Comparing the safety and efficacy of three different doses of atracurium in facilitating the insertion of laryngeal mask airway in patients undergoing phacoemulsification cataract surgery: A randomized clinical trial

Shetabi, Hamidreza; Shafa, Amir

Comparing the safety and efficacy of three different doses of atracurium in facilitating the insertion of laryngeal mask airway in patients undergoing phacoemulsification cataract surgery: A randomized clinical trial

Authors

Anesthesiology and Critical Care Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: In this study, we aimed to evaluate the safety and efficacy of three different doses of atracurium on conditions of laryngeal mask airway (LMA) insertion, first-try success rate, and possible complications. Materials and Methods: A total of 120 patient's ≥18 years old were randomly divided into three groups of 40. The study groups received fentanyl 2 μg/kg thiopental 5 mg/kg and atracurium in doses 0.2 mg/kg, 0.4 mg/kg, and 0.6 mg/kg, respectively, based on the patient group. The conditions of LMA insertion, hemodynamic responses, and complications were evaluated and compared in the groups. Results: In the study groups, the LMA placement was difficult in 15%, 7.5%, and 2.5%, respectively (P = 0.13). There was no statistically significant difference among the groups regarding the success rate in the first attempt to the insertion of LMA. Of the three groups, 5%, 2.5%, and 2.5% had bleeding at the place of mask insertion (P = 0.77). 17.5%, 7.5%, and12.5% had sore throat, respectively (P = 0.4). No patient experienced laryngospasm during the study. Furthermore, changes in blood pressure, heart rate, and oxygen saturation were not significant in the three groups. Conclusion: All three doses of atracurium have similar effects on the condition of LMA insertion. Atracurium 0.4 mg/kg accompanied by higher success on LMA insertion in the first attempt and lower airway complications (bleeding and sore throat), increasing this dose had no significant effect on the success rate of LMA insertion.

Keywords

References

1.	Sahraei R, Eftekhareian F, Kalani N, Kargar Jahromi H. The incidence rate of epigastric pain after laryngeal mask anesthesia in cataract surgery: A descriptive-sectional study. Int J Medl Res Health Sci 2016;5 Suppl 7:166-70.
2.	Henderson J. Airway management in the adult. In: Miller RD, editors. Text Book of Anesthesia. 7^th ed. Philadelphia: Elsevier; 2010. p. 1573-610.
3.	Darlong V, Garg R, Pandey R, Khokhar S, Chandralekha, Sinha R, et al. Evaluation of minimal dose of atracurium for cataract surgery in children: A prospective randomized double-blind study. Saudi J Anaesth 2015;9:283-8.
4.	Aghamohammadi D, Eydi M, Hosseinzadeh H, Amiri Rahimi M, Golzari SE. Assessment of mini-dose succinylcholine effect on facilitating laryngeal mask airway insertion. J Cardiovasc Thorac Res 2013;5:17-21.
5.	Monem A, Khan FA. Laryngeal mask airway insertion anaesthesia and insertion techniques. J Pak Med Assoc 2007;57:607-11.
6.	Palanisamy S, SolaiappanB, Munuswamy R. Comparative study on conditions for LMA insertion with two different low doses of succinylcholine following thiopentone induction. J Evol Med Dent Sci 2017;6:1767-71.
7.	Chen BZ, Tan L, Zhang L, Shang YC. Is muscle relaxant necessary in patients undergoing laparoscopic gynecological surgery with a ProSeal LMA™? J Clin Anesth 2013;25:32-5.
8.	Naguib M, Lien CA, Meistelman C. Pharmacology of neuromuscularblocking drug. Miller's Anesth 2015;8:901-94.
9.	El-Kasaby AM, Atef HM, Helmy AM, El-Nasr MA. Cisatracurium in different doses versus atracurium during general anesthesia for abdominal surgery. Saudi J Anaesth 2010;4:152
10.	Nazemroaya B, Moradi-Farsani D, Sadeghi-Vaghfi A. Comparison of Cisatracurium and Succinylcholine on Hemodynamic Changes during and after Electroconvulsive Therapy. J Isfahan Med Sch 2016; 34 (395): 963-70
11.	Brain AI. The laryngeal mask–a new concept in airway management. Br J Anaesth 1983;55:801-5.
12.	Pournajafian A, Alimian M, Rokhtabnak F, Ghodraty M, Mojri M. Success rate of airway devices insertion: Laryngeal mask airway versus supraglottic gel device. Anesth Pain Med 2015;5:e22068.
13.	Chui PT, Cheam EW. The use of low-dose mivacurium to facilitate insertion of the laryngeal mask airway. Anaesthesia 1998;53:491-5.
14.	Nasseri K. Effect of low-dose atracurium on laryngeal mask airway insertion conditions: A randomized double-blind clinical trial. Adv Biomed Res 2017;6:119. [PUBMED] [Full text]
15.	Gunaseelan S, Krishna Prabu R. Comparison of two doses of succinylcholine to facilitate the Laryngeal mask airway insertion under propofol anaesthesia in adult patients undergoing elective minor surgical procedures. Asian J Med Sci 2017;8:21-6.
16.	Chauhan G, Nayar P, Seth A, Gupta K, Panwar M, Agrawal N. Comparison of clinical performance of the I-gel with LMA proseal. J Anaesthesiol Clin Pharmacol 2013;29:56-60. [PUBMED] [Full text]
17.	Hayashi K, Suzuki A, Kunisawa T, Takahata O, Yamasawa Y, Iwasaki H. A comparison of the single-use i-gel with the reusable laryngeal mask airway Proseal in anesthetized adult patients in Japanese population. Masui 2013;62:134-9.
18.	Oh SK, Lim BG, Kim H, Lim SH. Comparison of the clinical effectiveness between the streamlined liner of pharyngeal airway (SLIPA) and the laryngeal mask airway by novice personnel. Korean J Anesthesiol 2012;63:136-41.
19.	Jarineshin H, Kashani S, Vatankhah M, Abdulahzade Baghaee A, Sattari S, Fekrat F. Better Hemodynamic Profile of Laryngeal Mask Airway Insertion Compared to Laryngoscopy and Tracheal Intubation. Iran Red Crescent Med J 2015;17:e28615.
20.	Rastegarian A, Abedi HA, Sepidkar AA, Kheyrkhah N, KargarJahromi H, Farzam M. The use of laryngeal mask airway in pilonidal cyst excisionafter muscle relaxant (atracurium) injection in prone position. Biosci Biotech Res Asia 2014;11:875-8.

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