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Belete E, W/Yahones M, Aweke Z, Dendir G, Mola S, Neme D, Melaku G, Ahmed S, Regasa T, Tesfaye B. Comparison of thiopentone with lidocaine spray vs propofol for laryngeal mask airway insertion at tikur anbessa specialized hospital. A prospective cohort study. Ann Med Surg (Lond) 2021; 66:102436. [PMID: 34141417 PMCID: PMC8187156 DOI: 10.1016/j.amsu.2021.102436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/22/2021] [Indexed: 11/25/2022] Open
Abstract
Background Insertion of laryngeal mask airway (LMA) requires an adequate depth of anesthesia. Optimal insertion conditions and hemodynamic stability during LMA insertion are mainly influenced by the choice of the intravenous induction agent. Propofol was recommended as a standard induction agent for LMA insertion. Due to unavailability and cost for treatment Propofol is not easily availed, thus this study aimed at assessing the effect of thiopentone with lidocaine spray compared to Propofol on hemodynamic change and LMA insertion on the patient undergoing elective surgery. Methods Eighty-four participants were followed in a prospective cohort study based on the induction type of either thiopentone-lidocaine group (TL) or Propofol (P). Hemodynamic variables, LMA insertion condition, apneic time, and cost of treatment during the perioperative time were recorded. Data were checked for normality using the Shapiro-Wilk test. Numeric data were analyzed unpaired student's t-test or Manny Whitney test. Categorical data were analyzed by the chi-square test. A p-value ≤ 0.05 was considered a statistically significant difference. Result The comparison of data showed that a significant reduction in mean arterial blood pressure (MAP) in the Propofol group during the first 10 min. The MAP at first minute after LMA insertion was 78.4 ± 5.5 in the Propofol group compared to 81.8 ± 5.6 in thiopentone-lidocaine group p < 0.001. the mean MAP at 5th and 10th minutes after LMA insertion is also significantly lower in the Propofol group compared to the thiopentone-lidocaine group, p < 0.05. There were no statistically significant differences regarding the heart rate change and insertion conditions between the two groups. Mean apneic time was 138 ± 45.8 s in the Propofol group and 85 ± 13.8 s in thiopentone-lidocaine group p < 0.001. Thiopentone-lidocaine group had a lower treatment cost compared to the Propofol group. Conclusion Thiopentone with 10% topical Lignocaine is an alternative for the insertion of LMA to Propofol, with better hemodynamic stability and cost-effectiveness. Insertion of laryngeal mask airway requires an adequate depth of anesthesia. The choice of induction agent influence the optimal insertion conditions of LMA. The hemodynamic stability can also be affected by types of induction agent. Thiopentone with 10% topical Lignocaine is an alternative for the insertion of LMA.
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Key Words
- ASA, American Society of Anesthesiology
- DBP, Diastolic Blood Pressure
- ECG, Electro Cardio Graph
- ETB, Ethiopian Birr
- HR, Heart Rate
- IV, Intra Venous
- LMA
- LMA, Laryngeal Mask Airway
- MAP, Mean Arterial Blood Pressure
- NIBP, Non Invasive Blood Pressure
- Propofol
- SBP, Systolic Blood Pressure
- SPSS, Statistical Package for Social Sciences
- Thiopentone
- Topical lignocaine
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Affiliation(s)
- Engidawork Belete
- Diredawa University, College of Medicine and Health Science, Department of Anesthesia, Diredawa, Ethiopia
| | - Misrak W/Yahones
- Addis Ababa University, College of Medicine and Health Science, Department of Anesthesia, Addis Ababa, Ethiopia
| | - Zemedu Aweke
- Dilla University, College of Medicine and Health Science, Department of Anesthesia, Dilla, Ethiopia
| | - Getahun Dendir
- WolaitaSodo University, College of Medicine and Health Science, Department of Anesthesia, Sodo, Ethiopia
| | - Simeneh Mola
- Dilla University, College of Medicine and Health Science, Department of Anesthesia, Dilla, Ethiopia
| | - Derartu Neme
- Dilla University, College of Medicine and Health Science, Department of Anesthesia, Dilla, Ethiopia
| | - Getnet Melaku
- Dilla University, College of Medicine and Health Science, Department of Midwifery, Dilla, Ethiopia
| | - Siraj Ahmed
- Dilla University, College of Medicine and Health Science, Department of Anesthesia, Dilla, Ethiopia
| | - Teshome Regasa
- Dilla University, College of Medicine and Health Science, Department of Anesthesia, Dilla, Ethiopia
| | - Brook Tesfaye
- Addis Ababa University, College of Medicine and Health Science, Department of Anesthesia, Addis Ababa, Ethiopia
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Nasseri K. Effect of Low-dose Atracurium on Laryngeal Mask Airway Insertion Conditions: A Randomized Double-blind Clinical Trial. Adv Biomed Res 2017; 6:119. [PMID: 28989912 PMCID: PMC5627563 DOI: 10.4103/abr.abr_265_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: The amount of sedation and muscle relaxation of the jaw may have an impact on complications caused by laryngeal mask airway (LMA). The aim of this study is to evaluate the effect of low-dose Atracurium on conditions of insertion, complications, and hemodynamic responses to LMA insertion following induction of anesthesia with propofol, in patients undergoing cataract surgery. Patients and Methods: In this double-blind randomized clinical trial study, 60 patients were randomly divided into two groups. Initially, the patients in the study group received 0.15 mg/kg intravenous injection of atracurium, and the patients in the control group received 2 ml of intravenous injection of normal saline, after which anesthesia in both groups were induced with midazolam, fentanyl, lidocaine, and propofol. The amount of jaw relaxation, ease of insertion, and the time needed for insertion, hemodynamic responses and complications of LMA insertion were evaluated. Results: Jaw relaxation and ease of LMA insertion in the study group was significantly better than that of the control group (P = 0.02). Average time needed for LMA placement in the study group (5/06 ± 0.52 second) was significantly lower than the control group (5/76 ± 0.67 second) (P = 0.001). Hemodynamic response to LMA insertion was similar in both groups. Sore throat at recovery and 24 h after surgery in the control group was significantly higher than that of the study group (3/30 vs. 10/30) (P = 0.01). Conclusions: Using low doses of atracurium decreases the time needed for LMA insertion and sore throat after the operation. Atracurium also increases jaw relaxation and facilitates the placement of LMA.
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Affiliation(s)
- Karim Nasseri
- Department of Anesthesiology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
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Liao AHW, Lin YC, Bai CH, Chen CY. Optimal dose of succinylcholine for laryngeal mask airway insertion: systematic review, meta-analysis and metaregression of randomised control trials. BMJ Open 2017; 7:e014274. [PMID: 28780538 PMCID: PMC5724107 DOI: 10.1136/bmjopen-2016-014274] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES To evaluate the optimal dose of succinylcholine for laryngeal mask airway (LMA) insertion and all related morbidities. DESIGN Systematic review, meta-analysis and metaregression of randomised controlled trials (RCTs). DATA SOURCE AND STUDY ELIGIBILITY CRITERIA A comprehensive search of RCTs in the PubMed, Embase, the Cochrane Library and the ClinicalTrials.gov registry up to July 2016 and articles that evaluated the use of succinylcholine chloride for LMA insertion were included in the analyses. The relative risk (RR) and the corresponding 95% CIs were determined. INTERVENTION Succinylcholine as the coinduction agent and the doses were divided into mini (≤0.3 mg/kg) and low (0.3-1.0 mg/kg) doses for dose-dependent effect analyses. PRIMARY AND SECONDARY OUTCOMES The primary outcome was the first-attempt LMA insertion failure rate. Secondary outcomes included all related adverse events. RESULTS Data from 10 RCTs comprising 625 participants showed that succinylcholine reduced the first-attempt LMA insertion failure rate (RR, 0.22; 95% CI 0.12 to 0.43), coughing and gagging (RR, 0.26; 95% CI 0.15 to 0.45) and laryngospasm (RR, 0.14; 95% CI 0.05 to 0.39). The use of succinylcholine did not result in a significant increase of postoperative myalgia (RR, 2.58; 95% CI 0.79 to 8.44) and did not reduce the risk of postoperative sore throat (RR, 0.76; 95% CI 0.55 to 1.03). Subgroup analysis further showed that low-dose succinylcholine reduced the LMA insertion failure rate and its related coughing and gagging when compared with mini dose. CONCLUSION The use of succinylcholine compared with none can facilitate LMA insertion and reduce insertion-related reflexes without significant postoperative myalgia. However, additional prospective studies with a larger sample size are required to fully evaluate the dose-dependent effect and complications of succinylcholine for LMA insertion.
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Affiliation(s)
- Alan Hsi-Wen Liao
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yu-Cih Lin
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Chyi-Huey Bai
- School of Public Health, College of Nutrition and Public Health, Taipei Medical University, Taipei, Taiwan
| | - Chien-Yu Chen
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Humanities in Medicine, College of Humanities and Social Sciences, Taipei Medical University, Taipei, Taiwan
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Dwivedi MB, Nagrale M, Dwivedi S, Singh H. What happens to the hemodynamic responses for laryngeal mask airway insertion when we supplement propofol with butorphanol or fentanyl for induction of anesthesia: A comparative assessment and critical review. Int J Crit Illn Inj Sci 2016; 6:40-4. [PMID: 27051621 PMCID: PMC4795361 DOI: 10.4103/2229-5151.177369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: There is a delicate balance between respiratory tract anatomy, its physiology, physiological response to anesthetic agents, and airway management. The traditional gadgets to secure airway are face masks or endotracheal tubes. Recently, laryngeal mask airway (LMA) is gaining popularity. It does not require laryngoscopy thereby minimizing hemodynamic responses. For LMA placement, propofol is the induction agent of choice. Propofol, when used alone, requires large doses and leads to undesirable cardiorespiratory depression. To culminate its dose, various adjuncts are combined with it. Aim: Comparison of hemodynamic response of LMA using either butorphanol or fentanyl (according to group allocated) in combination with propofol. Methodology: Hundred patients scheduled for various surgical procedures were randomly selected and divided into two groups of 50 patients each, Group F (propofol and fentanyl) and Group B (propofol and butorphanol). One minute after giving intravenous (IV) opioids, induction was achieved with IV propofol 2.5 mg/kg. Depth of anesthesia was assessed, and LMA was inserted. Hemodynamic variables were measured before premedication, after premedication; 1, 3, and 5 min after insertion and after extubation of LMA. Results: After insertion of LMA, statistically significant drop in mean heart rate, systolic blood pressure (BP), diastolic BP, and mean BP was noted in Group F as compared to Group B (P < 0.05). Conclusion: The use of propofol-butorphanol combination produces stable hemodynamics as compared to propofol-fentanyl combination.
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Affiliation(s)
- Manisha Bhatt Dwivedi
- Department of Anaesthesiology and Critical Care, MMIMSR, Mullana-Ambala, Haryana, India
| | - Manda Nagrale
- Department of Anaesthesiology and Critical Care, JNMC, Sawangi, Meghem, Wardha, Maharashtra, India
| | - Sankalp Dwivedi
- Department of Anaesthesiology and Critical Care, MMIMSR, Mullana-Ambala, Haryana, India
| | - Hardeep Singh
- Department of Anaesthesiology and Critical Care, MMIMSR, Mullana-Ambala, Haryana, India
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Lidocaine given intravenously improves conditions for laryngeal mask airway insertion during propofol target-controlled infusion. Eur J Anaesthesiol 2009; 26:377-81. [PMID: 19521294 DOI: 10.1097/eja.0b013e32831dcd4d] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Patient response to laryngeal mask airway insertion during propofol induction depends on many factors. Lidocaine has been used to reduce cardiovascular responses, coughing, and bucking induced by tracheal intubation. The aim of this study was to determine the effects of intravenous lidocaine on laryngeal mask airway insertion conditions during the induction of anaesthesia with propofol target-controlled infusion. METHODS Eighty patients, 16-54 years of age, weighing between 45 and 100 kg, who underwent minor surgery, were randomly divided into two groups (the lidocaine and control groups). Anaesthesia was induced with propofol target-controlled infusion at a target plasma concentration of 6 microg ml. The lidocaine group received 1.5 mg kg of lidocaine 50 s after starting target-controlled infusion and the control group received an equivalent volume of saline. Laryngeal mask airways were inserted when propofol effect-site concentrations reached 2.5 microg ml. Laryngeal mask airway insertion conditions (mouth opening, gagging, coughing, movements, laryngospasm, overall ease of insertion, and hiccups) were assessed, and haemodynamic responses were monitored for 3 min after laryngeal mask airway insertion. RESULTS No significant differences were observed between the two groups in terms of haemodynamic responses. However, the lidocaine group showed lower incidences of coughing (5 vs. 22.5%), gagging (25 vs. 55%), and laryngospasm (2.5 vs. 17.5%) (P < 0.05). CONCLUSION Pretreatment with intravenous lidocaine 1.5 mg kg during induction with propofol target-controlled infusion improves laryngeal mask airway insertion conditions.
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Chari P, Ghai B. Comparison of butorphanol and thiopentone vs fentanyl and thiopentone for laryngeal mask airway insertion. J Clin Anesth 2006; 18:8-11. [PMID: 16517325 DOI: 10.1016/j.jclinane.2005.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2004] [Accepted: 04/28/2005] [Indexed: 10/24/2022]
Abstract
STUDY OBJECTIVE To compare laryngeal mask airway (LMA) insertion conditions using a combination of butorphanol and thiopentone vs fentanyl and thiopentone. DESIGN Prospective, randomized, and double-blind study. SETTING Operating theater. PATIENTS One hundred four females, with American Society of Anesthesiologists grades I and II, diagnosed with carcinoma cervix scheduled for intracavitary implant placement, were recruited into the study. The patients were randomly divided into 2 groups of 52 each. INTERVENTION Anesthesia was induced with butorphanol (30 microg kg(-1)) and thiopentone in group B and fentanyl (1.5 microg kg(-1)) and thiopentone in group F, followed by LMA insertion. Anesthesia was maintained with O2, N2O, and isoflurane with spontaneous ventilation. MEASUREMENTS Six variables were noted on a 3-point scale: jaw relaxation (nil/slight/gross), ease of insertion (easy/difficult/impossible), swallowing (nil/slight/gross), coughing/gagging (nil/slight/gross), limb/head movement (nil/slight/gross), and laryngospasm (nil/slight/gross). Postoperatively, sedation score was assessed on a 4-point scale at 1/2 hour, 1 hour, and 2 hours. MAIN RESULTS The 2 groups were demographically similar. Incidence of full jaw relaxation at first attempt was significantly higher in group B vs F (48 vs 35 patients, P = 0.003). Insertion was easy in 48 vs 37 patients in group B and F, respectively (P = 0.017). The incidence of swallowing, patient movements, and laryngospasm was comparable among the groups. Coughing/gagging was significantly lower in group B (P = 0.008). Significantly more patients were sedated in group B at 1/2 hour (P = 0.010) and 1 hour (P = 0.000). None of the patients were deeply sedated at 1 hour. At 2 hours, all patients were awake. CONCLUSION The use of butorphanol and thiopentone as induction agents produced excellent LMA insertion conditions compared to fentanyl and thiopentone (98% vs 86% success rate with 92% vs 71% easy insertion).
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Affiliation(s)
- Pramila Chari
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh-160012, India
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Abstract
STUDY OBJECTIVE To compare the Laryngeal Mask Airway (LMA; The Laryngeal Mask Airway Co., Ltd., Nicosia, Cyprus) insertion conditions produced by 6 and 8 microg/mL of target plasma concentrations (Cpt) during the induction of anesthesia with target-controlled infusion (TCI) of propofol. DESIGN Randomized, prospective, single-blind, clinical study. SETTING University hospital. PATIENTS 44 ASA physical status I and II patients, 16 to 54 years of age, weighing between 45 and 100 kg, undergoing minor surgery in which the use of LMA was indicated. INTERVENTIONS Patients were randomly divided into two groups (1 and 2) of 22 to compare the effects of different propofol concentrations. Three minutes after intravenous (IV) injection of midazolam 0.04 mg/kg, group 1 and 2 received TCI of propofol with 6 and 8 microg/mL of Cpt, respectively. LMA was inserted when the effect-site concentration (EC) reached 2.5 microg/mL, which was displayed on the infusion pump. MEASUREMENTS The LMA insertion conditions (mouth opening, gagging, coughing, head or limb movement, laryngospasm, overall ease of insertion) were assessed, and hemodynamic responses were evaluated until 3 minutes after LMA insertion. Total dose of propofol, EC, and elapsed time since the start of TCI were recorded at five times: at the loss of consciousness and eyelash reflex, at 2.5 microg/mL of EC, and immediately, 1 minute, and 3 minutes after the insertion of LMA. MAIN RESULTS There was no significant difference between the two groups in insertion conditions, despite the significantly larger total dose and shorter elapsed time (2.6 +/- 0.08 mg/kg and 109 +/- 5.0 s) in Group 2 than those (2.1 +/- 0.02 mg/kg and 140 +/- 4.1 s) in Group 1 at 2.5 microg/mL of EC (p < 0.05). Systolic and diastolic blood pressure decreased and heart rate increased significantly throughout the study period in both groups (p < 0.05). But there was a significant decrease in arterial pressure in Group 2 compared with Group 1 1 and 3 minutes after the insertion (p < 0.05). CONCLUSIONS Induction with 8 microg/mL of Cpt, compared with 6 microg/mL, allowed earlier LMA insertion but, could not improve the conditions for LMA insertion and required more careful attention to the decrease in blood pressure after LMA insertion.
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Affiliation(s)
- H J Baik
- Department of Anesthesiology, Tong-Dae-Mun Hospital, College of Medicine, Ewha Womans University, Seoul, South Korea.
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