Midazolam co‐induction and laryngeal mask insertion

Abstract

Summary We have studied the effect of alfentanil and midazolam + alfentanil on the conditions for laryngeal mask airway insertion in patients receiving propofol for induction of anaesthesia. Ninety unpremedicated, ASA 1 or 2 adult patients were randomly allocated to one of three groups: group P received propofol only (2.5 mg.kg‐1); group PA received alfentanil (10 μg.kg‐1) followed by propofol (1.25 mg.kg‐1); group PMA received midazolam (0.04 mg.kg‐1) and alfentanil (10 μg.kg‐1) followed by propofol (1.25 mg.kg ‐1). Further boluses of propofol (0.25 mg.kg ‐1 every 15 s) were given if the initial dose was inadequate for induction of anaesthesia. Patients in the midazolam + alfentanil group required less propofol (p < 0.001), had better mouth opening (p < 0.001) and fewer undesired responses to laryngeal mask airway insertion (p < 0.001) than the other two groups.

A CLINICAL COMPARATIVE STUDY OF EFFECTIVENESS OF MIDAZOLAM 0.05mg.kg - 1 AS CO - INDUCTION AGENT WITH PROPOFOL 2.5mg. k g - 1 AND PROPOFOL 3.5mg.kg - 1 ALONE FOR LARYNGEAL MASK AIRWAY INSERTION IN CHILDREN

“…In the present study, the undesirable responses-coughing, gagging, laryngospasm, desaturation were nil in both the groups, both at insertion and removal of LMA and findings concur with Driver IK et al 15 Table 5: Showing changes in mean heart rate and mean systolic blood pressure …”

“…They reported that the combination of propofol with midazolam or ketamine improved conditions for laryngeal mask insertion and produced stable haemodynamics. Similarly, in adults, Driver IK et al, 15 , Short TG et al 1 also reported that the propofol-midazolam combination acts synergistically. Thus, in the present study, propofol 3.…”

“…Similarly, Martlew RA et al 14 considered conditions for laryngeal mask insertion at 60s after propofol bolus as satisfactory or unsatisfactory. In present study, similar to Driver IK et al 15 and Driver I et al, 16 we assessed the insertion characteristics based on mouth opening and ease of insertion of laryngeal mask airway. The mouth opening was full in 90% and 93.3% of patients while partial in 10% and 6.7% of patients in Group I and II respectively.…”

“…Driver IK et al, 15 Driver I et al 16 assessed the insertion characteristics 30s after propofol bolus and graded mouth opening on three point scale as full, partial and impossible, and ease of LMA insertion graded on four point scale as easy, some difficulty, difficult and impossible. Driver IK et al reported that the mouth opening was full in 100% and 70% while LMA insertion was easy in 100% and 93.3% in propofol-midazolam-alfentanil group and propofol group respectively.…”

Non-word reading test vs anaesthesia. How do anaesthetised patients decode the contents without referring to the meaning?

“…Moreover, after 3 h and 6 h the AG performance was still slower, though not less accurate, than the CG performance. Propofol, fentanyl, and midazolam suppress the laryngeal and pharyngeal responses, which are crucial to vocalisation [19][20][21]. However, the pharmacokinetic properties of a hypnotic agent seem to exclude such a possibility -propofol disappears from the effectory compartment after several minutes and its metabolites are inactive.…”