English

Abstract

INTRODUCTION: Anaesthesia has made major advances in recent years. Considerable efforts have been devoted to airway management by the anesthesiologist during the past 20 years. A large number of supraglottic airway devices have been introduced recently. The original purpose was to reduce the need for more invasive methods of airway management while offering a more reliable alternative to the facemask. The laryngeal mask airway (LMA) is one such innovative device designed for airway management. One of the principal aims of anaesthesia is to counter surgically induced stress. So the anesthesiologist should be able to use a method of delivering the anaesthetic that is by itself not stress inducing3. Since the LMA is placed directly over the posterior pharynx, it avoids tracheal stimulation and hence the systemic and ocular stress response associated with tracheal intubation. AIM OF THE STUDY: The aim of the study is to observe the usefulness of Midazolam and mini-dose of Succinyl choline to facilitate the insertion of laryngeal mask airway during Propofol anesthesia in elective general surgery patients based on the following parameters. 1. Conditions during insertion of laryngeal mask airway such as jaw relaxation, ease of insertion, number of attempts for insertion, airway trauma and total dose of Propofol. 2. Patient’s response to insertion of laryngeal mark airway such as gagging, coughing, head and limb movements, laryngospasm, etc. 3. Hemodynamic parameters like mean arterial pressure, heart rate and oxygen saturation. MATERIALS AND METHODS: After obtaining institutional ethical committee clearance and the patient consent, the study was carried out on 75 patients posted for elective surgical procedures lasting less than or equal to 45 min at Madras Medical College & GGH, Chennai. Patients belonging to the age group of 18 – 50 years of both the sexes were selected. Inclusion Criteria: 1. Elective short surgical procedures lasting less than or equal to 45 min Patients of ASA physical status I and II, 2. Aged between 18 – 50 years of both sexes. Exclusion Criteria: 1. Patients with full stomach ,pregnant patient, 2. Patients posted for emergency surgery, 3. Patients with oral, peri oral pathology such as tumours, abscess or grossly enlarged tonsils. OBSERVATIONS AND RESULTS: This study was conducted on 75 patients who were divided into 3 Groups of 25 patients each. Group A - Propofol Group, Group B - Propofol with midazolam Group, Group C - Propofol with succinyl choline Group. Demographic Profile: In group A and C, 48% of patients are males and rest 52% are females, while in group B 52% of patients are males and rest females. The mean age of patient is 30.52, 30.12 and 30.84 in groups A, B and C respectively. The mean weight is 51.8, 53 and 53.22 in groups A, B and C respectively. Patients in each group were statistically comparable in relation to sex, age and weight. SUMMARY: In this study, the conditions of LMA insertion, patient’s response to LMA insertion and the hemodynamic changes during and after LMA insertion in the following three groups of patients were observed. Group A - Inj. Propofol 2.5mg/kg only. Group B - Inj. Propofol 2.5 mg/kg + 0.04mg/kg midazolam. Group C- Inj. Propofol 2.5 mg/kg + 0.1 mg/kg succinyl choline. • The jaw relaxation was adequate in 100% of Group B patients compared to 32 % of patients in Group A and 64% in Group C. • Overall insertion conditions were excellent in 100% of patients in Group B compared to 32% in Group A and 44% in Group C. • LMA was inserted successfully in the first attempt in 100% of patients in Group A compared to 40% in Group A and 64% in Group C. • Airway trauma as evidenced by blood staining of LMA was found in 36% of patients in Group A and 32% in Group C while none of the patients in Group B had any airway trauma. • Post op myalgia was present in 40% of patients in Group C. • Patient movements were present in 48% of patients in Group A compared to 12% in Group C while no movement was present in any of the patient in Group B. • The total dose of Propofol required for successful insertion of LMA was 2.76mg/kg in Group A and 2.60 mg/kg in Group C, while it is the least 2.06mg/kg in Group B which is the cause of significant hemodynamic stability in patients of Group B CONCLUSION: To conclude, addition of Midazolam (0.04mg/kg) to the standard dose of propofol provides better LMA insertion conditions than the addition of mini-dose Succinyl Choline (0.1mg/kg).