Improving Laryngeal Mask Airway Insertion Success by Using Fentanyl or Succinylcholine as Adjunct in Propofol Induction

Abstract

Purpose: The successful insertion of a laryngeal mask airway (LMA) during propofol induction requires a proper mouth opening and minimal obstructive airway reflexes. We hypothesized that the concurrent use of fentanyl or succinylcholine in a propofol induction could reduce the occurrence of airway reflex and increase the success rate of laryngeal mask airway insertion. Methods: We randomly allocated 60 enrolled patients (scheduled to undergo surgery under general anesthesia) into three treatment groups: (1) propofol 2 mg/kg only; (2) propofol 2 mg/kg with fentanyl 2 μg/kg; (3) propofol 2 mg/kg with succinylcholine 0.5 mg/kg. After premedication with atropine (0.01 mg/kg, intravenous), we recorded the interval between the introduction of the treatment and the time of jaw relaxation, any excitatory movements after administering the induction agents and, after inserting the laryngeal mask, checked their airway reflex. Student's t test and Chi-square test were used to analyze the data. Results: Demographic data for all three groups were statistically identical. The concurrent use of fentanyl or succinylcholine during propofol induction significantly shortened LMA insertion time, decreased airway reflex, and increased the success rate of LMA insertion when compared to use of propofol alone. No process difference was found between the two adjuncts, fentanyl and succinylcholine. Conclusions: As an induction agent for the insertion of LMA, propofol alone (2 mg/kg ) is not recommended. Adding either fentanyl (2 μg/kg) or succinylcholine (0.5 mg/kg) significantly, and equally, improves the success rate. A further evaluation should be made to consider adverse postoperative effects.