Comparison of dexmedetomidine-propofol versus fentanyl-propofol for insertion of laryngeal mask airway

Ramaswamy, Ashwini H; Shaikh, Safiya I

doi:10.4103/0970-9185.155152

Cited by 16 publications

(23 citation statements)

References 16 publications

(29 reference statements)

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“…Numerous agents have been studied and are still being studied to aid propofol in LMA insertion. These include drugs such as midazolam,[ 6 9 ] opioids such as fentanyl,[ 10 ] alfentanil,[ 11 12 ] remifentanil,[ 2 13 ] and butorphanol,[ 14 ] muscle relaxants such as mivacurium,[ 15 ] atracurium,[ 16 ] and rocuronium,[ 17 ] and drugs such as clonidine,[ 18 ] dexmedetomidine,[ 19 20 ] ketamine,[ 9 21 22 ] and lignocaine. [ 21 ] Side effects such as sedation, postoperative nausea, and vomiting, residual neuromuscular blockade, and cost remains a concern with these drugs, especially in the day care setting.…”

Section: Discussionmentioning

confidence: 99%

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

2017

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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.

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Section: Discussionmentioning

confidence: 99%

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

2017

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“…Previous studies have shown that dexmedetomidine and fentanyl in a dose of 1 μg/kg are equally effective and safe adjuvants for insertion of CLMA. [67] However we found very few studies comparing the efficacy of these commonly used adjuvants for PLMA insertion which requires greater depth of anesthesia. The primary objective of our study was to compare the effects of single intravenous dose of dexmedetomidine and fentanyl administered prior to propofol on the PLMA insertion conditions as per the Muzi scoring system.…”

Section: Introductionmentioning

confidence: 99%

Dexmedetomidine with propofol versus fentanyl with propofol for insertion of Proseal laryngeal mask airway: A randomized, double-blinded clinical trial

Choudhary

Prabhudesai

Datta

2019

J Anaesthesiol Clin Pharmacol

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Background and Aims:Successful insertion of the proseal laryngeal mask airway (PLMA) requires much greater doses of propofol as compared to classic laryngeal mask (CLMA). Dexmedetomidine and fentanyl are equally effective adjuvants for CLMA insertion. We designed this study to compare the efficacy of these two drugs as sole adjuvant in PLMA insertion.Material and Methods:Seventy four American Society of Anesthesiologists (ASA) I and II patients were randomly allocated to receive either dexmedetomidine 1 μg/kg [Group PD] or fentanyl 1 μg/kg [Group PF]. Study drugs were diluted in 10 ml NS and administered over 10 min prior to induction of anesthesia with 2.5 mg/kg propofol. PLMA insertion condition was measured according to the Muzi scoring system. Score ≤2 was considered optimal for PLMA insertion. Patient's cardio-respiratory parameters, emergence time, and postoperative pain were also recorded.Results:In our study 83.8% patients in the group PF and 91.9% in the group PD achieved optimal insertion condition (not significant). Hemodynamic stability was maintained in both the groups but the incidence of apnea was significantly higher in the PF group (P = 0.011). We also observed that emergence time was prolonged but postoperative pain scores were significantly lower in the PD group (P < 0.001).Conclusion:We conclude that both dexmedetomidine and fentanyl in a dose of 1 μg/kg when used before induction with propofol provide comparable conditions for successful PLMA insertion. Dexmedetomidine has additional advantage of preserving spontaneous respiration and providing better analgesia.

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“…Hence, propofol as a sole anesthetic agent is unsatisfactory, and therefore, drugs such as opioids,[ 7 ] midazolam, ketamine, inhalational anesthetics, or muscle relaxants are used with propofol to decrease its dose and minimize undesirable effects. In addition, the use of muscle relaxants mandates that the patient be placed on mechanical ventilatory support, creating further stress on the pulmonary system.…”

Section: Introductionmentioning

confidence: 99%

Role of opioids as coinduction agent with propofol and their effect on apnea time, recovery time, and sedation score

Dwivedi¹,

Puri²,

Dwivedi³

et al. 2018

Int J Crit Illn Inj Sci

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Background:Laryngeal mask airway (LMA) is a supraglottic device which requires lesser depth of anaesthesia, evokes lesser hemodynamic response and causes lesser stimulation of airway as compared to traditional definitive airway device endotracheal tube. Its placement is possible without muscle relaxants thereby allowing maintenance of anaesthesia on spontaneous respiration thus preventing apnoea or minimizing apnoea time. Propofol, the commonly used induction agent, causes cardiorespiratory depression at higher induction doses. To attenuate this, co-induction agents combined with propofol has been a regular I/V anaesthetic technique these days.Aim:Comparing apnoea time, recovery time and sedation scores using propofol-fentanyl and propofol-butorphanol combination.Methodology:Hundred patients scheduled for various elective surgical procedures were randomly selected and divided into two groups of 50 each. As coinduction drug Group F received fentanyl and Group B received butorphanol. In both the groups induction was achieved with I/V propofol and LMA was placed. Apnoea time was noted after induction. Recovery time and sedation scores were recorded after anaesthetic agents were turned off.Results:As compared to group F apnoea time was significantly less and recovery time was significantly more in group B (P < 0.05). Statistically postoperative sedation was significantly higher in group B than in group F at 1/2 hr but clinically, majority were responding to verbal commands. At 1 hour no significant difference in sedation was noted between the groups.Conclusion:Considering respiratory and recovery profile propofol -butorphanol combination is a safer alternative to propofol-fentanyl combination for LMA insertion.

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Comparison of dexmedetomidine-propofol versus fentanyl-propofol for insertion of laryngeal mask airway

Cited by 16 publications

References 16 publications

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

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

Dexmedetomidine with propofol versus fentanyl with propofol for insertion of Proseal laryngeal mask airway: A randomized, double-blinded clinical trial

Role of opioids as coinduction agent with propofol and their effect on apnea time, recovery time, and sedation score

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