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Laryngeal mask insertion using thiopental and low dose atracurium: A comparison with propofol

Abstract

Purpose

To compare the laryngeal mask airway (LMA) insertion conditions produced by propofol and a thiopental — low dose atracurium combination.

Methods

In a randomized controlled double blind study, 120 premedicated patients were allocated into four groups. After pre-oxygenation, anesthesia was induced as follows: I μg·kgt-1 fentanyl, 2.5 μg·kgt-1 propofol (group I); μg·kgt-1 fentanyl, 5 μg·kgt-1 thiopental (group II); I μg·kgt-1 fentanyl, 5 mg·kgt-1 thiopental, 0.05 mg·kgt-1 or 0.1 mg·kgt-1 atracurium (groups III and IV respectively). The LMA was insertedby a blinded anesthesiologist who also assessed the following insertion conditions on a three point scale; jaw relaxation, biting, gagging, coughing, presence of laryngospasm, adequacy of airway patency, number of attempts at insertion and overall insertion conditions.

Results

There was no difference in insertion conditions between groups I, III and IV Group II produced the worst overall conditions (P < 0.05). There were no differences in hemodynamic changes and apnea times between all four groups.

Conclusion

The combination of fentanyl-thiopental with low dose atracurium (0.05 or 0.1 mg·kgt-1) provided conditions comparable with those of propofol for LMA insertion.

Résumé

Objectif

Comparer les conditions d’insertion du masque laryngé (ML) produites par le propofol et une combinaison de thiopental et d’une faible dose d’atracurium.

Méthode

Lors d’une étude contrôlée en double aveugle, 120 patients qui avaient reçu une prémédication ont été répartis en quatre groupes. Après la préoxygénation, l’anesthésie a été induite comme suit: I mg·kgt-1 de fentanyl, 2,5 mg·kgt-1 de propofol (groupe I); μg·kgt-1 de fentanyl, 5 mg·kgt-1 de thiopental (groupe II); I μg·kgt-1 de fentanyl, 5 mg·kgt-1 de thiopental, 0,05 mg·kgt-1 ou 0,1 mg·kgt-1 d’atracurium (groupes III et IV respectivement). Le ML a été inséré par un anesthésiologiste impartial qui a aussi évalué les conditions d’insertion suivantes sur une échelle de trois points: le relâchement de la mâchoire, la morsure, les haut-le-coeur, la toux, la présence de laryngospasme, la qualité de la perméabilité des voies aériennes, le nombre d’essais à l’insertion et les conditions générales de l’insertion.

Résultats

Les conditions d’insertion ont été semblables dans les groupes I, III et IV C’est dans le groupe II que les conditions ont été les pires (P < 0,05). Il n’y avait pas de différence intergroupe pour les changements hémo-dynamiques et les temps d’apnée.

Conclusion

La combinaison de fentanyl et de thiopental accompagnée d’une faible dose d’atracurium (0,05 ou 0,1 mg·kgt-1) a permis des conditions d’insertion du ML comparables à celles qui ont été produites avec le propofol.

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Correspondence to Kwong Fah Koh.

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Koh, K.F., Chen, F.G., Cheong, K.F. et al. Laryngeal mask insertion using thiopental and low dose atracurium: A comparison with propofol. Can J Anesth 46, 670–674 (1999). https://doi.org/10.1007/BF03013956

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Keywords

  • Fentanyl
  • Thiopental
  • Thiopentone
  • Atracurium
  • Laryngeal Mask Airway