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Comparison of dexmedetomidine–propofol vs. fentanyl–propofol for laryngeal mask insertion

Published online by Cambridge University Press:  01 August 2008

F. Uzümcügil ,
O. Canbay ,
N. Celebi ,
A. H. Karagoz  and
S. Ozgen
F. Uzümcügil*
Affiliation:
Hacettepe University School of Medicine, Anesthesiology and Reanimation, Ankara, Turkey
O. Canbay
Affiliation:
Hacettepe University School of Medicine, Anesthesiology and Reanimation, Ankara, Turkey
N. Celebi
Affiliation:
Hacettepe University School of Medicine, Anesthesiology and Reanimation, Ankara, Turkey
A. H. Karagoz
Affiliation:
Hacettepe University School of Medicine, Anesthesiology and Reanimation, Ankara, Turkey
S. Ozgen
Affiliation:
Hacettepe University School of Medicine, Anesthesiology and Reanimation, Ankara, Turkey
*
Correspondence to: Filiz Uzümcügil, Department of Anesthesiology and Reanimation, Hacettepe University, Ankara, Turkey. E-mail: [email protected]; Tel: +90 312 3051250; Fax: +90 312 3109600
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Summary

Background and objectives

There have been many studies to find the optimum anaesthetics to provide excellent conditions for laryngeal mask insertion. We compared the effects of dexmedetomidine administered before propofol, on laryngeal mask insertion with fentanyl combined with propofol.

Methods

In all, 52 patients, ASA I–II, scheduled to have minor urological procedures were randomized into two groups. Group F received 1 μg kg−1 fentanyl (in 10 mL normal saline) and Group D received 1 μg kg−1 dexmedetomidine (in 10 mL normal saline). We used 1.5 mg kg−1 propofol for induction and 50% N2O and 1.5% sevoflurane in oxygen for maintenance. We observed jaw mobility (1: fully relaxed; 2: mild resistance; 3: tight but opens; 4: closed), coughing or movement (1: none; 2: one or two coughs; 3: three or more coughs; 4: bucking/movement) and other events such as spontaneous ventilation, breath holding, expiratory stridor and lacrimation. In each category, scores <2 were acceptable for laryngeal mask insertion.

Results

More patients developed apnoea and their apnoea times were longer in Group F than Group D (P < 0.001). Respiratory rates increased in Group D (P < 0.001). Adverse events during laryngeal mask insertion were similar. The reductions in systolic and mean blood pressures were greater in Group F (systolic: P < 0.05, mean: P < 0.01). Emergence times were shorter in Group F than in Group D (P < 0.001).

Conclusion

Dexmedetomidine, when used before propofol induction provides successful laryngeal mask insertion comparable to fentanyl, while preserving respiratory functions more than fentanyl.

Keywords

DEXMEDETOMIDINELARYNGEAL MASKSPROPOFOLFENTANYLCARDIOVASCULAR RESPONSES
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 8 , August 2008 , pp. 675 - 680
Copyright
Copyright © European Society of Anaesthesiology 2008

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References

1.Gal, TJ. Airway management. In: Miller, RD, ed. Miller’s Anesthesia, 6th edn, vol. 2. Philadelphia, USA: Elsevier, Churchill Livingstone, 2005: 1617–1653.Google Scholar
2.Janssens, M, Lamy, M. Laryngeal mask. Intensive Care World 1993; 10 (2): 99–102.Google ScholarPubMed
3.Wilkins, CJ, Cramp, PG, Staples, J, Stevens, WC. Comparison of the anesthetic requirement for tolerance of laryngeal mask airway and endotracheal tube. Anesth Analg 1992; 75 (5): 794–797.CrossRefGoogle ScholarPubMed
4.Liou, CM, Hung, WT, Chen, CC, Hsu, SC, Lau, HK. Improving the success rate of laryngeal mask airway insertion during etomidate induction by using fentanyl or succinylcholine. Acta anesthesiol Taiwan 2004; 42 (4): 209–213.Google ScholarPubMed
5.Sıddik-Sayyid, SM, Aouad, MT, Taha, SK et al. A comparison of sevoflurane-propofol versus sevoflurane or propofol for laryngeal mask airway insertion in adults. Anesth Analg 2005; 100 (4): 1204–1209.CrossRefGoogle ScholarPubMed
6.Leong, WM, Ong, EL. Laryngeal mask airway can be inserted with inhaled desflurane induction. J Anesth 2005; 19 (2): 112–117.CrossRefGoogle ScholarPubMed
7.Suzuki, KS, Oohata, M, Morı, N. Multiple-deep-breath inhalation induction with 5% sevoflurane and 67% nitrous oxide: comparison with intravenous injection of propofol. J Anesth 2002; 16 (2): 97–101.CrossRefGoogle ScholarPubMed
8.Goh, PK, Chiu, CL, Wang, CY, Chan, YK, Loo, PL. Randomized double-blind comparison of ketamine-propofol, fentanyl-propofol and propofol-saline on hemodynamics and laryngeal mask airway insertion conditions. Anesth Intensive Care 2005; 33 (2): 223–228.CrossRefGoogle ScholarPubMed
9.Yazicioglu, H, Muslu, S, Yamak, B, Erdemli, O. Laryngeal mask airway insertion with remifentanyl. Acta Anesth Belg 2005; 56 (2): 171–176.Google Scholar
10.Tayler, N, Kenny, GNC. Requirements for target-controlled infusion of propofol to insert the laryngeal mask airway. Anesthesia 1998; 53: 222–226.CrossRefGoogle Scholar
11.Tanaka, M, Nishikawa, T. Propofol requirement for insertion of cuffed oropharyngeal airway versus laryngeal mask airway with and without fentanyl: a dose-finding study. Br J Anaesth 2003; 90 (1): 14–20.CrossRefGoogle ScholarPubMed
12.Kodaka, M, Okamoto, Y, Handa, F, Kawasaki, J, Miyao, H. Relationship between fentanyl dose and predicted EC50 of propofol for laryngeal mask airway insertion. Br J Anesth 2004; 92 (2): 238–241.CrossRefGoogle Scholar
13.Driver, IK, Wiltshire, S, Mills, P, Lillywhite, N, Howard-Griffin, R. Midazolam co-induction and laryngeal mask insertion. Anaesthesia 1996; 51: 782–784.Google ScholarPubMed
14.Mahajan, VA, Ni Chonghaile, M, Bokhari, SA, Harte, BH, Flynn, NM, Laffey, JG. Recovery of older patients undergoing ambulatory anesthesia with isoflurane or sevoflurane. Eur J Anesth 2007; 24: 505–510.CrossRefGoogle ScholarPubMed
15.Hemmerling, TM, Beaulieu, P, Klaus, EJ, Babin, D, Schmidt, J. Neuromuscular blockade does not change the incidence or severity of pharyngolaryngeal discomfort after LMA anesthesia. Can J Anaesth 2004; 51 (7): 728–732.CrossRefGoogle ScholarPubMed
16.Goyagi, T, Tanaka, M, Nishikawa, T. Fentanyl decreases propofol requirement for laryngeal mask airway insertion. Acta anesth Scand 2003; 47 (6): 771–774.CrossRefGoogle ScholarPubMed
17.Hsu, YW, Cortinez, LI, Robertson, KM et al. Dexmedetomidine pharmacodynamics: Part I, Crossover comparison of the respiratory effects of dexmedetomidine and remifentanil in healthy volunteers. Anesthesiology 2004; 101: 1066–1076.CrossRefGoogle ScholarPubMed
18.Maroof, M, Khan, RM, Jain, D, Ashraf, M. Dexmedetomidine is a useful adjunct for awake intubation. Can J Anaesth 2005; 52 (7): 776–777.CrossRefGoogle ScholarPubMed
19.Guler, G, Akın, A, Tosun, Z, Eskıtascoglu, E, Mızrak, A, Boyacı, A. Single-dose dexmedetomidine attenuates airway and circulatory reflexes during extubation. Acta Anesthesiol Scand 2005; 49: 1088–1091.CrossRefGoogle ScholarPubMed
20.Guler, G, Akın, A, Tosun, Z, Ors, S, Esmaoglu, A, Boyacı, A. Single-dose dexmedetomidine reduces agitation and provides smooth extubation after pediatric adenotosillectomy. Pediatr Anesth 2005; 15: 762–766.CrossRefGoogle Scholar
21.Muzi, M, Robinson, BJ, Ebert, TJ, O’Brien, TJ. Induction of anesthesia and tracheal ıntubation with sevofluran in adults. Anesthesiology 1996; 85 (3): 536–543.CrossRefGoogle ScholarPubMed
22.Avitsian, R, Lin, J, Michelle, L, Ebrahim, Z. Dexmedetomidine and awake fiberoptic ıntubation for possible cervical spine myelopathy. J Neurosurg Anesthesiol 2005; 17: 97–99.CrossRefGoogle ScholarPubMed
23.Lawrence, CJ, Lange, S. Effects of a single pre-operative dexmedetomidine dose on isoflurane requirements and peri-operative hemodynamic stability. Anesthesia 1997; 52: 736–744.CrossRefGoogle Scholar
24.Scheinin, B, Lindgren, L, Randell, T, Schenin, H, Schenin, M. Dexmedetomidine attenuates sympathoadrenal responses to tracheal intubation and reduces the need for thiopentone and perioperative fentanyl. Br J Anaesth 1992; 68: 126–131.CrossRefGoogle Scholar
25.Ebert, TJ, Hall, JE, Barney, JA, Uhrich, TD, Colinco, MD. The effects of increasing plasma concentrations of dexmedetomidine in humans. Anesthesiology 2000; 93: 382–394.CrossRefGoogle ScholarPubMed
26.Bellville, JP, Ward, DS, Bloor, BC, Maze, M. Effects of intravenous dexmedetomidine in humans: I. Sedation, ventilation, and metabolic rate. Anesthesiology 1992; 77: 1125–1133.CrossRefGoogle Scholar
27.Turan, A, Kaya, G, Koyuncu, O, Karamanlioglu, B, Pamukçu, Z. Comparison of the laryngeal mask (LMATM) and laryngeal tube (LT) with the new perilaryngeal airway (CobraPLA) in short surgical procedures. Eur J Anesth 2006; 23: 234–238.CrossRefGoogle Scholar