Dexmedetomidine with propofol versus fentanyl with propofol for insertion of Proseal laryngeal mask airway: A randomized, double-blinded clinical trial

Abstract

Background and Aims:Successful insertion of the proseal laryngeal mask airway (PLMA) requires much greater doses of propofol as compared to classic laryngeal mask (CLMA). Dexmedetomidine and fentanyl are equally effective adjuvants for CLMA insertion. We designed this study to compare the efficacy of these two drugs as sole adjuvant in PLMA insertion.Material and Methods:Seventy four American Society of Anesthesiologists (ASA) I and II patients were randomly allocated to receive either dexmedetomidine 1 μg/kg [Group PD] or fentanyl 1 μg/kg [Group PF]. Study drugs were diluted in 10 ml NS and administered over 10 min prior to induction of anesthesia with 2.5 mg/kg propofol. PLMA insertion condition was measured according to the Muzi scoring system. Score ≤2 was considered optimal for PLMA insertion. Patient's cardio-respiratory parameters, emergence time, and postoperative pain were also recorded.Results:In our study 83.8% patients in the group PF and 91.9% in the group PD achieved optimal insertion condition (not significant). Hemodynamic stability was maintained in both the groups but the incidence of apnea was significantly higher in the PF group (P = 0.011). We also observed that emergence time was prolonged but postoperative pain scores were significantly lower in the PD group (P < 0.001).Conclusion:We conclude that both dexmedetomidine and fentanyl in a dose of 1 μg/kg when used before induction with propofol provide comparable conditions for successful PLMA insertion. Dexmedetomidine has additional advantage of preserving spontaneous respiration and providing better analgesia.

Assessment of Efficacy of Dexmedetomidine and Fentanyl in Combination with Propofol for Ease of Laryngeal Mask Airway Insertion and Haemodynamic Stability

“…But when compared between the groups (Group F & Group D ) it was statistically significant at 30 sec, 1 min, 2min interval after the induction and insertion of LMA (p=0.034). These findings are comparable with the previous studies [16][17][18][19].…”

The anesthesia induction effect of dexmedetomidine in patients undergoing laryngeal mask intubation: a systematic review and meta-analysis of 7 RCTs

“…Effective rate of LMA catheterization Five articles (8,10,11,12,14), comprising a total of 300 patients, reported the effective rate of laryngeal canal.…”

“…Hill et al (19) found that intravenous fentanyl had a stronger effect on respiratory depression than other anesthetic drugs. In this meta-analysis, 3 articles (8,10,11) reported on changes in the respiratory rate of patients 1 min to 15 min after LM catheterization, and all 3 studies used fentanyl sedation in the control group. During anesthesia induction, the respiratory rate of patients in the control group was lower than that of patients in the dexmedetomidine group.…”

“…Three articles (8,10,11) (comprising 206 patients) examined the respiratory rate 5 min after the induction of anesthesia after LMA catheterization. The number of patients included in the dexmedetomidine group and control group was 103 and 103, respectively.…”

“…In the synthetic analysis of the respiratory rate, there was significant heterogeneity among the articles (8,10,11), but after excluding the article ( 8), there was no heterogeneity in the remaining 2 articles. The patients included in the article ( 8) were all undergoing urological surgery, while the other 2 articles did not specify the surgery type, which might be the source of the heterogeneity.…”