DISPOSABLE VERSUS REUSABLE LARYNGEAL TUBE SUCTION FOR VENTILATION IN PATIENTS UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY Disposable Versus Reusable Laryngeal Tube Suction for Ventilation in Patients Undergoing Laparoscopic Cholecystectomy

The laryngeal tube suction II (LTS-II; VBM, Medizintechnik GmbH, Sulz, Germany) is a recent version of the laryngeal tube (LT) family of supraglottic airway devices originally intended for emergency airway management including out of hospital use 1,2 and unexpected difficult airway situations 3,4, but which are currently also used during general anaesthesia 5-11. The original LT consists of an airway tube made of silicone and two cuffs. The distal and proximal cuffs block the oesophageal inlet and the pharyngeal space above the larynx, respectively, while the holes in the shaft between the cuffs allow ventilation. The laryngeal tube suction (LTS) introduced in 2002, is the dual-lumen version of the LT. The LTS has an oesophageal drainage tube that isolates the respiratory and alimentary tracts and allows passage of a gastric tube into the oesophagus 12,13. In 2004 the LTS was modified into the LTS-II 7,14. The major modifications include 1) a longer shaft 2) a more pointed tip, and 3) an oval shaped distal cuff to better fit the oesophageal inlet. Two types of LTS-II were introduced to clinical use, disposable and reusable type (Figure 1). Disposable type (LTS-D) is made from latex free PVC material only for single use but reusable type (LTS-II) is made from latex free silicone material for frequent use (up to 50 times) after cleaning and sterilization by autoclave (according to the manufacturer’s instructions). Given increasing safety concerns about the inability to adequately clean the reusable airway devices and the potential for cross contamination by these devices 15, disposable equipment is being used increasingly. The present investigation compared the performance of the two types of LTS-II (disposable and reusable type) in a randomized controlled study. Primary outcome was success rate in maintaining the airway with acceptable oxygenation and ventilation under conditions with elevated intra-abdominal pressure induced by capnoperitoneum. Secondary outcomes were airway seal pressure, insertion time, fiberoptic view and postoperative airway morbidity.