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Evaluation of Low Dose Fentanyl-Midazolam Premedication on Sevoflurane Induction for Ease of LMA Insertion in Adults

Meena Singh, Assistant Professor, Dept. of Anaesthesia, BPS Government Medical College, Khanpur Kalan, Sonepat, Haryana 131305, India. , Arin Choudhury1 , Meena Singh2 , Dootika Liddle3

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Indian Journal of Anesthesia and Analgesia 5(1):p 28-33, January-February 2018. | DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.5118.5

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Abstract

Background: Sevoflurane, a halogenated volatile anesthetic agent and premedication with fentanyl and midazolam are both helpful in deepening the plane of anaesthesia. When used in synergism, these can aid in a smooth laryngeal mask airway (LMA) insertion. Materials and Methods: 80 patients of ASA I and II status, posted for minor elective surgery were randomized in a double-blind study to compare the conditions for LMA insertion following premedication with fentanyl 0.6µg/kg and midazolam 9µg/kg with Sevoflurane (Group I) and Sevoflurane alone (Group II). The time to loss of eye reflex, time for LMA insertion, ease of LMA insertion was noted and hemodynamic variables (heart rate, mean arterial blood pressure) were recorded prior to induction of anaesthesia, prior to LMA insertion and every minute after LMA insertion for 5 minutes. Secondary outcomes included evaluation of adverse effects in two groups. Results: The groups were comparable with respect to the demographic profile and baseline parameters. The time to loss of eye reflex as well as time taken for insertion of LMA was significantly lower in the study group as compared to the control group (p<0.001). The composite scoring system (comprising Jaw opening, ease of insertion, coughing, gagging, laryngospasm, movement at insertion) was higher in the study group, demonstrating better LMA insertion conditions in the study group as compared to control group, even though it is not statistically significant. Adverse effects like apnea, movement, cough, nausea, shivering were comparable in both the groups. Conclusion: Addition of low dose fentanyl and midazolam intravenously preceding vital capacity induction with Sevoflurane 8% in O2 6l/min provides better conditions for LMA insertion with insignificant hemodynamic effects.

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DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.5118.5

Keywords

Volatile Induction; Sevoflurane; LMA; Premedication; Midazolam; Fentanyl.

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