Objective: Laryngeal mask airway(LMA) insertion requires anesthesia and suppression of airway reflexes. We compared dexmedetomidine and fentanyl in combination with propofol for insertion of LMA,In searching of an optimal drug. Methods: 90 patients of ASA class I or Ⅱ undergoing minor orthopedic surgery of lower limbs or minor urological surgery were randomly divided into two groups of 45 each. Group D received dexmedetomidine 1 mg·kg-1 and group S received sulfentanil 0.2 mg·kg-1 intravenously over 2 minutes. For induction, propofol 2 mg·kg-1 was given IV and 90 seconds later LMA was inserted. We observed HR, respiratory rate(RR), MAP, SpO2, BIS,and apnea time before induction, 30 seconds after induction, 1, 3, 5 and 10 minutes after insertion of LMA. Adverse event to LMA insertion like coughing or any other movement were noted and scored. Results: 42(93.3%) patients of group D and 40 (88.9%) patients of group S had LMA insertion score of <2. Adverse events to insertion of LMA and hemodynamic variables were comparable in the both groups. Number of patients developing apnoea was larger and apnoea times were longer in group S compared with group D. When compared to group F, group D showed an increased respiratory rate. Conclusion: Dexmedetomidine can be a comparable alternative to sulfentanil as an adjuvant to propofol for providing optimum insertion conditions for LMA and preservation of respiration. |
[1] GAL T J.Airway management.In:Miller RD,ed.Miller's Anesthesia(M),6th edn,vol.2.Philadelphia,USA:Elsevier,Churchill Livingstone,2005:1617-1653.
[2] CORTINEZ L I,HSU Y W,SUMPING S T,et al.Dexmedetomidine pharmacodynamics:Part Ⅱ:Crossover comparison of the analgesic effect of dexmedetomidine and remifentanil in healthy volunteers.[J].Anesthesiology,2004,101(5):1077-1083.
[3] KWAK H J,MIN S K,YOO J Y,et al.The median effective dose of dexmedetomidine for laryngeal mask airway insertion with propofol 2.0 mg·kg-1[J].Acta Anaesthesiol Scand,2014,58(7):815-819.
[4] RAMASWAMY A H,SHAIKH S I.Comparison of dexmedetomidine-propofol versus fentanyl-propofol for insertion of laryngeal mask airway[J].J Anaesthesiol Clin Pharmacol,2015,31(2):217-220.
[5] XUE F S,LIU K P,LIU M Y,et al.Assessment of small-dose fentanyl and sufentanil blunting the cardiovascular responses to laryngoscopy and intubation in children[J].Pediatr Anesth,2007,17(6):568-574.
[6] MAROOF M,KHAN R M,JAIN D,et al.Dexmedetomidine is a useful adjunct for awake intubation[J].Can J Anaesth,2005,52(7):776-777.
[7] BELLEVILLE J P,WARD D S,BLOOR B C,et al.Effects of intravenous dexmedetomidine in humans.I.Sedation,ventilation,and metabolic rate[J].Anesthesiology,1992,77(6):1134-1142.
[8] PARIKH D A,KOLLI S N,KARNIK H S,et al.A prospective randomized double-blind study comparing dexmedetomidine vs.combination of midazolam-fentanyl for tympanoplasty surgery under monitored anesthesia care[J].J Anaesthesiol Clin Pharmacol,2013,29(2):173-178.
[9] TANAKA M,NISHIKAWA T.Propofol requirement for insertion of cuffed oropharyngeal airway versus laryngeal mask airway with and without fentanyl:a dose-finding study[J].Bja British Journal of Anaesthesia,2003,90(1):14-20.
[10] GOYAGI T,TANAKA M,NISHIKAWA T.Fentanyl decreases propofol requirement for laryngeal mask airway insertion[J].Acta Anaesthesiol Scand,2003,47(6):771-774.
[11] RD.Anaesthetic pharmacology; intravenous anaesthetics.Miller's Anesthesia(M).Miller 7th ed.Philadelphia USA:Elsevier,Churchil Livingstone,2010:719-768.
[12] UZUMCUGIL F,CANBAY O N,KARAGOZ A,et al.Comparison of dexmedetomidine-propofol vs.fentanyl-propofol for laryngeal mask insertion[J].Eur J Anaesthesiol,2008,25(8):675-680.
[13] GOH P K,CHIU CLWANG C Y,CHAN Y K,et al.Randomized double-blind comparison of ketamine-propofol,fentanyl-propofol and propofol-saline on haemodynamics and laryngeal mask airway insertion conditions[J].Anaesth Intensive Care,2005,33(33):223-228.
[14] CORTINEZ L I,HSU Y W,SUMPING S T,et al.Dexmedetomidine pharmacodynamics:Part Ⅱ:Crossover comparison of the analgesic effect of dexmedetomidine and remifentanil in healthy volunteers[J].Anesthesiology,2004,101(5):1077-1083.
[15] BINDU B,PASUPULETI S,GOWD U P,et al.A double blind,randomized,controlled trial to study the effect of dexmedetomidine on hemodynamic and recovery responses during tracheal extubation[J].J Anaesthesiol Clin Pharmacol,2013,29(2):162-167. |