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.

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Sheehan's syndrome is postpartum hypopituitarism caused by necrosis of the pituitary gland due to severe hypotension or shock caused by massive hemorrhage during or after delivery. Patients with Sheehan's syndrome have varying degrees of pituitary hormone deficiency. There is increased sensitivity to barbiturates and opiates in patients with Sheehan's syndrome. They are more prone to hypotension, hypoxia, and hypothermia which must be addressed intraoperatively. Herein, we report successful anesthetic management of a patient with Sheehan's syndrome with distal third femoral shaft fracture for fixation who had numerous hormonal and electrolyte abnormalities. This case report emphasizes the importance of meticulous preanesthetic assessment, optimization, and perioperative management of patients with Sheehan's syndrome for successful management of the case.

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