The use of low‐dose mivacurium to facilitate insertion of the laryngeal mask airway

Abstract

SummaryWe have evaluated the effects of the volume and speed of administration of local anaesthetic during peribulbar anaesthesia. One hundred and forty patients scheduled for cataract surgery were randomly allocated to one of four groups of 35. Each patient received an injection of the same mixture of lignocaine, bupivacaine and hyaluronidase. Patients in group A were given 9 ml at a speed of 5 ml.min À1 , group B were given the same volume at 12 ml.min À1 , group C were given 13.5 ml at 5 ml.min À1 and group D were given 13.5 ml at 12 ml.min À1 . A significantly higher incidence of satisfactory akinesia was found in group D, whose pain score at injection was no higher than for the other groups. Large volumes of local anaesthetic significantly affected intraocular pressure. The incidences of early and late ptosis or diplopia were not affected by either the rate of injection or the volume of local anaesthetic.

Laryngeal mask insertion using thiopental and low dose atracurium: A comparison with propofol

“…They did not determine if mivacurium was effective for LMA insertion if thiopental had been used as the induction agent instead of propofol. 19 D'Honneur found that priming doses of atracurium (0.05 and 0.075 mg-kg -1) depressed swallowing. 2~ We suggest that the combination of low dose atracurium depressed the pharyngeal and laryngeal reflexes sufficiently to allow successful LMA insertion.…”

Topical lidocaine improves conditions for laryngeal mask airway insertion

“…In an effort to improve the insertion conditions without increasing the dose of propofol, short-acting opioids, muscle relaxants, or midazolam may be co-administered with propofol to facilitate LMA insertion. [4][5][6] Intravenous lidocaine is known to suppress cough reflexes and reduce cardiovascular responses associated with tracheal intubation. 7 Its use prior to induction has been reported to improve LMA insertion conditions, 8,9 but not to reduce propofol requirements.…”

Fentanyl dose–response curves when inserting the LMA Classic™ laryngeal mask airway*

“…A three-point, six-category scale (a-f) that had been used in previous studies [6,9,10] was used to grade insertion conditions. The three grades were scored 1, 2 or 3 in order of severity.…”

“…If malpositioned it can obstruct the airway and inadequate depth of anaesthesia may result in the patient coughing, gagging and rejecting the cLMA [3]. To provide reliable insertion conditions, a number of induction agents and adjuncts have been investigated [4][5][6][7][8]. Propofol 2.5-3.5 mg.kg )1 appears to be the most appropriate induction agent [4,8], but the choice of adjunct is less clear.…”