A Study of Ease of Laryngeal Mask Airway Insertion and Haemodynamic Effects Following Co-induction with Midazolam and Propofol versus Propofol Alone in Children

Abstract

Background: Propofol alone for LMA insertion requires a high dose with associated haemodynamic and respiratory depressant effects which can be prevented by co-induction technique. This study compared the ease of LMAinsertion following propofol versus midazolam-propofol induction in children.

Patients And Methods: Seventy –two children aged 3-10 years were randomly allocated into Group A, to receive placebo (saline) prior to induction with propofol 3.5mg/kg and Group B to receive intravenous midazolam 0.05mg/kg prior to induction with propofol 2.5mg/kg. Appropriate-sized LMA was inserted. The insertion conditions, haemodynamic changes (MAP, HR) and incidence of adverse effects were noted.

Results: Mouth opening was full in 88.9% and 91.7% for group Aand B. Group Arecorded 91.7% easy insertion and group B 100% (p =0.04).  Following propofol induction, MAPfell by 5.3% (Group A) vs 2.4% (Group B) (p=0.01). MAP and HR rose above baseline values after LMAinsertion with  Group Aexhibiting significantly higher increases in MAP (8.8% vs 5.4% p= 0.01), and HR (6.6%, vs 3.4% p=0.01).Thereafter, MAPand HR dropped below baseline for the rest of the study, this drop was more marked in group A. Slight cough occurred in 8.3% of patients in group Aonly (p=0.083). No  incidence of bradycardia or hypotension was recorded in either group.

Conclusion: Co-induction of midazolam with propofol produced better haemodynamic stability compared to propofol alone.