Comparison of Dexmedetomidine Propofol v I Rus Fentanyl – Propofol for Conditions of Laryngeal Mask Airway Insertion in Elective Surgeries

Abstract

BACKGROUND: Laryngeal Mask Airway (LMA) is a supraglottic airway device, requiring optimal conditions for insertion to minimize the hemodynamic perturbation associated with LMA insertion. The aim of our study is to compare Dexmedetomidine-Propofol (Dp) and Fentanyl-Propofol (Fp) for conditions of LMA insertion in short surgeries under general anesthesia. AIMS AND OBJECTIVES: To compare efficacy of Dexmedetomidine-Propofol and Fentanyl-Propofol for LMA insertion in terms of 1) Ease of insertion, 2) The Hemodynamic responses to LMA insertion. MATERIALS AND METHODS: Ours was a double blinded randomized comparative study having 30 patients in each group, Dp and Fp, where patients received 1µg/kg of dexmedetomidine and fentanyl respectively followed by Propofol 2.5mg/kg as per protocol. The ease of LMA insertion parameters (Jaw relaxation, Coughing or movement during insertion, number of attempts required) and hemodynamic parameters (Mean heart rate, mean Systolic BP, mean Diastolic BP, Respiratory rate, SPO2) were monitored at following time intervals: Baseline, Pre-med, Pre LMA, Post LMA (at insertion), 1 min, 2 mins, 3 mins, 5 mins, 7 mins, 10 mins. Statistical analysis: Statistical analysis was done by using descriptive and inferential statistics using Chi square test, Wilcoxon signed rank test and Mann Whitney U test. The software used in the analysis was SPSS 17.0 version and Graph Pad Prism 5.0 and p< 0.05 is considered as level of significance. RESULTS: Jaw relaxation was statistically better, with less incidence of coughing in dexmedetomidine group. Hemodynamic parameters remained stable in Dexmedetomidine group whereas in fentanyl group a rise in HR and SBP was seen Post LMA insertion which stabilized quickly. Numbers of attempts of LMA insertion were comparable, with SPO2 and ETCO2 values within normal limits. CONCLUSION: Dexmedetomidine gives better insertion conditions and better attenuation of pressor response to LMA insertion compared to fentanyl in the given doses.

Comparative Evaluation of the Effects of Dexmedetomidine-Propofol and Fentanyl-Propofol on Various Parameters During I-Gel Insertion

“…The overall insertion condition, as summarized by Lund and Stovener's modified scheme [5], was comparable in both groups (Tables 2 and 3). Our findings are consistent with the findings of Lande et al [9], who compared Dexmedetomidine and Fentanyl for LMA insertion and found that Dexmedetomidine resulted in an absolutely relaxed jaw in 96.6% of patients.…”

Comparative evaluation of i-gel® insertion conditions using dexmedetomidine-propofol versus fentanyl-propofol - A randomised double-blind study

“…Our findings are in accordance with study by Lande SA et al . [5] who compared dexmedetomidine and fentanyl for LMA insertion and reported 96.6% patients having absolutely relaxed jaw with dexmedetomidine. The superiority of dexmedetomidine over fentanyl in providing better jaw relaxation for insertion of the SGAD has been reported by other studies as well.…”

“…The superiority of dexmedetomidine over fentanyl in providing better jaw relaxation for insertion of the SGAD has been reported by other studies as well. [561012]…”

“…Dexmedetomidine when used as an adjuvant to propofol has shown to provide satisfactory insertion conditions and better attenuation of pressor response during SGAD insertion. [56]…”