A comparison between propofol and sevoflurane for easy insertion of laryngeal mask airway among adults in minor elective surgeries: An observational study

Background: The laryngeal mask airway (LMA) has reached ample popularity for the management of airway during surgery. Propofol, used as induction agent, causes change in blood pressure and heart rate (HR) while insertion of LMA. Sevoflurane, whereas, has the potential to be a good induction agent as propofol. We have compared propofol and sevoflurane for easy insertion of LMA among adults in minor surgeries. Aim and Objectives: The primary objective of the study was to compare the ease of insertion of LMA and its characteristics related to insertion among adults in minor elective surgeries using intravenous propofol or inhalational sevoflurane. While time taken to set induction and actual event of LMA insertion along with number of attempts, jaw relaxation time, LMA insertion time, apnea time, monitoring hemodynamic changes, and occurrence of complications were taken as secondary objectives. Materials and Methods: It was a prospective and observational study done in Department of Anesthesiology and Operation Theaters of Fortis Hospital, Kolkata, after getting ethical approval. Total 100 patients were recruited by consecutive sampling and divided into two groups - P (propofol) and S (sevoflurane) group. Anesthesia induction time, jaw relaxation time, LMA insertion time, etc. were noted. LMA insertion conditions were assessed by a 3-point scale using six variables, total score was calculated for each group. Hemodynamic parameters and induction complications were also recorded. Results: There was no significant difference in demographic parameters, American Society of Anesthesiologists class, Modified Mallampati Grading, and LMA size, between the groups. LMA insertion time was comparable between the two groups. Regarding complications, there was no incidence of coughing while minor gagging (4%) and laryngospasm (6%) were noted only with sevoflurane. Final summation of scores showed excellent insertion characteristics with propofol (94%) and sevoflurane (84%), respectively, with no significant difference. Conclusion: Inhalational sevoflurane may be regarded as a viable alternative to inj. propofol for insertion of laryngeal mask among adults in minor elective surgeries.

Evaluation of Midazolam as an Intravenous Induction Agent for General Anaesthesia-Comparision with Thiopentone

Introduction: Midazolam, a water-soluble benzodiazepine, isnon-irritant on intravenous injection and has a shorter durationof action than diazepam. In this research, we evaluated theinduction time achieved with midazolam and compared withthiopentone. We also observed the hemodynamic effectsfollowing induction with midazolam and thiopentone. In thecurrent study, we also studied undesirable or unwanted effectsof the two drugs.Material and methods: The present study was conductedat Civil Hospital, Aizawl Mizoram in thedepartmentofAnaesthesiology and Critical Care. The study was conductedbetween November 2018 to October 2019. A clinical studywas carried out in hundred patients with a physical status ofASA I and ASA II patients, patients between 20-50 years ofage and weight 45-70 kg were selected and were divided intotwo groups each group consisting of fifty patients. Group A– Midazolam (0.2mg/kg) and Group B – Thiopentone (5mg/kg). A routine preanaesthetic check-up was carried out beforethe operation. The procedure of anaesthesia to be given wasexplained to the patients and written informed consent wastaken accordingly.Results: The mean age (in years) of the midazolam group was35.54 ± 8.5 and it was 34.06 ± 10.2 in the thiopentone group.We found a statistically significant difference of weight,spontaneous closure of eye, Loss of lid reflex between boththe groups. Patient Good acceptance was good in 16 (66.67%)participants in midazolam and 8 (33.33%) participants in thethiopentone group.Conclusion: We conclude that midazolam is a satisfactorysubstitute to thiopentone.

Study to assess the effect of mini-dose Succinylcholine for ease of laryngeal mask airway insertion

Background: Propofol as sole induction agent is often insufficient for the laryngeal mask airway insertion and higher doses are at times required. The present study proposes to assess the effectiveness of 0.25mg/kg mini dose succinylcholine towards facilitation of laryngeal mask airway (LMA) insertion.Methods: In a single blinded randomized controlled trial, 68 patients posted for elective general and orthopaedic surgery were equally assigned to two groups during LMA insertion: Group S (Study group)- patients received a bolus of succinylcholine 0.25mg/kg diluted in 2 ml of 0.9% sodium chloride. Group C (Control group)-patients received a bolus dose of 2 ml of 0.9% sodium chloride. The number of attempts required and ease of LMA insertion, hemodynamic parameters and adverse responses were noted and compared between the groups.Results: The LMA was inserted in first attempt in 32 (94.11%) patients in group S and in 24 (70.58%) patients in group C. The control group had 67.62% grade 1, 32.38% grade 2 and 0% grade 3, while succinylcholine group had 73.53% grade 1, 26.47% grade 2 and 0% grade 3. Hemodynamic parameters didn’t differ significantly between the two groups at any point, but significant difference was observed between occurrence of fasciculation, head and limb movements, sore throat and coughing.Conclusions: Succinylcholine does seem to help in insertion of the laryngeal mask airway but the results could not gain the level of statistical significance, partly attributed to small sample size.

The Comparison of Vecuronium with Succinylcholine for Endotracheal Intubation / 대한마취과학회지

Depolarizing muscle relaxant, succinylcholine, has a rapid onset of action, allowing early endotracheal intubation. Succinylcholine, however, has a number of undesirable side effects. Therefore, some methods using nondepolarizing muscle relaxants for rapid endotracheal intubation have been tried, i.e. single large bolus, priming principle, timing principle, but their results were not enough to satisfy. In this study, there were administered vecuronium prior to anesthetic induction in order to shorten the intubation time, and compared intubation time and intubating condition in succinylcholine and vecuronium groups respectively. Sixty adult patients were adminstered succinylcholine 1mg/kg(group 1, 30 patients) or vecuronium 0.15 mg/kg(group 2, 30 patients), and measured intubation time and intubating condition. As a result, intubation time and intubation condition was not different in both groups significantly. It is concluded that vecuronium administered prior to induction agent for the endotracheal intubation is a reliable alternative in cases where succinylcholine is contraindicated.

The Comparison of Vecuronium with Succinylcholine for Endotracheal Intubation / 대한마취과학회지

Depolarizing muscle relaxant, succinylcholine, has a rapid onset of action, allowing early endotracheal intubation. Succinylcholine, however, has a number of undesirable side effects. Therefore, some methods using nondepolarizing muscle relaxants for rapid endotracheal intubation have been tried, i.e. single large bolus, priming principle, timing principle, but their results were not enough to satisfy. In this study, there were administered vecuronium prior to anesthetic induction in order to shorten the intubation time, and compared intubation time and intubating condition in succinylcholine and vecuronium groups respectively. Sixty adult patients were adminstered succinylcholine 1mg/kg(group 1, 30 patients) or vecuronium 0.15 mg/kg(group 2, 30 patients), and measured intubation time and intubating condition. As a result, intubation time and intubation condition was not different in both groups significantly. It is concluded that vecuronium administered prior to induction agent for the endotracheal intubation is a reliable alternative in cases where succinylcholine is contraindicated.

Cardiovascular Effects of Anesthetic induction with Midazolam for Open Heart Surgery / 대한마취과학회지

Midazolam, an imidazobenzodiazepine derivative, is utilized as a premedicant, sedative and anesthetic induction agent. Cnmpared to diazepam, midazolam is characterized by better solubility in water, better venous tolerance and a more rapid onset of action. Though the onset of pharmacological action of midazolam takes longer than thiopental, midazolam exerts more gradual effects on circula- tion than thiopental. Because it maintains hemodynamic stability and induces amesthesia smoothly, madazolam is a potential alternative as an induction agent in high-risk patients. To evaluate the safe margin of i. v. midazolam and to investigate the effect of carbon dioxide retention by midazolam, 32 cardiac patients were divided into 4 groups: Group I, midazolam 0.2 mg/ kg with spontaneous respiration: Group II, midazolam 0.2 mg/kg with assist respiration: Group III, midazolam 0.4 mg/kg with assist respiration: Group IV, midazolam 0.4 mg/kg with spontaneons respiration. In each group, systolic blood pressure, diastolic blood pressure, heart rate, respiratory rate, cardiac output and arterial blood gas analysis were checked before and 2,4 and 6 minutes after i. v. injection of midazolam. Systolic blood pressure decreased significantly after injection of midazolam in all four groups. Diastolic blood pressure decreased significantly in group II and IlI. Systolic blood pressure was lower in group III than II 4 and 6 minutes following midazolam administration. The elevation of arterial carbon dioxide tension in group I and IV did not cause any changes in cardiovascular variables. The time from the end of injection of midazolam to spontanous closing of eyes and the time from the end of injection to disappearance of eyelash reflex were measured. But there were no significant differen-ces between all four groups. .On the basis of these data, we could conclude that in unpremedicated patients for open heart surgery midazolam alone allows rapid and smooth induction. In case of using the dose of 0.4 mg/kg, care must be taken in the decrease of systolic blood pressure.

A Clincal Study on Anesthetic Induction with a Thiopental and Ketamine Combination during C-Section / 대한마취과학회지

The incidence of C-sections has increased up to 15~20% and general anesthesia of C-sections is usually induced with thiopental or ketamin. Thiopental can produce significant fetal depression in doses higher than 4mg/kg and ketamine can cause dysphoria. The purpose of this study was to evaluate the possibility of minimizing untoward effects of both drugs by combination of the two. Sixty four pregnant women who underwent general anesthesia and C-section received thiopental 5 mg/kg(n=24); ketamine 1mg/kg(n=19); or a combination of thiopental 2.5mg/kg and ketamine 0.5mg/kg(n=21). The results were as follows: 1. At endotracheal intubation, mean arterial pressure, pulse rate, systolic blood pressure, and rate pressure product were increased from the values before anesthetic induction but there was no statistical significance among groups(p>0.05). 2. The patient's movement to the strong stimulus of skin incision and intraoperative awareness were lower in the ketamine group and higher in the combined group. 3. The induction delivery interval and uterine incision delivery interval did not differ significantly among groups. 4. The incidence of 1 and 5 min Apgar scores below 7 was highest in the thiopental group and lowest in the ketamine group. 5. Postoperative recalling of intraoperative awareness occurred in two patients only in the combined group. 6. PAR scores in the recovery room did not differ significantly among 3 groups. From the above results, the combination of thiopental and ketamine appeared to offer little advantage over thiopental or ketamine. ketamine(1mg/kg) was though to be appropriate for the induction of anesthesia for C-section with respect to the incidence of intraoperative awareness, patient's movemnet to surgical stimuli, and neonatal Apgar scores.