解除后，上述各项指标均部分恢复至基线水平。采用PCV模式通气的患者，其气道峰压与动脉血二氧化碳分压水平显著更低，动态肺顺应性更高；两组OLP与PIP的差值无统计学差异，但PCV组的漏气分数更高。本研究结果显示，PCV组患者气道峰压、PaCO₂水平更低，动态肺顺应性更高，漏气分数亦更高；但两种通气模式均可有效实现巴斯卡面罩通气，且在整个手术过程中均可维持OLP，两组OLP与PIP的差值无统计学差异。