title: What happens to the hemodynamic responses for laryngeal mask airway insertion when we supplement propofol with butorphanol or fentanyl for induction of anesthesia: A comparative assessment and critical review.
abstract: BACKGROUND
  There is a delicate balance between respiratory tract anatomy, its physiology, physiological response to anesthetic agents, and airway management. The traditional gadgets to secure airway are face masks or endotracheal tubes. Recently, laryngeal mask airway (LMA) is gaining popularity. It does not require laryngoscopy thereby minimizing hemodynamic responses. For LMA placement, propofol is the induction agent of choice. Propofol, when used alone, requires large doses and leads to undesirable cardiorespiratory depression. To culminate its dose, various adjuncts are combined with it.
  
  
  OBJECTIVE
  Comparison of hemodynamic response of LMA using either butorphanol or fentanyl (according to group allocated) in combination with propofol.
  
  
  METHODS
  Hundred patients scheduled for various surgical procedures were randomly selected and divided into two groups of 50 patients each, Group F (propofol and fentanyl) and Group B (propofol and butorphanol). One minute after giving intravenous (IV) opioids, induction was achieved with IV propofol 2.5 mg/kg. Depth of anesthesia was assessed, and LMA was inserted. Hemodynamic variables were measured before premedication, after premedication; 1, 3, and 5 min after insertion and after extubation of LMA.
  
  
  RESULTS
  After insertion of LMA, statistically significant drop in mean heart rate, systolic blood pressure (BP), diastolic BP, and mean BP was noted in Group F as compared to Group B (P < 0.05).
  
  
  CONCLUSIONS
  The use of propofol-butorphanol combination produces stable hemodynamics as compared to propofol-fentanyl combination.
authors.affiliation: Department of Anaesthesiology and Critical Care, MMIMSR, Mullana-Ambala, Haryana, India.
authors.forename: Manisha Bhatt
authors.initials: MB
authors.lastname: Dwivedi
authors.affiliation: Department of Anaesthesiology and Critical Care, JNMC, Sawangi, Meghem, Wardha, Maharashtra, India.
authors.forename: Manda
authors.initials: M
authors.lastname: Nagrale
authors.affiliation: Department of Anaesthesiology and Critical Care, MMIMSR, Mullana-Ambala, Haryana, India.
authors.forename: Sankalp
authors.initials: S
authors.lastname: Dwivedi
authors.affiliation: Department of Anaesthesiology and Critical Care, MMIMSR, Mullana-Ambala, Haryana, India.
authors.forename: Hardeep
authors.initials: H
authors.lastname: Singh
keywords: Butorphanol; fentanyl; hemodynamics; insertion conditions; laryngeal mask airway; propofol