Comparison of sevoflurane with propofol for laryngeal mask airway insertion in adults

We conducted a prospective, randomized, controlled trial to compare the quality and ease of laryngeal mask airway (LMA) insertion after either rapid inhaled sevoflurane or IV propofol induction of anesthesia. Placement of the LMA under inhalational anesthesia is not performed universally in adult patients. A famous method of anesthesia for Laryngeal Mask airway placement is with use of intravenous propofol, it has the benefits of inducing anesthesia quickly and depressing reflexes of upper airway. On the other hand, propofol is not ideal agent, it is associated with many side effects like apnea, pain on injection and hypotension. Recently, single VCB technique induction of inhalational sevoflurane is used as an alternate method to intravenous induction of propofol in adult patients. Sevoflurane induction method is quick, with greater acceptance, better hemodynamic profiles and slight excitatory phenomena. Sevoflurane can be used for both maintenance and induction of anesthesia. It made the conversion period easier. Hence, we compared sevoflurane inhaled induction and propofol IV induction. After getting the Institutional Ethical Committee approval, eighty adult patients of American society of Anesthesiologists Physical status 1 & 2 of either sex undergoing minor surgical procedures are allocated randomly in to 2 groups, Group A (propofol induction) and Group B (sevoflurane induction). LMA was inserted more rapidly in propofol group than in patients with sevoflurane group (53.88s vs 80.15s). There was a greater incidence of difficulty in mouth opening initially in sevoflurane group. Once mouth was possible, the degree of attenuation of laryngeal reflexes was similar. The incidence of complications related to LMA insertion, especially apnoea was more frequent in the propofol group. There were two failures of LMA insertion in sevoflurane group. Both groups had stable hemodynamic parameters. However, prolonged jaw tightness after the sevoflurane inhalational induction may delay LMA insertion. This study shows no significant difference between the two groups based on the demographic variables. The time to LMA insertion in sevoflurane group was significantly different from propofol.(p value <0.05) Successful initial mouth opening in sevoflurane group was significantly different from Propofol group.( p value <0.05). The hemodynamic responses were significantly different from Sevoflurane (P value less than 0.05). There was no statistical difference between the two groups in number of attempts for Laryngeal Mask Airway insertion. We concluded that, even though extended jaw muscle tightness can delay LMA placement in patients with sevoflurane inhalational induction, it can be compared favorably with intravenous induction of propofol.