A comparative study of propofol and N2O versus sevoflurane and N2O with respect to haemodynamic response and ease of laryngeal mask airway insertion: a prospective randomized double blinded study
Keywords:Laryngeal mask airway, Propofol, Sevoflurane, Haemodynamics, Ease of insertion
Background: Laryngeal mask airway (LMA) is an accepted airway device for spontaneous and modest positive pressure ventilation. Propofol is widely used Induction agent. Sevoflurane is a newer pleasant volatile anaesthetic with rapid induction and recovery with stable haemodynamics. The aim of this study was to compare propofol and sevoflurane with respect of haemodynamic changes and conditions for LMA insertion.
Methods: This study was done on 60 female patients of ASA I, II grade between 20-60 years of age. Patients were randomized into two groups (n=30). All patients were preoxygenated and received inj. fentanyl 2µg/kg. Induction agent was propofol 2.5mg/kg (group P) or sevoflurane 8% with vital capacity breath (group S). Loss of eyelash reflex was the end point of induction. Induction time, conditions for LMA insertion, number of attempts, time of successful LMA insertion and haemodynamic parameters were noted.
Results: time for induction and LMA insertion was significantly faster in propofol group than group S (p<0.05). Successful LMA insertion in first attempt was 100% in group P with excellent conditions (score 18) while in group S, it was 86.7% with excellent to satisfactory conditions (score 16-17). A significant fall in mean arterial pressure (p<0.05) was noted in group P while pulse rates were comparable in both groups.
Conclusions: Sevoflurane vital capacity breath inhalational induction can be used as an effective alternative to propofol though it requires greater time for LMA insertion but with better haemodynamic stability.
Krohner RG, Ramanathan S. Anatomy of airway in Benumofs airway management 2nd edition. 2006;1-19, 476- 97, 1027-9.
Driver I, Wilson C, Wiltshire S, Mills P, Howard – Griffin R.Co-induction and Laryngeal Mask Airway; a comparison of thiopentone versus propofol. Anaesthesia. 1997;52:698-703.
Baker CE, Smith I. Sevoflurane: a comparison between vital capacity and tidal breathing techniques for induction of anesthesia and laryngeal mask airway placement. Anesthesia 1995;54:841-4.
Ti LK, Chow MY, Lee TL. Comparison of Sevoflurane with propofol for laryngeal mask airway insertion in adults. Anesth Analog. 1999;88;908-12.
Mary EM, Donal JB, Patrick S. Propofol or Sevoflurane for Laryngeal Mask Airway insertion. Can J Anesth. 1999;46:4:322-6.
Sivalingam P, Kandaswamy R, Madhavan G, Dhakshinamoorthi P. Conditions for laryngeal mask insertion. A comparison of propofol versus sevoflurane with or without alfentanyl Anesthesia 1999;54:271-5.
Hall JE, Stewart JIM, Harmer M. Single-breath inhalation induction of sevoflurane anaesthesia with and without nitrous oxide: A feasibility study in adults and comparison with an intravenous bolus of propofol. Anaesthesia. 1997;52:410-5.
Thwaites A, Edmends S, Smith I. Inhalation induction with sevoflurane: a double – blind comparison with propofol. BJA. 1997:78:356- 61.
Priya V, Divatia JB, Dasgupta D. Comparison of propofol versus Sevoflurane for laryngeal mask airway insertion. Indian J An. 2002;46(1):31-4.
Dwivedi R, Sudhakar D, Chourasia HK. A Comparative Study of Sevoflurane and Propofol for Laryngeal Mask Airway Insertion in Adults. DOI: 10.17354/ijss/2015/158.
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 J Anesth. 2004;21(4):265-71.
Sivalingam P, Kandaswamy R, Madhavan G, Dhakshinamoorthi P. Conditions for laryngeal mask insertion. A comparison of propofol versus sevoflurane with or without alfentanil. Anesthesia 1999;54:271-5.