Intravenous fentanyl vs. topical lignocaine for ProSeal™ laryngeal mask airway insertion with propofol induction

Abstract

Insertion of the laryngeal mask airway (LMA) without muscle relaxant requires adequate obtundation of airway reflexes, which may otherwise lead to incorrect or failed LMA placement. This study compared topical lignocaine spray vs. intravenous (IV) fentanyl, during propofol induction for insertion of the ProSeal™ LMA (PLMA). This was a prospective, randomized, double blind study, in ASA I or II patients, for elective or emergency surgery. Seventy patients (n = 70) who fulfilled the inclusion criteria were randomly assigned to receive IV fentanyl 2 mcg/kg or topical lignocaine spray 40 mg, prior to anesthesia induction with IV propofol (2–2.5 mg/kg). ProSeal™ LMA insertion condition was regarded optimal in the absence of adverse responses (gag, cough, laryngospasm and body movements), and successful LMA placement at the first attempt. Hemodynamic parameters were recorded and patients were assessed for sore throat and hoarseness post operatively. Seventy patients were analyzed. The number of patients with optimal PLMA insertion conditions were comparable between the groups (60% vs. 57%, P = 0.808). All hemodynamic parameters were comparable between groups with the exception of heart rate. Sympathetic obtundation of heart rate was greater with IV fentanyl than topical lignocaine (P < 0.05). The proportion of patients with postoperative sore throat significantly increased with the number of insertion attempts (P < 0.05). Topical lignocaine spray to the pharynx is as effective, and may be an alternative to IV fentanyl, during propofol induction for PLMA insertion. Success rate and optimal insertion condition at the first attempt, propofol requirement, blood pressure, adverse events and airway complications were comparable. Heart rate obtundation was less with topical lignocaine spray but remained within clinically acceptable values.

Effective dose of propofol combined with intravenous esketamine for smooth flexible laryngeal mask airway insertion in two distinct age groups of preschool children

“…Based on previous studies [ 21 , 22 ], smooth insertion of FLMA was defined as follows: the FLMA was easily inserted without significant resistance; there was no physical movement, coughing, swallowing, breath holding, apnea, and laryngospasm; there was stable spontaneous breathing at 1 min after connecting the anesthesia machine; and the fluctuation of HR and MAP during and at 1 min after FLMA insertion was less than 20% of those before insertion. Otherwise, it was considered an unsmooth FLMA insertion.…”

Comparison of remimazolam tosylate and propofol in patients undergoing general anesthesia using a laryngeal mask airway without muscle relaxants

“…The Laryngeal mask airway (LMA) is a widely used supraglottic airway device in general anesthesia, eliminating the need for vocal cord visualization and reducing airway stimulation, making muscle relaxants unnecessary for LMA anesthesia [1]. This approach minimizes the risk of anaphylaxis and residual effects associated with muscle relaxants, particularly in shortduration surgeries [2].…”

“…Propofol is a commonly used intravenous anesthetic with rapid onset and offset, frequently employed for anesthesia induction and tracheal intubation. Propofol can also reduce muscle power during deep anesthesia [3], leading to its use in combination with opioids for LMA insertion during anesthesia induction without muscle relaxants [1]. However, propofol is known to cause issues such as hypotension and injection pain, which can be concerning for anesthesiologists.…”

Commentary: Intravenous fentanyl vs. topical lignocaine for ProSeal™ laryngeal mask airway insertion with propofol induction

“…In a recent randomized, controlled, double-blind cohort study, Rahmat Ameen Noorazyze et al ( 1 ) discovered that topical spraying of lignocaine was more effective than intravenous fentanyl in inserting the ProSeal™ laryngeal mask airway (PLMA). Aside from the shortcomings mentioned in the article, the authors must clarify several methodological issues.…”