Effect of Low-dose Atracurium on Laryngeal Mask Airway Insertion Conditions: A Randomized Double-blind Clinical Trial

Nasseri, Karim

Effect of Low-dose Atracurium on Laryngeal Mask Airway Insertion Conditions: A Randomized Double-blind Clinical Trial

Document Type : Original Article

Author

Karim Nasseri

Department of Anesthesiology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran

Abstract

Background: The amount of sedation and muscle relaxation of the jaw may have an impact on complications caused by laryngeal mask airway (LMA). The aim of this study is to evaluate the effect of low-dose Atracurium on conditions of insertion, complications, and hemodynamic responses to LMA insertion following induction of anesthesia with propofol, in patients undergoing cataract surgery. Patients and Methods: In this double-blind randomized clinical trial study, 60 patients were randomly divided into two groups. Initially, the patients in the study group received 0.15 mg/kg intravenous injection of atracurium, and the patients in the control group received 2 ml of intravenous injection of normal saline, after which anesthesia in both groups were induced with midazolam, fentanyl, lidocaine, and propofol. The amount of jaw relaxation, ease of insertion, and the time needed for insertion, hemodynamic responses and complications of LMA insertion were evaluated. Results: Jaw relaxation and ease of LMA insertion in the study group was significantly better than that of the control group (P = 0.02). Average time needed for LMA placement in the study group (5/06 ± 0.52 second) was significantly lower than the control group (5/76 ± 0.67 second) (P = 0.001). Hemodynamic response to LMA insertion was similar in both groups. Sore throat at recovery and 24 h after surgery in the control group was significantly higher than that of the study group (3/30 vs. 10/30) (P = 0.01). Conclusions: Using low doses of atracurium decreases the time needed for LMA insertion and sore throat after the operation. Atracurium also increases jaw relaxation and facilitates the placement of LMA.

Keywords

References

1.	Monem A, Khan FA. Laryngeal mask airway insertion anaesthesia and insertion techniques. J Pak Med Assoc 2007;57:607-11.
2.	Bein B, Scholz J. Supraglottic airway devices. Best Pract Res Clin Anaesthesiol 2005;19:581-93.
3.	Singh R, Arora M, Vajifdar H. Randomized double-blind comparison of ketamine-propofol and fentanyl-propofol for the insertion of laryngeal mask airway in children. J Anaesthesiol Clin Pharmacol 2011;27:91-6. [PUBMED] [Full text]
4.	Mansfield MD, Miller CD. The laryngeal mask airway and resuscitation. Anaesthesia 1993;48:637-8.
5.	Scanlon P, Carey M, Power M, Kirby F. Patient response to laryngeal mask insertion after induction of anaesthesia with propofol or thiopentone. Can J Anaesth 1993;40:816-8.
6.	Goh PK, Chiu CL, Wang CY, Chan YK, Loo PL. Randomized double-blind comparison of ketamine-propofol, fentanyl-propofol and propofol-saline on haemodynamics and laryngeal mask airway insertion conditions. Anaesth Intensive Care 2005;33:223-8.
7.	Ozgul U, Begec Z, Karahan K, Ali Erdogan M, Said Aydogan M, Colak C, et al. Comparison of propofol and ketamine-propofol mixture (Ketofol) on laryngeal tube-suction II conditions and hemodynamics: A randomized, prospective, double-blind trial. Curr Ther Res Clin Exp 2013;75:39-43.
8.	Cheam EW, Chui PT. Randomised double-blind comparison of fentanyl, mivacurium or placebo to facilitate laryngeal mask airway insertion. Anaesthesia 2000;55:323-6.
9.	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.
10.	Yoshino A, Hashimoto Y, Hirashima J, Hakoda T, Yamada R, Uchiyama M. Low-dose succinylcholine facilitates laryngeal mask airway insertion during thiopental anaesthesia. Br J Anaesth 1999;83:279-83.
11.	Young HS, Clarke RS, Dundee JW. Intubating conditions with AH 8165 and suxamethoniun. Anaesthesia 1975;30:30-3.
12.	Kiliçkan L, Baykara N, Gürkan Y, Toker K. The effect on intraocular pressure of endotracheal intubation or laryngeal mask use during TIVA without the use of muscle relaxants. Acta Anaesthesiol Scand 1999;43:343-6.
13.	Koh KF, Chen FG, Cheong KF, Esuvaranathan V. Laryngeal mask insertion using thiopental and low dose atracurium: A comparison with propofol. Can J Anaesth 1999;46:670-4.
14.	Chui PT, Cheam EW. The use of low-dose mivacurium to facilitate insertion of the laryngeal mask airway. Anaesthesia 1998;53:491-5.
15.	Monem A, Chohan U. Comparison of low dose succinylcholine with low dose atracurium to evaluate LMA insertion during thiopentone induction. J Anaesth Clin Pharmacol 2004;20:39-44.
16.	van Vlymen JM, Coloma M, Tongier WK, White PF. Use of the intubating laryngeal mask airway: Are muscle relaxants necessary? Anesthesiology 2000;93:340-5.
17.	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]
18.	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.
19.	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.
20.	Goyagi T, Tanaka M, Nishikawa T. Fentanyl decreases propofol requirement for laryngeal mask airway insertion. Acta Anaesthesiol Scand 2003;47:771-4.
21.	Ziyaeifard M, Azarfarin R, Massoumi G. A comparison of intraocular pressure and hemodynamic responses to insertion of laryngeal mask airway or endotracheal tube using anesthesia with propofol and remifentanil in cataract surgery. J Res Med Sci 2012;17:503-7.
22.	Alipour M, Derakhshan A, Pourmazar R, Abrishami M, Ghanbarabadi VG. Effects of propofol, etomidate, and thiopental on intraocular pressure and hemodynamic responses in phacoemulsification by insertion of laryngeal mask airway. J Ocul Pharmacol Ther 2014;30:665-9.
23.	Ratajczyk P, Malachowska B, Gaszynska E, Gaszynski T. A randomised comparison between Cobra PLA and classic laryngeal mask airway and laryngeal tube during mechanical ventilation for general anaesthesia. Anaesthesiol Intensive Ther 2013;45:20-4.
24.	Abdellatif AA, Ali MA. Comparison of streamlined liner of the pharynx airway (SLIPA™) with the laryngeal mask airway Proseal™ for lower abdominal laparoscopic surgeries in paralyzed, anesthetized patients. Saudi J Anaesth 2011;5:270-6. [PUBMED] [Full text]
25.	Nagai S, Inagaki Y, Harada T, Watanabe T, Hirosawa J, Ishibe Y. A modified technique for insertion of the laryngeal mask airway in children. Masui 2000;49:1367-70.
26.	Ghai B, Wig J. Comparison of different techniques of laryngeal mask placement in children. Curr Opin Anaesthesiol 2009;22:400-4.

Advanced Biomedical Research