A COMPARISON OF SEVOFLURANE AND PROPOFOL INDUCTION CHARACTERISTIC FOR THE INSERTION OF LARYNGEAL MASK AIRWAY IN PAEDIATRIC DAY CASE ANAESTHESIA IN ABUJA, NIGERIA

EFU M E, ISAMADE E S, FOM A D, EDEM B E, ADEKWU A, SOO C T, AHACHI C N, EKE B A

Abstract


Background: Recently, there has been a tendency towards performing surgeries on children on a day-stay basis. Daycase
surgery has gained popularity because it results in reduction in healthcare cost, psychological and emotional
impacts on children. Day--case surgery reduces behavioural problems as well as gives rise to less disruption to family
life. In addition, susceptibility to nosocomial infections is less.
The laryngeal mask airway is a supraglottic airway device. Its development is believed to represents the greatest
advancement in airway management since the advent of endotracheal intubation. It has several advantages for day-case
anaesthesia in children.
The intravenous induction agent of choice for LMA insertion is propofol. Administration of intravenous agents such as
propofol would require intravenous access, which children abhor. Inhalational induction is the more desirable method
in paediatrics patients, since it does not require intravenous access before its administration. This is where halothane has
held sway for several decades. However, halothane causes bradycardia, hypotension and arrhythmias. The desire to
manufacture an inhalational agent which would match the induction properties of halothane, but without these
drawbacks, led to the discovery of sevoflurane. The study, therefore, was aimed at comparing the induction
characteristics of sevoflurane and propofol for the insertion of LMA in paediatric day case patients.
Methodology: This was a prospective randomised study which was undertaken over a six-month period at the National
Hospital, Abuja, a 200-bed tertiary hospital in the capital of Nigeria. The approval of the National Hospital Research and
Ethics Committee was sought and obtained. A total of sixty-six (66) patients aged 3-12 years with ASA physical status I or
II, scheduled for elective day-case surgery lasting less than 60 minutes were recruited. Patients were randomised into
one of the two groups, S (sevoflurane) and P (propofol). All patients were premedicated with 0.01mg/kg atropine and
analgesia was provided by administration of intravenous 2μg/kg fentanyl. Patients in group S received incremental
inhalational induction with up to 6% sevoflurane, while group P underwent induction of anaesthesia with intravenous
3mg/kgpropofol. Loss of eyelash reflex was solely used to determine loss of consciousness with inhalational sevoflurane
induction while loss of verbal contact was solely used for intravenous propofol induction. Maintenance of anaesthesia
was provided with1-2% isoflurane in 100% oxygen, while patients were allowed to breathe spontaneously.
Result: Time from the onset of induction to loss of verbal contact in the propofol group ranged from15s to 56s with a mean
of 21± 0.08s, while that of loss of eye lash reflex in the sevoflurane group ranged from 55s to 2mins 9s with a mean of 1min
35s ±25s. A statistically significant difference was observed between the time from the commencement of induction to
loss of verbal contact for group P, and the time from the beginning of induction to loss of eyelash reflex for group S. The
time from initiation of induction to loss of verbal contact was less than the time from initiation of induction to loss of eye
lash reflex. A comparison of the two means gave a p = 0.01.
A statistically significant difference was observed in the average time it took from the initiation of induction to successful
insertion of the LMA between the propofol and the sevoflurane groups with mean values of 1min 54s ±1min 12s and
4mins 23s ±87 respectively (p<0.05). In this study, the HR and MAP were higher in the sevoflurane group than the
propofol group demonstrating better haemodynamic stability with sevoflurane. While no significant difference was
observed in the incidence of cough between the two groups, apnoea was found to be a substantial side effect of propofol
induction, and head movement was associated more with sevoflurane induction.
Conclusion: This study demonstrated that both loss of consciousness and LMA insertion time were faster with
intravenous propofol than inhalational sevoflurane. Also, Inhalational sevoflurane showed better haemodynamic
stability (p =0.03), as apnoea was more associated with IV propofol induction compared to the inhalational sevoflurane
(p=0.003).


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