Background:Management of airway is of great importance in the practice of anesthesia. Supraglottic airway devices, such as laryngeal mask airway (LMA), have greatly revolutionized the management of airway both in terms of ease and degree of invasiveness. Propofol, by its inherent property of decreasing airway reflexes, is used to aid in LMA insertion. In this study, we have evaluated the LMA insertion conditions and hemodynamic stability, comparing butorphanol, fentanyl, and ketamine as co-induction agents with propofol.Materials and Methods:A total of 90 female patients planned to undergo minor gynecological procedures were randomly allocated to one of the three study groups. Patients in Group B received butorphanol 20 μg/kg, patients in Group F received fentanyl 1 μg/kg, and patients in Group K received ketamine 0.5 mg/kg intravenously before injection of propofol 2.5 mg/kg. LMA insertion conditions were graded according to the modified scheme of Lund and Stovner, and hemodynamic parameters were recorded. The results were analyzed statistically.Results:The patients in all the three groups were comparable in their demographic characteristics. The mean total dose of propofol used in Group B was 136.50 mg (standard deviation [SD] 27.70), in Group F was 139.33 mg (SD 28.52), and in Group K was 156.33 mg (SD 38.64). Excellent insertion conditions were observed in 25 (83.3%) patients in Group B, 25 (83.3%) patients in Group F, and 15 (50%) patients in Group K. Group B and Group K showed a more stable hemodynamic profile than Group F.Conclusion:It is concluded that the use of butorphanol as a co-induction agent with propofol provides excellent insertion conditions and stable hemodynamics compared to fentanyl or ketamine.

BACKGROUND Safety margin of various local anaesthetics have been analysed in the context of toxicity. Many studies have shown that Levobupivacaine has a higher safety profile, but there have been very few studies demonstrating an overwhelming benefit of Levobupivacaine over racemic Bupivacaine for paediatric regional anaesthesia. MATERIALS AND METHODSA randomised, double-blinded study was aimed to determine the presence of clinically significant differences in the analgesic efficacy and motor blockade of Levobupivacaine and Bupivacaine for caudal block under propofol based anaesthesia in children. After obtaining Ethical Committee approval and informed written parental consent, sixty children 2 -12 years of either sex belonging to ASA PS I -II, undergoing elective subumbilical surgeries were equally randomised and received 1 mL/kg, 0.25% of either Levobupivacaine (Group L) or Bupivacaine (Group B) caudally. Intraoperatively, onset of analgesia and haemodynamic variability were noted. Caudal block was assessed using FLACC pain score (0-10), time for first rescue analgesia and motor blockade with Modified Bromage score (0 -3). Statistical analysis was done with SPSS version 16.0. The independent 't' test, chi-square or Fisher's exact test were used to analyse the variables. Significance was defined as 'p' value was < 0.05. RESULTSOnset of analgesia was 21.68 ± 1.28 minutes in Group B and 26.12 ± 1.48 minutes in Group L, showing statistical significance (p value= 0.01). BP (systolic and diastolic) was significantly lower in Group B at 25, 30, 45 and 60 minutes. FLACC pain score at recovery was < 3 in both groups. Time for first rescue analgesia was 313.20 ± 63.10 minutes in Group B and 345.60 ± 73.55 minutes in Group L (p value > 0.05). Motor blockade at 120 minutes showed that complete recovery (score 0) was 36% higher in Group L than Group B (p value-0.02).