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

Ganatra, Sameer; D'Mello, J.; Butani, Manju; Jhamnani, P.

doi:10.1017/s0265021502000601

Cited by 15 publications

(12 citation statements)

References 11 publications

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“…9 Ganatra SB et al and Rajiv Dwiwedi et al in their study found similar results and was comparable with present study. 10,11 Significant fall in MAP was noted in propofol group at baseline, 1 minute, 2 minutes, and 5 minutes after induction. Pulse rates were comparable in both groups in this study.…”

Section: Discussionmentioning

confidence: 94%

A comparative study of propofol and N2O versus sevoflurane and N2O with respect to haemodynamic response and ease of laryngeal mask airway insertion: a prospective randomized double blinded study

et al. 2016

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INTRODUCTIONToday, the LMA has a clearly established role as an airway device in elective setting when tracheal intubation is difficult or does not required like day care anaesthesia. It is a simple, well tolerated, safe, reusable, cost effective method for airway management. It ensures a better control of airway than the facemask, laryngoscopy is avoided and haemodynamic changes are minimized during insertion.1 It avoids the disadvantages of endotracheal tube like pressure response during intubation and sore throat, croup, hoarseness postoperatively. LMA has also been included in ASA difficult airway algorithm. Satisfactory insertion of the Laryngeal Mask Airway requires sufficient depth of anaesthesia to provide loss of consciousness, jaw relaxation, absence of upper airway reflexes rapidly without cardio respiratory compromise. 2Propofol with or without opioid is the induction agent of choice for laryngeal mask airway insertion having rapid induction and upper airway reflexes depressing properties but pain on injection and cardiovascular depression are the major limiting factors. Sevoflurane, a halogenated, volatile anaesthetic agent with pleasant odour and low blood: gas solubility allows a fast, smooth induction and ABSTRACT Background: Laryngeal mask airway (LMA) is an accepted airway device for spontaneous and modest positive pressure ventilation. Propofol is widely used Induction agent. Sevoflurane is a newer pleasant volatile anaesthetic with rapid induction and recovery with stable haemodynamics. The aim of this study was to compare propofol and sevoflurane with respect of haemodynamic changes and conditions for LMA insertion. Methods: This study was done on 60 female patients of ASA I, II grade between 20-60 years of age. Patients were randomized into two groups (n=30). All patients were preoxygenated and received inj. fentanyl 2µg/kg. Induction agent was propofol 2.5mg/kg (group P) or sevoflurane 8% with vital capacity breath (group S). Loss of eyelash reflex was the end point of induction. Induction time, conditions for LMA insertion, number of attempts, time of successful LMA insertion and haemodynamic parameters were noted. Results: time for induction and LMA insertion was significantly faster in propofol group than group S (p<0.05). Successful LMA insertion in first attempt was 100% in group P with excellent conditions (score 18) while in group S, it was 86.7% with excellent to satisfactory conditions (score 16-17). A significant fall in mean arterial pressure (p<0.05) was noted in group P while pulse rates were comparable in both groups. Conclusions: Sevoflurane vital capacity breath inhalational induction can be used as an effective alternative to propofol though it requires greater time for LMA insertion but with better haemodynamic stability.

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Section: Discussionmentioning

confidence: 94%

A comparative study of propofol and N2O versus sevoflurane and N2O with respect to haemodynamic response and ease of laryngeal mask airway insertion: a prospective randomized double blinded study

et al. 2016

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“…Ganatra et al 6 The intravenous low-dose Fentanyl-Midazolam combination seems to have dampened the haemodynamic response to LMA insertion. Pulse rate, systolic blood pressure and diastolic blood pressure revealed lower values in the group AII and BII, which were statistically significant when compared to group AI and BI respectively (p<0.001).…”

Section: Discussionmentioning

confidence: 99%

To Evaluate the Effect of Low Dose Fentanyl-Midazolam Combination on Sevoflurane/Propofol Induction in Adult Using Laryngeal Mask Airway: A Comparative Study

Pareek¹,

Bhataia²,

Jain³

2016

jemds

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“…Previous studies have shown that this time interval averaged around 135 sec with a SD of 40 sec. 3,4 We decided that a difference of 30 sec in insertion time would be deemed clinically significant. Sample size calculation, accepting alpha and beta errors of 0.05 and 0.2, respectively, suggested that 35 patients per group would be required.…”

Section: Methodsmentioning

confidence: 99%

“…Inhaled induction allows for maintenance of spontaneous ventilation, 1,2 which, in some patients, can facilitate airway management and help to preserve hemodynamic stability. 3 Despite such advantages, IIAS is generally lengthier than intravenous induction and can be less satisfactory for patients. [1][2][3][4] Several authors have studied the effect of adding a small dose of either a benzodiazepine or an opioid during IIAS and found that the pre-induction administration of sedative-hypnotics can accelerate induction, facilitate airway management, and increase patient satisfaction.…”

Section: Résumémentioning

confidence: 99%

“…3 Despite such advantages, IIAS is generally lengthier than intravenous induction and can be less satisfactory for patients. [1][2][3][4] Several authors have studied the effect of adding a small dose of either a benzodiazepine or an opioid during IIAS and found that the pre-induction administration of sedative-hypnotics can accelerate induction, facilitate airway management, and increase patient satisfaction. [5][6][7] The possible drawbacks of intravenous premedication include respiratory depression and episodes of apnea, thus decreasing speed of induction.…”

Section: Résumémentioning

confidence: 99%

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Low-dose fentanyl-midazolam combination improves sevoflurane induction in adults

Lesage

Drolet

Donati

et al. 2009

Can J Anesth/J Can Anesth

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Purpose We investigated the effects of a combination of low-dose fentanyl-midazolam premedication on the speed of inhaled induction with sevoflurane and ProSeal TM laryngeal mask airway (PLMA) insertion conditions. Methods Eighty adult patients undergoing elective surgery were randomized in a double-blind fashion to receive either a normal saline placebo (Group PLAC) or a fentanyl 0.6 lg Á kg -1 and midazolam 9 lg Á kg -1 premedication (Group FM) 5 min before tidal volume sevoflurane 8%/O 2 induction. Anxiety levels, times to loss of eyelash reflex (LER) and PLMA insertion, and cardiorespiratory data were recorded. Results Times to LER (Group PLAC: 66 ± 34 sec vs Group FM: 47 ± 18 sec, P = 0.0027, difference = 19 sec: 95% confidence interval [CI] 7-31 sec) and to PLMA insertion (Group PLAC: 186 ± 80 sec vs Group FM: 119 ± 44 sec, P \ 0.0001, difference = 68 sec: 95% CI 39-97 sec) were shorter following FM. After PLMA insertion, end-tidal sevoflurane concentration (EtSevo) was lower and end-tidal CO 2 (EtCO 2 ) was higher following FM. Respiratory rate (RR) was lower with FM, but there was no difference regarding tidal volume. Adverse events, such as movements and apnea, occurred more often in Group PLAC. Systolic blood pressure (SBP) and heart rate (HR) during induction were both lower with FM. Anxiety level after premedication was lower following FM administration. All participants remembered the face mask being applied in Group PLAC vs 69% in Group FM, P \ 0.0001. Conclusion Administration of a low-dose fentanylmidazolam combination prior to sevoflurane induction decreases time to LER and allows for more rapid and less eventful PLMA insertion. Both SBP and HR were lower when premedication was administered. Patients receiving premedication were less anxious and less likely to remember the face mask. However, premedication was associated with a lower RR and increased EtCO 2 values following PLMA insertion, in spite of lower EtSevo concentrations. (ClinicalTrials.gov ID NCT00723164). RésuméObjectif Nous avons examine´les effets d'une combinaison de fentanyl -midazolam a`faible dose en pre´me´dication sur la vitesse d'une induction par inhalation de se´voflurane et sur les conditions d'insertion du masque larynge´Pro-Seal TM (PLMA). Méthode Quatre-vingts patients adultes subissant une chirurgie non urgente ont e´te´randomise´s en double aveugle a`recevoir soit un placebo de solution sale´e (groupe PLAC) ou une pre´me´dication compose´e de fentanyl 0,6 lgÁkg -1 et midazolam 9 lgÁkg -1 (groupe FM) cinq minutes avant l'induction avec du se´voflurane 8 %/O 2 av olume courant. Les niveaux d'anxie´te´, le temps jusqu'a`la perte du re´flexe ciliaire (PRC) et l'insertion du PLMA ainsi que les donne´es cardiorespiratoires ont e´te´enregistre´es. Résultats Les temps jusqu'a`PRC (groupe PLAC : 66 ± 34 secondes vs groupe FM : 47 ± 18 secondes, P = 0,0027, diffe´rence = 19 secondes : intervalle de confiance [IC] 95 % 7-31 secondes) et jusqu'a`insertion du PLMA (groupe PLAC : 186 ± 80 secondes vs groupe FM : 119 ± 44 s...

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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

Abstract: Although there was a faster induction with propofol-fentanyl, conditions for insertion of the laryngeal mask airway were similar in both groups. Haemodynamic stability was better with sevoflurane-fentanyl. The propofol-fentanyl combination was more cost-effective.

Cited by 15 publications

References 11 publications

A comparative study of propofol and N2O versus sevoflurane and N2O with respect to haemodynamic response and ease of laryngeal mask airway insertion: a prospective randomized double blinded study

A comparative study of propofol and N2O versus sevoflurane and N2O with respect to haemodynamic response and ease of laryngeal mask airway insertion: a prospective randomized double blinded study

To Evaluate the Effect of Low Dose Fentanyl-Midazolam Combination on Sevoflurane/Propofol Induction in Adult Using Laryngeal Mask Airway: A Comparative Study

Low-dose fentanyl-midazolam combination improves sevoflurane induction in adults

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