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BRIEF COMMUNICATION
Year : 2011  |  Volume : 27  |  Issue : 1  |  Page : 91-96

Randomized double-blind comparison of ketamine-propofol and fentanyl-propofol for the insertion of laryngeal mask airway in children


1 Associate Professor, Department of Anaesthesiology & Critical Care, Lady Hardinge Medical College & Associated Kalawati Saran Children's Hospital, New Delhi, India
2 Post Graduate Student, Department of Anaesthesiology & Critical Care, Lady Hardinge Medical College & Associated Kalawati Saran Children's Hospital, New Delhi, India
3 Director, Professor & Head, Department of Anaesthesiology & Critical Care, Lady Hardinge Medical College & Associated Kalawati Saran Children's Hospital, New Delhi, India

Correspondence Address:
Ranju Singh
Associate Professor, Department of Anaesthesiology & Critical Care, Lady Hardinge Medical College & Associated Kalawati Saran Children's Hospital, New Delhi
India
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Source of Support: None, Conflict of Interest: None


PMID: 21804715

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Background: Till date, different combinations of adjuncts with induction agents have been tried for Laryngeal Mask Airway (LMA) insertion; yet, the ideal combination that provides the best insertion conditions with minimal side effects has not been identified, particularly in children. Patients & Methods: Hundred paediatric ASA grade I and II patients, aged 3-12 years, were randomly allocated to receive intravenously either fentanyl 2μg kg -1 (Group F, n=50) or ketamine 0.5 mg kg -1 (Group K, n=50), before induction of anaesthesia with propofol 3.5 mg kg -1 . Arterial blood pressure and heart rate were measured before induction (baseline), immediately before induction, immediately before LMA insertion, and at 1, 3 and 5 minutes after LMA insertion. Following LMA insertion, the following six subjective endpoints were graded by a blinded anaesthetist using ordinal scales graded 1 to 3: mouth opening, gagging, swallowing, head and limb movements, laryngospasm and resistance to insertion. Duration and incidence of apnoea was also recorded. Results: The incidence of resistance to mouth opening, resistance to LMA insertion and incidence of swallowing was not statistically significant between the two groups. Coughing/ gagging was seen in 8% patients in group K as compared to 28% patients in group K. Limb/ head movements were observed in 64% patients in the fentanyl group and in 76% patients in the ketamine group. Laryngospasm was not seen in any patient in either group. Incidence of apnoea was 80% in the fentanyl group and 50% in the ketamine group. The heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were consistently higher in the ketamine group as compared to the fentanyl group. Conclusion: The combination of fentanyl (2μg kg-1) and propofol (3.5mg kg-1) provides better conditions for LMA insertion in children than a combination of ketamine (0.5 mg kg-1) and propofol (3.5mg kg-1).


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