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

Abstract

Background: In clinical practice, the laryngeal mask airway is an easy-to-use supraglottic airway device. However, the cis-atracurium dosage for laryngeal mask insertion has not been standardised. We aimed to determine the optimal dose of cis-atracurium using a sequential method for successful laryngeal mask insertion.Methods: The cohort study protocol is registered at clinicaltrial.gov (NCT-03668262). Twenty-three patients undergoing elective urinary surgery were sequentially administered cis-atracurium doses as follows: 150, 100, 70, 50, 30, and 20 μg·kg − 1 . The main outcome involved the determination of the response to laryngeal mask airway insertion: ≥16 points and < 16 points indicated "satisfactory" and "unsatisfactory" responses, respectively. The median effective dose was estimated using the mean of the seven crossovers from "satisfactory" and "unsatisfactory" responses. The primary outcome involved the determination of the median effective dose (ED50) of cis-atracurium for laryngeal mask airway insertion. Results:The median effective dose of cis-atracurium was 26.5 μg·kg − 1 (95% CI 23.6-29.8) using the sequential method. Heart rate was decreased in the 50 μg·kg − 1 group compared to that in the 30 μg·kg − 1 group at timepoints T7, T8, and T10 (P = 0.0482, P = 0.0460, and P = 0.0236, respectively), but no difference was observed in the 20 μg·kg − 1 group. Systolic blood pressure was decreased in the 50 μg·kg − 1 group compared to that in the 20 μg·kg − 1 group at timepoints T2, T3, and T4 (P = 0.0159, P = 0.0233, and P = 0.0428, respectively). The train-of-four value was significantly lower in the 50 μg·kg − 1 group than in the 30 μg·kg − 1 group at timepoint T3 (P = 0.0326). Conclusions: The ED50 of cis-atracurium was 26.5 μg·kg − 1 for laryngeal mask airway insertion.

Determination of the median effective dose of sufentanil for inhibiting the laryngeal mask insertion response in geriatric patients: a prospective, double-blinded, dose–response trial

“…The 3-point, 6-category scale used in the assessment of LMA insertion is a widely accepted and mature assessment method [ 13 , 14 ]. A comprehensive assessment of LMA insertion is carried out through two indicators of LMA insertion difficulty (mouth opening and insertion resistance) and four indicators of insertion response (swallowing, choking, head or body movement, and laryngospasm).…”

The effects of laryngeal mask airway versus endotracheal tube on atelectasis in patients undergoing general anesthesia assessed by lung ultrasound: A protocol for a prospective, randomized controlled trial

“…Endotracheal tube (ETT) has always been considered the gold standard for ensuring a patent airway and adequate ventilation during general anesthesia, but mechanical irritation caused by ETT can lead to reflex bronchoconstriction, and intubation requires more muscle relaxants, which are related to the formation of atelectasis. Laryngeal mask airway (LMA) is increasingly used for ventilation maintenance during general anesthesia as it is more comfortable, causes less irritation and has lower airway resistance [13][14][15][16][17]. Therefore, we hypothesized that using LMA can improve atelectasis in general anesthesia.…”