George Leah R, Sahajanandan Raj, Ninan Sarah
Department of Anaesthesiology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.
Anesth Essays Res. 2017 Oct-Dec;11(4):1051-1056. doi: 10.4103/aer.AER_98_17.
Around the world, the use of the laryngeal mask airway (LMA) is becoming more common for different surgeries accounting for it being the dominant choice of airway in numerous surgeries. Although propofol is known to blunt the laryngeal reflexes often patient movement, coughing, and gagging occur on insertion. This study aims to identify the optimum dose of succinylcholine required to facilitate LMA insertion comparing placebo, 0.1 mg/kg and 0.25 mg/kg of succinylcholine. Further objectives were to compare (a) the overall insertion conditions of the LMA, (b) the number of insertion attempts, (c) the amount of propofol consumption, and (d) the hemodynamics in the three groups.
This is a prospective, double-blinded, randomized control trial of 283 patients randomized into three groups-placebo, 0.1 mg/kg and 0.25 mg/kg of succinylcholine. It was done in the day case theatres of a tertiary hospital in Southern India.
Patients were induced with 2 mg/kg of propofol, after 2 μg/kg of fentanyl. The study drug was given after loss of consciousness. After 60 s, a classic LMA was inserted by the standard method by a single investigator. Jaw relaxation, coughing, gagging, movement, laryngospasm, ease of insertion, number of attempts, propofol usage, and hemodynamics were assessed.
Statistical methods used were analysis of variance with Bonferroni's -test, Chi-square test, and Fisher's test. < 0.05 was considered statistically significant.
Jaw relaxation was significantly better in the 0.25 mg/kg succinylcholine group. There was no significant difference in coughing and gagging in the groups, but patient movement was more in the placebo group. Two patients in the placebo group experienced partial laryngospasm. Overall insertion conditions were significantly better in the 0.25 mg/kg group compared to the other two groups. Propofol consumption was significantly more in the placebo group.
The study concludes that 0.25 mg/kg succinylcholine facilitates insertion of the LMA.
在全球范围内，喉罩气道（LMA）在不同手术中的应用越来越普遍，在众多手术中它是气道管理的主要选择。尽管异丙酚已知可减弱喉反射，但在插入喉罩时患者常出现肢体活动、咳嗽和恶心。本研究旨在确定与安慰剂、0.1mg/kg和0.25mg/kg琥珀酰胆碱相比，便于插入喉罩所需的琥珀酰胆碱最佳剂量。进一步的目标是比较三组患者：（a）喉罩的总体插入情况；（b）插入尝试次数；（c）异丙酚消耗量；（d）血流动力学情况。
这是一项前瞻性、双盲、随机对照试验，将283例患者随机分为三组——安慰剂组、0.1mg/kg琥珀酰胆碱组和0.25mg/kg琥珀酰胆碱组。该试验在印度南部一家三级医院的日间手术室进行。
患者先静脉注射2μg/kg芬太尼，随后静脉注射2mg/kg异丙酚进行诱导麻醉。意识消失后给予研究药物。60秒后，由一名研究人员采用标准方法插入经典喉罩。评估下颌松弛情况、咳嗽、恶心、肢体活动、喉痉挛、插入难易程度、尝试次数、异丙酚用量及血流动力学情况。
采用方差分析、Bonferroni检验、卡方检验和Fisher检验等统计方法。P<0.05被认为具有统计学意义。
0.25mg/kg琥珀酰胆碱组下颌松弛情况明显更好。三组患者咳嗽和恶心情况无显著差异，但安慰剂组患者肢体活动更多。安慰剂组有两名患者出现部分喉痉挛。与其他两组相比，0.25mg/kg组的总体插入情况明显更好。安慰剂组异丙酚消耗量明显更多。
该研究得出结论，0.25mg/kg琥珀酰胆碱有助于喉罩的插入。
