Hemodynamic Responses and
intubating conditions in laryngeal mask airway insertion a comparative
study of propofol versus sevoflurane
Mathew S 1, Peter V 2,
Thomas M. K.3
1Dr. Sumesh Mathew, Assistant Professor, 2Dr. Vijil
Peter, Assistant Professor, 3Dr. Mariam Koshy Thomas, Professor
& Head, all authors are affiliated with Department of
Anaesthesiology, Jubilee Mission Medical College and Research
Institute, Thrissur, Kerala, India
Address for Correspondence: Dr. Sumesh Mathew, Mundiyanickal house,
Thellakom p o, kottayam, Kerala, India. Email: sumesh.math@gmail.com
Abstract
Background:
LMA is an effective alternative to the endotracheal tube for securing
the airway in short surgical procedures. Propofol is a widely used
anaesthetic agent for the insertion of Laryngeal Mask Airway.
Sevoflurane is a volatile anaesthetic agent, which combines rapid,
smooth inhalational induction of anaesthesia with rapid recovery,
making it ideal for day care anaesthesia. Objective: To study
if the use of sevoflurane can be used as an alternative to IV propofol
for laryngeal mask airway insertion. Primary objective: Hemodynamic
responses during Laryngeal mask insertion. Secondary objective:
Intubating conditions during laryngeal mask airway insertion. Study
design: A Randomized control trial. Methods:
100 adults were allocated by randomization into two groups of 50 each;
group P (Propofol) and group S (Sevoflurane). Patients in group P were
induced with 2.5mg/kg intravenous propofol with 50%O2 & 50%N2O
and in group S with 8% sevoflurane in 50%O2 & 50% N2O vital
capacity breath technique. Laryngeal mask airway was inserted after
adequate jaw relaxation was attained and hemodynamic responses like
pulse rate, blood pressure were monitored. The grading of conditions
for laryngeal mask airway insertion and number of attempts were noted.
All the data collected was analysed statistically. Results: We observed
that more number of attempts were required for LMA insertion in Group S
(14.0%) compared to Group P (0.0%) which is statistically significant
with P=0.012. Heart rate at one minute and 2 minutes after LMA
insertion showed a fall with Propofol which was statistically
significant as compared to Sevoflurane. There is a significant
difference of fall in mean arterial blood pressure in group P during
induction, one minute, 2 minutes and 5 minutes when compared between
the two groups. Sevoflurane took longer time for induction and LMA
insertion compared to Propofol which is statistically significant.
Moderate patient movement were noticed in 5 patients of group S and no
patient movement were noticed in group P and is statistically
significant (P – 0.022). Quality of insertion with propofol
was excellent in all patients. With sevoflurane quality of insertion
ranged from excellent to satisfactory. Conclusion:
Sevoflurane is associated with good hemodynamic stability but
intubating conditions provided with propofol is superior. Prolonged
time for jaw relaxation with sevoflurane when compared to propofol may
delay laryngeal mask airway insertion. Quality of insertion with
propofol was excellent in all patients. With sevoflurane quality of
insertion ranged from excellent to satisfactory.
Keywords:
Laryngeal Mask Airway, Propofol, Sevoflurane
Manuscript received: 7th
March 2017, Reviewed:
16th March 2017
Author Corrected:
24th March 2017, Accepted
for Publication: 31st March 2017
Introduction
Laryngeal mask airway has been used in millions of patients and is
accepted as a safe technique, in variety of surgical procedures [1]. It
ensures a better control of airway than the facemask, leaving the
anesthetists hands free and avoids the disadvantages of endotracheal
tube like presser response during intubation and sore throat, croup,
hoarseness postoperatively. Laryngeal mask also provides an effective
and simple solution to many problems of difficult intubation. The
laryngeal mask airway is an ingenious supraglottic airway device that
is designed to provide and maintain a seal around the laryngeal inlet
for spontaneous ventilation and allow controlled ventilation at modest
levels (<15cms of H2O) of positive pressure [2]. With use of
LMA, muscle relaxation is unnecessary, laryngoscopy is avoided and
hemodymanic changes are minimized during insertion[2]. Ideal induction
agent for LMA insertion would provide loss of consciousness, jaw
relaxation, absence of upper airway reflexes rapidly without cardio
respiratory compromise. Most currently available induction agents have
been used for LMA insertion, but propofol is probably the best
intravenous agent and sevoflurane is the best volatile agent, though
neither is ideal[1].
IV propofol with or without opioid is the induction agent of choice for
laryngeal mask airway insertion. Because of its favourable recovery
profile and low incidence of side effects, propofol has become the drug
of choice for insertion of laryngeal mask airway, but is associated
with pain on injection and cardiovascular and respiratory depression
[3]. Sevoflurane, a halogenated, volatile anesthetic agent is
nonirritating to the airways, and mask induction with this agent is
associated with a very low incidence of breath holding, coughing, and
laryngospasm. In addition, low lipid solubility allows a fast, smooth
induction; and a predictably short recovery. Induction technique using
a high inspired concentration of sevoflurane and vital capacity breaths
provides good conditions for the insertion of LMA[4]. Recently, vital
capacity breath inhaled induction of anesthesia with sevoflurane has
been used as an alternative to intravenous induction in adults. This
method is rapid, with little excitatory phenomena, high patient
acceptance and good hemodynamic stability [5]. Rapid insertion of LMA
after vital capacity breath induction may allow the use of sevoflurane
as a single drug for the induction and maintenance of anesthesia, which
would ease the transition period and lead to cost saving [6].
Aims of the study is
- To compare the induction with sevoflurane and propofol for LMA
insertion.
- To assess the quality of jaw relaxation between them for LMA
insertion.
- To estimate the incidence of respiratory complications (
laryngospasm, coughing,and gagging) and cardio vascular complications
with both agents.
Materials
and Methods
A prospective randomized study was conducted on 50 ASA grade I
&II patients, aged between 18 – 60 years who are
undergoing minor surgical procedures under general anesthesia. Both
inpatients and day cases were included in the study. They were
randomized into two groups of 25 each.
Group S – sevoflurane group
Group P – propofol group
Inclusion criteria
Patients of age between 18 – 60 years
ASA grade I & II patients
Exclusion criteria
Adults <18years, >60years
ASA III, IV, V
Morbidly obese
Patients requiring endotracheal intubation, A preanesthetic evaluation
was done on the previous day of surgery and was reviewed on the day of
surgery. A detailed medical history was taken. Systemic examination was
arried out and relevant investigations were advised. An informed
written consent was taken from all patients. Nil per oral status was
maintained for all patients. Patients were premeditated with tab.
Ranitidine 150mg and tab Ondansetron 4mg. On arrival to operation room-
IV line was secured, Monitors for ECG, NIBP and SPO2 were connected.
Patients received injection fentanyl 1.5 - 2µg/kg prior to
induction. All patients were preoxygenated for 3min with 100% oxygen
using a fresh gas flow of 8l/min. Patients were randomly allocated into
group S and group P. Patients baseline vital data like heart rate,
NIBP, SPO2 was recorded.
Group P – received propofol 2 –2.5mg/kg body weight
at the rate of 40mg every 10 sec was given.
Group S – Sevoflurane 8% was introduced into fresh gas flow
of 8l of oxygen and patients were instructed to take vital capacity
breath and hold it as long as they could. The point of start of
injection of propofol or introduction of sevoflurane 8% was considered
as starting point of induction. Their anesthesia circuit was primed
with 8% sevoflurane with O2 at 8 L/min.
Loss of verbal contact was considered as the desired endpoint for
induction in both techniques which was assessed by the response to
calling out the patient’s name. Then the time of loss of
eyelash reflex was noted. After this jaw relaxation was assessed by
anesthesiologist after loss of eyelash reflex, If jaw relaxation was
not adequate, it was reassessed after every 15 seconds. Once jaw
relaxation was adequate, LMA insertion was attempted. The following
data was recorded.
1. Time taken from start of induction to loss of verbal contact, loss
of eyelash reflex, jaw relaxation and successful LMA insertion.
2. Number of attempts of LMA insertion.
3. Total dose of requirement of propofol in each patients.
4. NIBP, HR and SPO2 were monitored from beginning of induction up to 5
minutes of induction.
The conditions of insertion of LMA were graded by observer on a three
point scale using 6 variables based on LMA insertion score [3,8].
Overall conditions for insertion of LMA were assessed as excellent,
satisfactory or poor on basis of total score obtained by summing up the
individual scores of each component. [Maximum score of 18].
The following parameters are assessed during LMA insertion: Jaw
relaxation, Ease of LMA insertion, Coughing, Gagging, Laryngospasm,
Number of attempts of LMA insertion.
Excellent 18, Satisfactory 16 –17 and Poor <
16.
LMA was inserted by the method described by Brain. After insertion of
LMA, anaesthesia was continued with 66% N2O + 33% O2 + isoflurane. The
study ended when the patient was considered to reach an adequate depth
of anaesthesia and was well settled after insertion of LMA. Manual
ventilation was employed if necessary. Study design: This is a
randomised control trial. All eligible consenting persons will be
included in the study and randomly allocated on the basis of a
randomisation list in the study arm.
Statistical Methods: Descriptive statistical analysis has been carried
out in the present study. Results on continuous measurements are
presented on Mean SD (Min-Max) and results on categorical
measurements are presented in Number (%). Significance is assessed at 5
% level of significance. The following assumptions on data is made,
Assumptions: 1.Dependent variables should be normally distributed,
2.Samples drawn from the population should be random, Cases of the
samples should be independent.Student t test ( two tailed, independent)
has been used to find the significance of study parameters on
continuous scale between two groups (Inter group analysis) on metric
parameters. Levene’s test for homogeneity of variance has
been performed to assess the homogeneity of variance. Chi-square/
Fisher Exact test has been used to find the significance of study
parameters on categorical scale between two or more groups.
Significant figures used are statistically not significant - P value:
> 0.05
Statistically significant - P value: 0.05, Strongly significant - P
value : P0.01
Results
A Comparative two arm clinical study with 100 patients randomized in to
two groups, 50 patients in Group P (Propofol) and 50 patients in Group
S (sevoflurane) is undertaken to study the Haemodynamic responses and
intubating conditions during laryngeal mask airway insertion. There is
no statistically significant difference in age distribution. Samples
are age matched with [P = 0.610]. There is no statistically significant
difference in weight distribution. Samples are weight matched with [ P
= 0.719]. In group P 88% of patients were in ASA grade 1 and 12% were
in ASA grade 2. In group S 80% of patients were in ASA grade 1 and 20%
were in ASA grade 2. In group P 46 patients were used LMA size 3 and 4
were used LMA size 4 for their surgical procedure. In group S 48
patients were used LMA size 3 and 2 were used LMA size 4 for their
surgical procedure.
Table-I: Number of
attempts
|
No
of attempts
|
Group
I
|
Group
II
|
|
No
|
%
|
No
|
%
|
|
1 attempt
|
50
|
100.0
|
43
|
86.0
|
|
2 attempts
|
0
|
0.0
|
7
|
14.0
|
|
Total
|
50
|
100.0
|
50
|
100.0
|
Inference: All patients of group P (propofol) in this study had
successful LMA insertion in 1st attempt. 43 patients of group S
(sevoflurane) had successful LMA insertion in 1st attempt and 7
patients were undergone 2nd attempt for successful LMA insertion. The
number of attempts are more in Group S (14.0%) compared to Group P
(0.0%) which is statistically significant with [P=0.012].
Table-II: Comparison of
Pulse rate in two groups of patients studied
|
Pulse
|
Group
I
|
Group
II
|
P
value
|
|
Base line
|
84.00±8.13
|
85.00±7.53
|
0.525
|
|
Induction
|
81.48±7.84
|
84.48±8.11
|
0.063
|
|
1 minute
|
78.48±8.49
|
86.48±10.63
|
<0.001
|
|
2 minutes
|
77.04±9.08
|
83.08±11.21
|
0.004
|
|
5 minutes
|
76.40±9.95
|
79.84±9.87
|
0.086
|
Inference: Comparison of heart rate between the two groups was done
using student t test. The heart rate at baseline and at the time of
induction were comparable between the groups. Heart rate at one minute
and 2 minutes after LMA insertion showed a fall in heart rate with
propofol compared to Sevfurane which is statistically significant as
compared to the sevoflurane group.No statistically significant
difference was noted at 5 minutes after induction.
Table- III: Comparison of
Blood pressure (SBP mmHg) in two groups of patients studied
|
SBP
mmHg
|
Group
I
|
Group
II
|
P
value
|
|
Base line
|
124.88±8.62
|
125.48±5.78
|
0.684
|
|
Induction
|
120.24±9.58
|
125.75±11.16
|
0.009
|
|
1 minute
|
110.70±9.03
|
117.80±10.65
|
0.001
|
|
2 minutes
|
105.60±8.12
|
112.32±8.69
|
<0.001
|
|
5 minutes
|
101.32±9.51
|
104.04±10.84
|
0.188
|
Inference: There was no statistically significant difference in
systolic blood pressure in baseline between the two groups. There is
statistically significant difference in systolic blood pressure at
induction, one minute and two minute when compared between the two
groups. A fall in the systolic blood pressure in group P was noted when
compared to group S. There is no statistically difference fall in blood
pressure between the two groups at 5 minutes.
Table IV: Comparison of
Blood pressure (DBP mmHg) in two groups of patients studied
|
DBP
mmHg
|
Group
I
|
Group
II
|
P
value
|
|
Base line
|
78.64±6.55
|
80.24±7.21
|
0.252
|
|
Induction
|
76.56±6.60
|
80.48±8.72
|
0.013
|
|
1 minute
|
69.36±4.90
|
74.00±7.55
|
<0.001
|
|
2 minutes
|
68.16±5.23
|
71.92±7.39
|
0.004
|
|
5 minutes
|
64.24±9.32
|
69.20±7.51
|
0.004
|
Inference: There was no statistically significant difference in
diastolic blood pressure in preoperative period between the two groups.
There was statistically significant difference in diastolic blood
pressure at induction, one minute, 2minute and 5 minutes when compared
between the two groups. A fall in the diatolic blood pressure in group
P was noted when compared to group S at induction,1, 2 and 5 minute.
Table -V: Comparison of
Blood pressure (MAP mmHg) in two groups of patients studied
|
MAP
mmHg
|
Group
I
|
Group
II
|
P
value
|
|
Base line
|
93.80±6.81
|
95.88±6.07
|
0.125
|
|
Induction
|
91.04±6.32
|
95.20±8.13
|
0.005
|
|
1 minute
|
82.92±5.15
|
88.72±7.18
|
<0.001
|
|
2 minutes
|
80.52±5.25
|
85.80±6.92
|
<0.001
|
|
5 minutes
|
76.48±8.04
|
81.00±6.58
|
0.003
|
Inference: There was no statistically significant difference in mean
arterial blood pressure in preoperative period between the two groups.
There was significant difference in mean arterial blood pressure during
induction, one minute, 2 minutes and 5 minutes when compared between
the two groups. A fall in the mean blood pressure in group P was noted
when compared to group S.
Table-VI: Time of events
|
|
Group
I
|
Group
II
|
P
value
|
|
Loss of verbal contact
|
51.40±9.95
|
65.40±9.57
|
<0.001
|
|
Time of jaw relaxation
|
77.40±8.93
|
106.00±13.17
|
<0.001
|
|
Time of LMA insertion
|
88.40±7.91
|
126.20±15.37
|
<0.001
|
Inference: Sevoflurane took longer time for induction and LMA
insertion. Loss of verbal contact, adequate jaw relaxation and LMA
insertion were earlier with propofol when compared with sevoflurane and
is statistically significant.
Table-VII: Grading of
conditions for laryngeal mask airway insertion
|
Parameter
|
Grading
|
Description
|
Group p
|
Group s
|
|
Jaw opening
|
3
|
Full
|
50
|
47
|
|
2
|
Partial
|
0
|
3
|
|
1
|
Nil
|
0
|
0
|
|
Ease of insertion
|
3
|
Easy
|
50
|
50
|
|
2
|
Difficult
|
0
|
0
|
|
1
|
Impossible
|
0
|
0
|
|
Coughing
|
3
|
Nil
|
50
|
50
|
|
2
|
Minor
|
0
|
0
|
|
1
|
Severe
|
0
|
0
|
|
Gagging
|
3
|
Nil
|
50
|
50
|
|
2
|
Minor
|
0
|
0
|
|
1
|
Severe
|
0
|
0
|
|
Laryngospasm
|
3
|
Nil
|
50
|
50
|
|
2
|
Partial
|
0
|
0
|
|
1
|
Total
|
0
|
0
|
|
Patient movements
|
3
|
Nil
|
50
|
45
|
|
2
|
Moderate
|
0
|
5
|
|
1
|
Vigorous
|
0
|
0
|
Table-VII: Grading
|
|
Group
I
|
Group
II
|
P
value
|
|
Jaw opening
|
3.00±0.00
|
2.94±0.23
|
0.080
|
|
Ease of insertion
|
3.00±0.00
|
3.00±0.00
|
-
|
|
Coughing
|
3.00±0.00
|
3.00±0.00
|
-
|
|
Gagging
|
3.00±0.00
|
3.00±0.00
|
-
|
|
Laryngospasm
|
3.00±0.00
|
3.00±0.00
|
-
|
|
Patient movements
|
3.00±0.00
|
2.90±0.31
|
0.022
|
Inference:
Occurrence of complications likes coughing, biting, and laryngospasm
during LMA insertion were not noticed in both the groups of this study.
The overall insertion was excellent with propofol with all 50 patients
scoring 18. With sevoflurane, 43 patients had excellent conditions for
LMA insertion and 7 had satisfactory condition for LMA insertion when
grading was done using 18 point score. Jaw opening was partial in 3
patients in group S but there is no statistically significant
difference (P – 0.080) between the groups. Moderate patient
movement were noticed in 5 patients of group S and no patient movement
were noticed in group p and is statistically significant ( p
– 0.022 ).
Discussion
Hemodynamic changes while inserting LMA- Heart rate at 1 minute and 2
minutes after LMA insertion showed a fall in propofol group as compared
to sevoflurane group which was statistically significant with [p value
of <0.001 and 0.004] respectively. There was no statistically
significant difference in systolic blood pressure in preoperative
period between the two groups. A significant fall in the systolic blood
pressure in-group P was noted when compared to group S at induction,
one and two minutes. There was statistically significant fall in
diastolic blood pressure at induction, one minute, 2minute and 5
minutes when compared between the two groups. There was significant
fall in mean arterial blood pressure during induction, one minute, 2
minutes and 5 minutes when compared between the two groups.
A Thwaites, S Edmends and I Smith [6] while comparing the hemodynamic
parameters noted induction of anaesthesia with propofol was associated
with decrease of approximately 20 mmHg in MAP which occurred within 2
min and persisted for at least 5 min of anaesthesia. In contrast they
noted that decrease with MAP with sevoflurane was only 10 mm Hg. The
MAP was significantly lower at 2- 5 minutes after induction with
propofol compared with sevoflurane. Heart rate did not differ
significantly between the groups at any time during the induction. In
our study there is significant difference in mean arterial blood
pressure during induction, one minute, 2 minutes and 5 minutes which is
comparable in both studies. In our study heart rate showed a
significant difference between the groups at one and two minutes after
LMA insertion
Lian et al [5]conducted a study in which found that propofol produced a
larger decrease in mean blood pressure compared with sevoflurane and
was statistically significant at 4 and 5 minutes after induction .
Heart rate were comparable in both groups. But in our study there is
significant difference in mean arterial blood pressure during
induction, one minute, 2 minutes and 5 minutes and heart rate showed a
significant difference between the groups at one and two minutes after
LMA insertion.
Charles E. Smith et al[7] found heart rate was lower 5 and 10 minutes
after LMA insertion in the sevoflurane-N2O group versus the control
group (p < 0.05). But in our study heart rate at 1 minute and 2
minutes after LMA insertion showed a fall in propofol group as compared
to sevoflurane group.
Priya et al [8]in their study found that haemodynamic parameters (Mean
Arterial Pressure, Heart Rate) between the two groups showed a
statistically significant difference in the Mean Arterial Pressure in
group P three minutes after induction but heart rates were comparable
in both groups. However in our study Heart rate at 1 minute and 2
minutes after LMA insertion showed a fall in propofol group as compared
to sevoflurane group and a significant fall in mean arterial blood
pressure during induction, one minute, 2 minutes and 5 minutes when
compared between the two groups.
Timing of insertion of LMA insertion-In our study mean time taken from
induction to successful laryngeal mask insertion was significantly
shorter with propofol compared with sevoflurane. With sevoflurane group
the LMA insertion took 126.20±15.37 seconds while propofol
group took 88.40±7.91 seconds with [p< 0.001] which
is highly significant.
A Thwaites, S Edmends and Smith [6] in their study observed that
induction with sevoflurane was significantly slower when compared with
propofol, but was associated with lower incidence of apnoea and shorter
time to establish spontaneous ventilation.
Lian et al [5] in their study achieved insertion of LMA with
sevoflurane in 127 sec almost similar to the time taken in our study
(126 sec). They concluded that prolonged jaw tightness after
sevoflurane induction of anaesthesia may delay LMA insertion.
Charles E. Smith et al [7] found that time to loss of consciousness was
faster after propofol (mean ± SEM: 51 ± 3 sec)
than after sevoflurane-N2O (85 ± 10 sec; p < 0.05).
These findings are comparable to our study.
In contrast Ravikumar Koppula and Anitha Shenoy [3] in their study
noted that verbal contact and eyelash reflex with sevoflurane was lost
earlier when compared to propofol. But propofol and sevoflurane took
similar times to jaw relaxation and subsequent LMA insertion.
Analysis of condition for LMA insertion and patients response-
Occurrence of complications likes coughing, biting and laryngospasm
during LMA insertion were not noticed in both the groups of this study.
The overall insertion was excellent with propofol with all 50 patients
scoring 18. With sevoflurane, 43 patients had excellent conditions for
LMA insertion and 7 had satisfactory condition for LMA insertion when
grading was done using 18 point score. Jaw opening was partial in 3
patients in group S but there was no statistically significant
difference (P – 0.080) between the groups. Moderate patient
movement were noticed in 5 patients of group S and no patient movement
were noticed in group P and is statistically significant (p –
0.022).
Number of attempts for LMA insertion are significantly more in Group S
(14.0%) compared to Group I (0.0%) with[ P=0.012]. The overall
conditions of LMA insertion were graded as excellent in all 50 patients
belonging to propofol group. 43 patients in sevoflurane group had
excellent conditions with score of 18. 6 patients in sevoflurane group
had score of 17 and one patient had score of 16 with LMA insertion
graded as satisfactory.
Lian et al [5]in their study found that more attempts at insertion of
LMA were required in patients in sevoflurane group versus those in
propofol group and they suggested that this was primarily because of
incidence of initially impossible mouth opening.
In a similar study conducted by Priya et al [8], 4 patients in each
group (Group P: Propofol and Group S: Sevoflurane) required a second
attempt for insertion of Laryngeal Mask Airway. In the remaining 21
patients each in both groups, Laryngeal Mask Airway was placed
successfully at the first attempt itself. Conditions for Laryngeal Mask
Airway insertion were noted. Excellent conditions were obtained in a
significantly greater number of patients in Group P (p=0.02).Analysis
of the total scores for conditions for Laryngeal Mask Airway
insertion indicated that conditions for Laryngeal Mask Airway insertion
were superior in Group P. The mean score in Group P was 17.5
± 0.77 and 16.8 ± 1.15 in Group S (p=0.012).
Analysis of the individual scores for criteria for Laryngeal Mask
Airway insertion and the patient’s response indicated that
scores for jaw opening in Group P were significantly better than Group
S (p=0.047). In our study number of attempts were significantly more
with sevoflurane compared to propofol and individual scores for
criteria for Laryngeal Mask Airway insertion and the
patient’s response indicated that scores for patient movement
in Group P were significantly better than Group S.
Ganatra SB et al [9] in their study sixty patients were equally and
randomly divided into two groups. Both groups received fentanyl 1
microg /kg. Patients in the sevoflurane group were induced with 8%
sevoflurane and those in the propofol group with propofol 2.5 mg/kg.
Excellent or satisfactory conditions were observed in 30 (100%)
patients in the propofol group and in 29 (96.66%) in the sevoflurane
group.
Ravikumar Koppula and Anitha Shenoy [3] in their study found that both
sevoflurane and propofol had similar quality for insertion of LMA and
concluded that sevoflurane is a good alternative to propofol for LMA
insertion.
Conclusion
• In our study sevoflurane is associated with good
hemodynamic stability compared to propofol.
• Intubating conditions provided with propofol is
superior. Prolonged time for jaw relaxation with sevoflurane when
compared to propofol may delay laryngeal mask airway insertion.
• Numbers of attempts for LMA insertion were
significantly more with sevoflurane group.
• Quality of insertion with propofol was excellent in
all patients. With sevoflurane quality of insertion ranged from
excellent to satisfactory.
• Patients who received propofol complained of pain
while injection and patients who received sevoflurane complained of
odour when the mask was held.
• Sevoflurane is an acceptable alternative to
propofol for LMA insertion
Funding:
Nil, Conflict of
interest: None initiated
Permission from IRB:
Yes
References
1. Robert G Krohner, Sivam Ramanathan . Anatomy of airway in Benumofs
airway management 2nd edition.2006; 1 – 19, 476 –
497, 1027 – 29.
2. Bogetz MS. Using the laryngeal mask airway to manage the difficult
airway. Anesthesiol Clin North America. 2002 Dec;20(4):863-70. [PubMed]
3. Koppula R, Shenoy A. Comparison of
sevoflurane with Propofol for LMA insertion. Journal of Anaesthesiology
and Clinical Pharmacology, 2005, 21(3), 271-274.
4. Molloy ME, Buggy DJ, Scanlon P. Propofol or
sevoflurane for laryngeal mask airway insertion. Can J Anaesth. 1999
Apr;46(4):322-6. [PubMed]
5. Ti LK, Chow MY, Lee TL. Comparison of
sevoflurane with propofol for laryngeal mask airway insertion in
adults. Anesth Analg. 1999 Apr;88(4):908-12. [PubMed]
6. Thwaites A, Edmends S, Smith I. Inhalation
induction with sevoflurane: a double-blind comparison with propofol. Br
J Anaesth. 1997 Apr;78(4):356-61. [PubMed]
7. Smith, C. E., Lever, J. S., Sawkar, S.,
Pinchak, A. C., & Hagen, J. F. Sevoflurane-N2O versus
propofol/isoflurane-N2O during elective surgery using the laryngeal
mask airway in adults. Journal of Clinical Anesthesia 2000, 12(5),
392-396.
8. V Priya, Divatia JV, Dasgupta D. A comparison
of Propofol versus sevoflurane for laryngeal mask airway insertion.
Indian Journal of Anaesthesia, 2002, 46(1), 31-34.
9. Ganatra SB, D’Mello J, Butani M,
Jhamnani P. Conditions for insertion of the laryngeal mask airway,
comparisons between sevoflurane and Propofol using fentanyl as a
co-induction agent. A pilot study. European Journal of Anaesthesiology,
19, 2002, 371-375.
How to cite this article?
Mathew S, Peter V, Thomas M. K. Hemodynamic Responses and intubating
conditions in laryngeal mask airway insertion a comparative study of
propofol versus sevoflurane. Int J Med Res Rev 2017;5(03):253-260
doi:10.17511/ijmrr.2017.i03.07.