Abstract
To determine the haemodynamic changes at induction during laryngeal mask airway (LMA) insertion comparing propofol versus lignocaine-thiopentone admixture. In this comparative randomised study, patients of American Society of Anesthesiologists’ (ASA) class I and II with age range of 18-60 years scheduled for short elective surgeries were randomly assigned into two equal groups. Patients were premedicated with fentanyl 1ug.kg-1. Anaesthesia was induced with either 2.5mg.kg-1 propofol or a sequence of 2mg.kg-1 lignocaine and 5mg.kg-1 thiopental given by a trained assistance. Anaesthesia was maintained with 2% isoflurane and 100% oxygen. Haemodynamic variables [Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP) and Heart Rate (HR)] were measured non-invasively in three periods; before drug administration, immediately after drug administration prior to insertion of LMA and finally after LMA insertion.In group A, the baseline heart rate (92.3±11) was compared to the post-induction heart rate (100.7±09) with p=0.765 and post-insertion heart rate (98.0±13) with p=0.767. Although, there was a rise in the heart rate from the baseline after induction and insertion of LMA, this was not statistically significant. Also, baseline SBP (120.7±09) was compared to the post-induction SBP (102.5±07) with p=0.001 and post-insertion SBP (102.59±07) with p=0.001. This was statistically significant. The baseline DBP (77.9±08) was compared to the post-induction DBP (67.0±12) with p=0.004 and post-insertion DBP (62.5±09) with p=0.001.This was statistically significant. The baseline MAP (92.6±01) was compared to the post-induction MAP (79.7±01) with p=0.008 and post-insertion MAP (76.2±07) with p=0.001. This was also statistically significant. In group B, the baseline heart rate (93.2±12) was compared to post-induction heart rate (99.2±11) with p=0.520 and post-insertion heart rate (94.8±12) with p=0.989. This was not statistically significant. The baseline SBP (120.7±13) was compared to the post-induction SBP (115.9±12) with p=0.139 and post-insertion SBP (117.5±13) with p=0.318. This was not statistically significant. The baseline DBP (80.6±14) was compared to the post-induction DBP (75.2±11) with p=0.636 and post-insertion DBP (76.6±13) with p=0.712. This was also not statistically significant. The baseline MAP (94.3±01) was compared to the post-induction MAP (87.5±01) with p=0.779 and post-insertion MAP (88.3±01) with p=0.882. This was not statistically significant. We concluded that propofol and lignocaine-thiopentone admixture exhibited similar haemodynamic profile in our study and therefore recommend that both drugs can be used for patients.
Highlights
The laryngeal mask airway is a supraglottic airway device used to maintain the airway during anaesthesia
The Systolic Blood Pressure (SBP) decreased from baseline value by 2.5% in groups of each as follows; propofol (group A) compared to a decrease of 13.3% in group B with p=0
There was a 20.1% decrease in the Diastolic Blood Pressure (DBP) from the baseline value in group A compared to a 1.2% decrease in group B with p=0.0001
Summary
The laryngeal mask airway is a supraglottic airway device used to maintain the airway during anaesthesia. It can be used to maintain airway during difficult or failed intubation and in cardiopulmonary resuscitation.[1,2] While maintaining the airway, it allows the Anaesthesiologist have free hands to attend to other responsibilities. Different induction agents and adjuvants have been employed to facilitate placement of the LMA.[3,4]. The optimal depth of anaesthesia for LMA placement is considerably less than that for tracheal intubation[5,6] Various induction agents and their combinations have been used to facilitate its insertion with least side effects as well as to blunt associated haemodynamic changes.[7,8] Thiopentone is an intravenous anaesthetic agent that has been studied several times either alone or in combination with other drugs like lignocaine, midazolam, dextometodimidine, succinylcholine or butorphanol as induction agent for LMA insertion.[9,10] The relative high
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