Low-dose succinylcholine to facilitate laryngeal mask airway insertion: A comparison of two doses

Abstract

Background and Aims:Around the world, the use of the laryngeal mask airway (LMA) is becoming more common for different surgeries accounting for it being the dominant choice of airway in numerous surgeries. Although propofol is known to blunt the laryngeal reflexes often patient movement, coughing, and gagging occur on insertion. This study aims to identify the optimum dose of succinylcholine required to facilitate LMA insertion comparing placebo, 0.1 mg/kg and 0.25 mg/kg of succinylcholine. Further objectives were to compare (a) the overall insertion conditions of the LMA, (b) the number of insertion attempts, (c) the amount of propofol consumption, and (d) the hemodynamics in the three groups.Setting and Design:This is a prospective, double-blinded, randomized control trial of 283 patients randomized into three groups-placebo, 0.1 mg/kg and 0.25 mg/kg of succinylcholine. It was done in the day case theatres of a tertiary hospital in Southern India.Subjects and Methods:Patients were induced with 2 mg/kg of propofol, after 2 μg/kg of fentanyl. The study drug was given after loss of consciousness. After 60 s, a classic LMA was inserted by the standard method by a single investigator. Jaw relaxation, coughing, gagging, movement, laryngospasm, ease of insertion, number of attempts, propofol usage, and hemodynamics were assessed.Statistical Analysis:Statistical methods used were analysis of variance with Bonferroni's t-test, Chi-square test, and Fisher's test. P < 0.05 was considered statistically significant.Results:Jaw relaxation was significantly better in the 0.25 mg/kg succinylcholine group. There was no significant difference in coughing and gagging in the groups, but patient movement was more in the placebo group. Two patients in the placebo group experienced partial laryngospasm. Overall insertion conditions were significantly better in the 0.25 mg/kg group compared to the other two groups. Propofol consumption was significantly more in the placebo group.Conclusions:The study concludes that 0.25 mg/kg succinylcholine facilitates insertion of the LMA.

Study to assess the effect of mini-dose Succinylcholine for ease of laryngeal mask airway insertion

“…The results are comparable with the findings of Leah George et al where he divided 283 patients into three groups to receive either normal saline, 0.1mg/kg succinylcholine or 0.25mg/kg succinylcholine and found that 84.9% patients had excellent overall insertion conditions in the 0.25 mg/kg group. 1 The results are also in correlation with the study conducted by Korula S et al, where he used low dose succinylcholine (0.35mg/kg) for insertion of LMA during thiopental induction in comparison with atracurium (0.08mg/kg). He found the inserting conditions and ease of insertion to be better in the succinylcholine group.…”

“…12 Two different doses of succinylcholine 0.1mg/kg and 0.25mg/kg were compared by Leah George et al for LMA insertion and observed that overall insertion conditions were better in 0.25mg/kg group than 0.1mg/kg group. 1 After much deliberation, the dose of 0.25mg/kg of succinylcholine was chosen for the present study.…”

“…Given the setting, general anaesthesia through the laryngeal mask airway (LMA) is widely used now-a-days, since it fills the gap between the face mask and tracheal tube and is purported to cause minimal disturbances in cardiovascular and respiratory parameters. 1,2 Further, it ensures better control of the airway leaving the anaesthesiologist's hands free throughout surgery.…”

“…[3][4][5] Additional doses of propofol are then required to prevent these undesirable airway reflexes and multiple insertion attempts may also be needed, which can be associated with adverse hemodynamic changes and airway trauma. 1 Tajne MP et al Int J Res Med Sci. 2019 Jun;7 (6): [2089][2090][2091][2092][2093][2094] International Journal of Research in Medical Sciences | June 2019 | Vol 7 | Issue 6 Page 2090…”

The median effective dose (ED50) of cis-Atracurium for laryngeal mask airway insertion during general Anaesthesia for patients undergoing urinary surgery

“…The estimated ED50 for the total patient group was 35.11 μg·kg − 1 [24]. The effective dose in our study differed from the 48 μg·kg − 1 that was estimated as the ED95 of cis-atracurium by Belmont et al [25] and differed from the ED50 and ED95 of 30 μg·kg − 1 and 53 μg·kg − 1 , respectively, reported by Lepage et al [26]. In our study, the SBP was significantly lower in the 20 μg·kg − 1 group at T2 (i.e., anaesthesia induction timepoint), T3, and T4, and was indistinguishable from the SBP in the 30 μg·kg − 1 group and the 50 μg·kg − 1 group.…”