COMPARATIVE STUDY OF EFFICACY OF INTRAVENOUS SUFENTANIL, FENTANYL AND LIGNOCAINE WITH PROPOFOL AS AN INDUCTION AGENT TO FACILITATE THE INSERTION OF LARYNGEAL MASK AIRWAY

BACKGROUND: The aim of this study was to compare the conditions of LMA insertion using i.v. sufentanil, i.v. fentanyl or i.v. lignocaine as premedicants with propofol induction. Also we evaluated the hemodynamic changes, adverse reactions and number of attempts required for LMA insertion. PATIENTS AND METHODS: Seventy five ASA1 & 2 patients undergoing elective surgery were included in this study. Patients were randomized into three groups to receive either sufentanil 0.4mcg/kg or fentanyl2mcg/kg or lignocaine 1.5mg/kg 2 min before induction of anesthesia. All patients were induced with propofol 2mg/kg. After 60 sec specialist anesthetist inserted appropriate size, deflated LMA. Mean arterial blood pressure, heart rate, respiratory rate and SPO2 were noted till 10 min from the time of LMA insertion. Conditions for LMA insertion i.e. jaw opening, ease of LMA insertion, coughing, gagging, laryngospasm and airway obstruction and patient's movements were assessed. RESULTS: There was statistically significant difference in jaw opening between three groups. 1 patient (4%) in group A, 4 patients (16%) in group B, 9 patients (36%) in group C had partial jaw opening. 1patient (4%) in group B and 4 patients (16%) in group C had no jaw opening with the recommended doses. Number of patients with difficulty in LMA insertion were more in lignocaine group 7 (28%) as compared to sufentanil 2 (8%) and fentanyl 2 (8%). There was no significant difference in the incidence of coughing among three groups. There was statistically significant difference with regard to gagging 12% in group C and 4% in group B had partial gagging. There was no statistically significant difference in the incidence of laryngospasm and airway obstruction among the three groups (P=0. 1592). 6 (24%) patients in group C showed moderate movement as compared to 5 (20%) patients in group B and 0% in group A. 1 (4%) patient in lignocaine group showed vigorous movement. Thus the conditions for LMA insertion were more favorable with drugs like fentanyl and sufentanil. Compared to the above two drugs, lignocaine is a poor agent in suppressing the upper airway reflexes (When given intravenously) causing more patients movement. CONCLUSION: Conditions for LMA insertion were more favorable with sufentanil as compared to fentanyl and fentanyl was better than lignocaine. So sufentanil can be the choice of adjuvant with propofol induction for LMA insertion.