Conditions for insertion of the laryngeal mask airway: comparisons between sevoflurane and propofol using fentanyl as a co-induction agent. A pilot study

Background: LMA is an effective alternative to the endotracheal tube for securing the airway in short surgical procedures. Propofol is a widely used anaesthetic agent for the insertion of Laryngeal Mask Airway. Sevoflurane is a volatile anaesthetic agent, which combines rapid, smooth inhalational induction of anaesthesia with rapid recovery, making it ideal for day care anaesthesia. Objective: To study if the use of sevoflurane can be used as an alternative to IV propofol for laryngeal mask airway insertion. Primary objective: Hemodynamic responses during Laryngeal mask insertion. Secondary objective: Intubating conditions during laryngeal mask airway insertion. Study design: A Randomized control trial. Methods: 100 adults were allocated by randomization into two groups of 50 each; group P (Propofol) and group S (Sevoflurane). Patients in group P were induced with 2.5mg/kg intravenous propofol with 50% O 2 & 50% N 2 O and in group S with 8% sevoflurane in 50% O 2 & 50% N 2 O vital capacity breath technique. Laryngeal mask airway was inserted after adequate jaw relaxation was attained and hemodynamic responses like pulse rate, blood pressure were monitored. The grading of conditions for laryngeal mask airway insertion and number of attempts were noted. All the data collected was analysed statistically. Results: We observed that more number of attempts were required for LMA insertion in Group S (14.0%) compared to Group P (0.0%) which is statistically significant with P=0.012. Heart rate at one minute and 2 minutes after LMA insertion showed a fall with Propofol which was statistically significant as compared to Sevoflurane. There is a significant difference of fall in mean arterial blood pressure in group P during induction, one minute, 2 minutes and 5 minutes when compared between the two groups. Sevoflurane took longer time for induction and LMA insertion compared to Propofol which is statistically significant. Moderate patient movement were noticed in 5 patients of group S and no patient movement were noticed in group P and is statistically significant (P-0.022). Quality of insertion with propofol was excellent in all patients. With sevoflurane quality of insertion ranged from excellent to satisfactory. Conclusion: Sevoflurane is associated with good hemodynamic stability but intubating conditions provided with propofol is superior. Prolonged time for jaw relaxation with sevoflurane when compared to propofol may delay laryngeal mask airway insertion. Quality of insertion with propofol was excellent in all patients. With sevoflurane quality of insertion ranged from excellent to satisfactory.

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“…Ganatra SB et al [9] in their study sixty patients were equally and randomly divided into two groups. Both groups received fentanyl 1 microg /kg.…”

Section: Analysis Of Condition For Lma Insertion and Patients Response-mentioning

confidence: 99%

Hemodynamic Responses and intubating conditions in laryngeal mask airway insertion a comparative study of propofol versus sevoflurane

2017

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“…[8] In a study by Ti et al (1999) reported that 127 ± 35 seconds. [9] In a study by Ganatra SB et al (2002) reported that the Mean±SD time taken from induction to successful laryngeal mask insertion was significantly shorter with propofol (68.70 ±22.60 s) compared with sevoflurane (149.83±55.25 s). Excellent or satisfactory conditions were observed in 30 (100%) patients in the propofol group and in 29 (96.66%) in the sevoflurane group.…”

Section: Discussionmentioning

confidence: 99%

“…The propofol-fentanyl combination was more costeffective. [10] Shao G and Zhang G, compared the efficacies of sevoflurane and propofol inductions for laryngeal mask airway (LMA) insertion in elderly patients. Reported that LMA was inserted most, less or least rapidly with propofol (89 ±28 s), sevoflurane 8% using the VCB (163 ± 34 s) or TVB (205 ± 44 s) techniques, respectively.…”

Section: Discussionmentioning

confidence: 99%

A Prospective Study of Single Breath Vital Capacity Inhalation Induction with High Concentration of Sevoflurane (Sbvc-Hc) for LMA Insertion in Adults for Short Surgical Cases

Prabhudev

2020

AAN

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Background: Sevoflurane is a new volatile anesthetic agent with rapid induction and recovery. A randomized study was carried to access conditions for LMA insertion using Sevoflurane in 25 ASA I & II patients undergoing short duration surgeries.Subjects and Methods:This prospective study was conducted at Department of Anesthesiology and Critical Care, SVS Medical College and Hospital, Mahabubnagar, Telangana, India. After obtaining the institutional ethics committee and written informed consent from the patients, 25 subjects of either sex were included in this study. Age of the subjects was 18 to 60 years. Patients received injection Fentanyl 1 – 2mcg/kg prior to induction. All patients were pre-oxygenated for 3 min with 100% oxygen using a fresh gas flow of 81/min. All patients received inhalational induction with 8% Sevoflurane and O2 flow at 8 L/min with single vital capacity breathe technique. Loss of verbal contact was considered as the desired endpoint for induction, which was assessed by the response to calling out the patient’s name. Then the time of loss of eyelash reflex and jaw relaxation was assessed by anesthesiologist. After adequate jaw relaxation, LMA insertion was attempted.Results:The mean loss of verbal contact was 65.40±9.67second, while the mean for time for loss of eyelash reflex and jaw relaxation were found to be 81.20±9.39 seconds and 103.20 ±12.07 seconds respectively. The mean time for LMA insertion was 122.00±15.61 and the mean attempts for successful LMA insertion was 1.12±0.33. LMA insertion was easy in 23 cases as against difficult in 2 cases. In 2 cases transient cough and biting were recorded. LMA insertion was excellent and satisfactory in 88.0 and 12 percent. However, the mean heart rate at 5 minute after induction showed a significant fall at 5 minutes after induction. The mean values of SBP, DBP and MAP did not differ significantly at pre and induction. However, a significant decrease in SBP was noticed at 1, 2 and at 5 minutes.Conclusion:Sevoflurane is an smooth inhalation anesthesia with rapid onset with adequate jaw relaxation for insertion of LMA in Adults for short duration surgeries. Sevoflurane has got good hemodynamic profile with lesser complications owing to choice of inhalation agent for insertion of LMA.

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“…On other hand, sevoflurane is non-pungent inhalational anaesthetic with a low blood gas solubility co-efficient (0.69) and minimal respiratory irritant characteristics that makes it suitable as inhalational agent for induction of anaesthesia and insertion of LMA. 9,10 Therefore, the present study was planned to evaluate and compare the ease of insertion of LMA in children after induction with IV propofol 3 mg/kg over 30 seconds and sevoflurane having dose regimen similar to those used in previous studies. [11][12][13][14][15] The study included 50 patients in each group to obtain the power >80% based on previous study.…”

Section: Discussionmentioning

confidence: 99%

Comparative evaluation of induction with propofol vs induction with sevoflurane for insertion of laryngeal mask airway in children

2019

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Background: There is increasing use of laryngeal mask airway in children because of ease of insertion and minimal disturbances in cardio respiratory system and lesser risk of airway injury during perioperative period as compared to endotracheal tube. It is also simple, well-tolerated, safe, reusable, cost effective method of airway management in paediatric patients. Intravenous propofol (1%) is a preferred induction agent for LMA insertion till date, while sevoflurane, a halogenated volatile inhalational, non-irritating anaesthetist agent with pleasant odour is also suitable for inhalational induction of children. This study was carried out to study and compare clinical efficacy of propofol and sevoflurane for laryngeal mask airway (LMA) insertion in children undergoing short surgical procedures.Methods: In this study, total 100 children of ASA grade I/II of either sex with age group 3-8 years, weighing between 10-20 kg were enrolled. They were induced with either sevoflurane (group S) or intravenous propofol (group P) 3 mg/kg. Then appropriate size LMA was inserted. Various parameters like jaw relaxation and ease of insertion attempts required hemodynamic changes were noted and compared in two groups.Results: In group P, 94% patients and groups S, 90% patients had full jaw relaxation. The LMA insertion was easy in 98% patients in groups P and 94% patients in groups S. In 98% patients of groups P and 96% patients in groups S, LMA was inserted successfully in first attempt. The mean time required for LMA insertion was 19.16±5.29 seconds in groups P and 20.8±6.39 seconds in groups S. Both the groups were comparable with respect to haemodynamic changes observed which were transient and clinically not significant though statically significant.Conclusions: Both the groups showed comparable and satisfactory LMA insertion conditions, hence both can be routinely used for induction of anaesthesia in children.

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Conditions for insertion of the laryngeal mask airway: comparisons between sevoflurane and propofol using fentanyl as a co-induction agent. A pilot study

Cited by 14 publications

References 10 publications

Hemodynamic Responses and intubating conditions in laryngeal mask airway insertion a comparative study of propofol versus sevoflurane

Hemodynamic Responses and intubating conditions in laryngeal mask airway insertion a comparative study of propofol versus sevoflurane

A Prospective Study of Single Breath Vital Capacity Inhalation Induction with High Concentration of Sevoflurane (Sbvc-Hc) for LMA Insertion in Adults for Short Surgical Cases

Comparative evaluation of induction with propofol vs induction with sevoflurane for insertion of laryngeal mask airway in children

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