COMPARISON OF INDUCTION WITH PROPOFOLAND SEVOFLURANE FOR LARYNGEAL MASK AIRWAY INSERTION DURING ELECTIVE SURGERIES

Background And Aims: Laryngeal mask airways are gaining popularity these days in airway management and can be used for various types of surgeries and also during resuscitation. The aim of the study is to compare the induction characteristics and hemodynamic changes associated with intravenous injection of Propofol or inhalational Sevourane induction for LMAinsertion during elective surgeries. Materials And Methods: It is a prospective, single blind, randomized controlled study that is conducted at Maharajah's Institute of Medical Sciences, Nellimarla,Vizianagaram from January 2019 to July 2019. The study consists of sixty patients belonging to ASA grade I & II, aged between 20-60 years of both sexes, undergoing elective surgical procedures, which were randomly divided into 2 groups of 30 each. Patients in Group-A were induced with intravenous injection of Propofol 2mg/kg and inhalation of 100% Oxygen whereas in Group-B were induced with inhalation of 8% Sevourane in 100% Oxygen. The data regarding time for induction, LMAinsertion and hemodynamic parameters were recorded and compared in both the study groups. Results: The mean time taken for induction and insertion of LMAwas less in Group A(100±13.6sec) compared to Group B(120±14.2sec) and this difference is statistically signicant. The fall in MAPand HR in group - Ais also signicant. Conclusion: The quality of anaesthesia provided by propofol is better when compared to Sevourane for LMAinsertion, even though Sevourane is associated with better haemodynamic stability.

Comparative Evaluation of Topical Lignocaine Versus Intravenous Lignocaine for Laryngeal Mask Airway Insertion in Wardha, Maharashtra

BACKGROUND The purpose of present study was to compare and evaluate both topical lignocaine and intravenous lignocaine for laryngeal mask airway (LMA) insertion prior to propofol. Main objective was to study the conditions for LMA insertion with respect to gagging, coughing, Laryngospasm and No. of attempts for LMA insertion and also study the hemodynamic parameters in both the groups (Heart rate, SBP,DBP, MAP, SpO2) METHODS This study included 60 patients of 30 in each group, ASA I & II day care surgeries were performed in our hospital between 2019 and 2021. Patients were randomized into two groups. Group I received intravenous lignocaine 1.5 mg / kg over 30 seconds and group II received topical lignocaine 40 mg. Conditions of LMA insertion, gagging, laryngospasm, coughing were noted at the time of insertion, ECG, NIBP, SPO2 and ETCO2 were recorded according to scheduled times. RESULTS In conditions of LMA insertion, difference between both the groups was found to be significant, P < 0.05 in groups with first minute rise in heart rate, fall in Systolic blood pressure, diastolic blood pressure, mean arterial pressure was significant. At two minutes and three minutes after the LMA insertion, HR, SBP, DBP, MAP all these parameters changed slightly but these changes were statistically not significant. CONCLUSIONS Prior to Propofol induction, compared to intravenous lignocaine, topical lignocaine 10 % aerosol provided excellent conditions for the insertion of LMA without the use of neuromuscular blockers. KEY WORDS IV Lignocaine, Topical Lignocaine, LMA

EFFECTS OF SEVOFLURANE, PROPOFOL, AND COMBINATION OF SEVOFLURANE AND PROPOFOL FOR CLASSIC LARYNGEAL MASK AIRWAY INSERTION IN ADULTS- A CLINICAL COMPARATIVE STUDY

Background and Aims:Although LMA insertion is less invasive than endotracheal intubation,it also requires adequate mouth opening and blunting of minimal airway reflexes. Propofol is considered an appropriate IV agent for LMA insertion owing to its prompt induction and suppression of airway reflexes but induction doses required are often associated with hypotension,pain and apnea.Sevoflurane on the other hand,has minimal respiratory irritability,better hemodynamic stability and less apnea, but is associated with delayed jaw relaxation. Our hypothesis is that the combination of sevoflurane and propofol may be of better outcome whereby the insertion conditions of the LMA may be optimized adequately,at the same time the potential side-effects of individual drugs are effectively curtailed. Methods: 90 patients aged 20-60yrs of ASA I and II, 30 in each group were induced with Propofol (2mg/kg) in Group P, 8% Sevoflurane in N O: O (67%:33%) TVB technique in Group S and Group SP with additional propofol (1mg/kg) in 2 2 Group SP after loss of eyelash reflex. Induction characteristics, hemodynamic parameters and complications were observed. Results: 87% of the patients of Group SP had successful LMA insertion at first attempt, compared to 53% and 40% in Group P and Group S respectively, which was statistically significant. Less apnea was seen in Group SP(20%) as compared to Group P(60%),which was statistically significant. Conclusion: Our study showed that the combination group stood out to be the best with highest successful LMA insertion at first attempt and less incidence of apnea.

AN OBSERVATIONAL STUDY TO EVALUATE THE HAEMODYNAMIC CHANGES BETWEEN ENDOTRACHEAL INTUBATION AND LARYNGEAL MASK AIRWAY INSERTION

Introduction: Airway management is a crucial skill for the clinical anaesthesiologist. It is an integral part of general anesthesia, allowing ventilation and oxygenation as well as a mode for anesthetic gas delivery. The laryngeal mask airways (LMA) have become popular in airway management as a missing link between facemask and tracheal tube in terms of both anatomical position and degree of invasiveness. Haemodynamic stability is an important aspect to the anaesthesiologist for the benet of the patients especially during intubations, laryngeal mask insertion. Laryngoscopy and endotracheal intubation can cause striking changes in Haemodynamics as result of intense stimulation of sympathetic nervous system. The aim of this study was to evaluate the hemodynamic changes between endotracheal intubation and laryngeal mask airway insertion. Material And Methods: This was a prospective observational study on 46 patients of ASA I-II status divided into 2 groups of 23 each. In the ETT (Endotracheal tube) group endotracheal intubation was done using Macintosh laryngoscope by using portex cuffed endotracheal while in LMA (Laryngeal mask airway) group laryngeal mask airway was inserted according to the standard recommendation. Heart rate, Systolic, Diastolic and Mean arterial pressure and dysrhythmias were monitored. Results: The two groups were comparable in terms of demographic data as there were no signicant differences between the 2 groups in terms of age, sex, duration of surgery, ASA grades and MPC classication. Heart rate (HR), Systolic blood pressure (SBP), Diastolic blood pressure(DBP), Mean arterial pressure (MAP) remains on higher side in ETT group than LMA group which was statistically signicant. P<0.05. Dysrhythmias were noted in 2 patients of ETT group while LMA group did not notice any dysrhythmias. Conclusion: This study demonstrated that there is a haemodynamic response consisting of an increase in Heart rate, SBP, DBP and MAP that comes with ETT insertion as well as with LMA insertion. However, the response caused by ETT insertion is signicantly greater than that caused by LMA insertion.

Haemodynamic Changes at Induction during Laryngeal Mask Airway Insertion: Comparison of Propofol Versus Lignocaine-Thiopentone Admixture

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.