Comparative study of effective-site target controlled infusion with standard bolus induction of propofol for laryngeal mask airway insertion

Abstract

Background:The laryngeal mask airway (LMA) is widely used in emergency medicine and surgical anesthesia. Several studies demonstrated induction of anesthesia with different plasma target-controlled infusion (TCI) of propofol for LMA insertion. However, there has been no study to compare the standard bolus propofol induction with the effective site TCI for LMA insertion. Objective: Compare the efficacy of induction of anesthesia with propofol for LMA insertion between the effective-site TCI, using 6 μg/mL, and the standard bolus propofol dose of 2.5 mg/kg in elective surgical patients. Methods: A randomized, prospective, single-blinded, clinical study was used for this study. Seventy-eight unpremedicated patients, American Society of Anesthesiologists (ASA) physical status I and II undergoing elective surgical procedure were randomly allocated between two groups. Group 1 received the standard bolus propofol dose of 2.5 mg/kg. Group 2 received effective site TCI (Schnider model) dose of 6 μg/mL for LMA insertion. The hemodynamics and anesthetic depth (Bispectral index score) were monitored and recorded during and immediately after LMA insertion. The number of insertion attempted, insertion quality score, induction time, and propofol doses used were recorded and compared between groups. Results: The success rate of first insertion attempt was equal in both groups (92.3%). There was no significant hemodynamic response difference between the groups during pre-induction, induction, insertion, and post insertion period. The BIS score was significantly lower during post insertion period in group 1 (51.4+11.0) than group 2 (58.4+3.2) (p=0.013). The propofol doses in group 2 were significantly lower than in group 1 (110.6+14.8 vs. 153.5+21.5) (p <0.001). Patients in group 2 required significantly more induction time than group 1 (146.9+42.3 vs. 103.4+33.6 (p <0.001). Conclusion: Propofol induction with TCI provided equal success rate as compared with standard bolus propofol induction for LMA insertion and insertion quality score. TCI significantly lowered the propofol consumption when compared with the standard 2.5 mg/kg propofol dose.

Propofol affects the biological behavior of ovarian cancer SKOV3 cells via ERK1/2-MMP-2/9 signaling pathway

“…Studies have shown that postoperative infection and tumor diffusion are closely related to the inhibitory effect of anesthesia on cellular immune function [9]. Some scholars have found that isoflurane inhalation promotes the proliferative and migratory abilities of tumor cells by upregulating the activity of tumor growth factors such as chemokine receptors [10]. In recent years, propofol, a popular drug used in radical operation of ovarian cancer, has attracted a lot of research interest with regard to its effect on the biological activities of tumor cells.…”

Comparison of dexmedetomidine with fentanyl as intravenous adjuvants to propofol induction for LMA supreme insertion

“…Any kind of stimulus including the painting and draping by surgeon were avoided following insertion up to 5 min to minimize the interference with findings. The attempts at LMA insertion and Insertion Quality Score (IQS) as follows [2,6] and was noted by an investigator who was not further involved in the study.…”

“…Archie Brain devised supraglottic airway device (LMA) has revolutionized the anaesthetic procedures [1] . LMA insertion necessitates an optimum depth of anaesthesia to allow adequate relaxation of the jaw and prevention of reflexes of upper airway along with maintaining a cardio-respiratory equilibrium in a non-paralyzed patient [2] . Propofol as an induction agent for insertion of LMA has been widely used [2,3] .…”

“…LMA insertion necessitates an optimum depth of anaesthesia to allow adequate relaxation of the jaw and prevention of reflexes of upper airway along with maintaining a cardio-respiratory equilibrium in a non-paralyzed patient [2] . Propofol as an induction agent for insertion of LMA has been widely used [2,3] . For a quality LMA insertion use of propofol at 2.5 mg/Kg is practiced routinely but is accompanied with cardiovascular and respiratory depression [4] .…”

Dose Response Curves of Plasma Concentration 50 of Propofol Target-Controlled Infusion for Supraglottic Airway Devices: A Randomized Controlled Trial

“…Target-controlled infusion (TCI) is widely used for generating propofol with a pharmacokinetic microprocessor. TCI offers improved hemodynamic stability and requires lower propofol doses when compared with manually controlled infusion (MCI) 2 . The anesthesiologist can also set the target-plasma or effectsite concentration of TCI to achieve the desired clinical effect 3,4 .…”