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Manisha Bhatt Dwivedi

Manisha Bhatt Dwivedi

MMIMSR | India

Title: Comparative evaluation of butorphanol and fentanyl as coinduction drugs to assess their effect on apnoea time, recovery time and sedation score using Laryngeal Mask Airway

Biography

Biography: Manisha Bhatt Dwivedi

Abstract

Problem of Statement: Securing definitive airway traditionally requires placement of endotracheal tube which has got some undesirable effects like eliciting sympathoadrenal stress response, requirement of muscle relaxants and inevitable apnoea. To overcome these effects Laryngeal Mask Airway was invented. It is such an innovation in the field of airway management that has led to drastic reforms in the traditional aspects of general anaesthesia. Its placement is possible without relaxants. This implies that this method minimizes apnoea time or even prevents apnoea. It reduces the degree of atelectasis and offers various other advantages. In this study we compared the combination of propofol-butorphanol with propofol-fentanyl for Laryngeal Mask Airway insertion without using muscle relaxant and allowing the patient to resume spontaneous ventilation and apnoea time, recovery time and sedation scores were compared.

Methodology: Hundred patients scheduled for elective surgeries were randomly divided into two groups of 50 each. As coinduction drug Group F received fentanyl and Group B received butorphanol. In both the groups induction was achieved with I/V propofol and LMA was placed. Apnoea time, recovery time and sedation scores were noted and analysed statistically.

Findings: As compared to group F apnoea time was significantly less in group B and recovery time was significantly more in group B. In group B statistically postoperative sedation was significantly higher than in group F at 1/2 hour, but clinically, majority of the patients were responding to verbal commands. At 1 hour no significant difference in sedation were noted and none of the patients were deeply sedated at 2 hour in both the groups.

Conclusion and Significance: Propofol-butorphanol combination is a safer alternative to propofol-fentanyl combination because of decreased apnoea time and various advantages of maintaining spontaneous ventilation. Sedation score and recovery time though higher with butorphanol group, was clinically within acceptable limit.

References

1.  Ghafoor H, Afshan G,  Kamal R. General Anesthesia with Laryngeal Mask Airway: Etomidate vs Propofol for Hemodynamic Stability. Open J Anesthesiology 2012;2:161-5

 2. Yousef GT,Elsayed KM .A clinical comparison of ketofol (ketamine and propofol admixture) versus propofol as an induction agent on quality of laryngeal mask airway insertion and hemodynamic stability in children. Anesth Essays Res  2013 ;7(2):194-9

3.  Ramaswamy AH, Shaikh S. Comparison of dexmedetomidine-propofol versus fentanyl-propofol for insertion of laryngeal mask airway.Journal of  Clinical Pharmacology 2015 ; 31(2);217-20

4.Pournajafian A,Alimian M ,Rokhtabnak F,Ghodraty M,Mojri M.Success rate of airway devices insertion:Laryngeal mask airway versus supraglottic gel device.Anaesth Pain Med march2015;5:e22068

5. Sirian R,Wills J.Physiology of apnoea and the benefits of preoxygenation. Contin Educ Anaesth Crit Care Pain 2009; 9 : 105-108.

6.Ziyaeifard M,Azarfarin R,Ferasatkish R,Dashti M.Management of difficult airway with laryngeal mask airway in a child with mucopolysaccharidosis and mitral regurgitation:A case report.Resp Cardiovasc Med 2014;3:e17456

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