Co-administration of alfentanil-propofol improves laryngeal mask airway insertion compared to fentanyl-propofol.
OBJECTIVE
Insertion of the laryngeal mask airway (LMA) requires sufficient depth of anesthesia to relax the jaw and obtund airway reflexes. Recent studies suggest that the short-acting opioid alfentanil provides the best insertion conditions. We therefore compared the insertion conditions following co-administration of alfentanil-propofol with more commonly used fentanyl-propofol.


METHODS
One hundred forty ASA I or II patients, age 18-81 yr, requiring minor surgery were recruited. They were randomized to receive either alfentanil (10 microg x kg(-1); n = 73) or fentanyl (1 microg x kg(-1); n = 67) with propofol (2.5 mg x kg(-1)) 90 sec prior to LMA (size 3 or 4) insertion. A six variable (mouth opening, ease of insertion, swallowing, coughing, movement and laryngospasm) three-point (nil / partial / total) score was used to assess insertion conditions. Duration of post-insertion apnea was recorded. Insertion conditions were compared using Chi-square for trends.


RESULTS
The two groups were demographically similar. Mouth opening and ease of insertion were not improved with alfentanil co-administration. Alfentanil-propofol reduced the incidence of swallowing, gagging, movement and laryngospasm (P < 0.05), with 29% (alfentanil) compared to 45% (fentanyl) of patients responding (P = 0.05) to LMA insertion. Apnea [mean (SD)] following alfentanil lasted 154 (139) sec compared to 82 (61) sec following fentanyl (P = 0.001).


CONCLUSIONS
Co-administration of alfentanil-propofol provided better insertion conditions than fentanyl-propofol, though apnea was prolonged by 72 sec.
Hui
Jacqueline K L
JK
Department of Anaesthesia Intensive Care, The Chinese University of Hong Kong Prince, of Wales Hospital, Shatin, New Territories, Hong Kong, Peoples Republic of China.
Critchley
Lester A H
LA
Karmakar
Manoj K
MK
Lam
Patrick K K
PK
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015760:Alfentanil; D018686:Anesthetics, Intravenous; D005260:Female; D005283:Fentanyl; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D017214:Laryngeal Masks; D008297:Male; D008875:Middle Aged; D015742:Propofol
D018686:Anesthetics, Intravenous; D015760:Alfentanil; D005283:Fentanyl; D015742:Propofol