Laryngeal mask airway insertion with remifentanil.

Introduction: We conducted a study to find out the best conditions for LMA insertion with two different doses of remifentanil added to propofol and propofol administered alone.

Methods: Following hospital clinical research ethics committee approval, 60 ASA I-II patients were included in the randomized double-blind study. Following premedication, patients received i.v. 0.25 microg kg(-1) remifentanil (Group R1), 0.50 microg kg(-1) remifentanil (Group R2) or normal saline (Group P) in 60 sec. Then following 20 mg lidocaine, propofol 2 mg kg(-1) were administered in R1 and R2 groups and 2.5 mg kg(-1) in P group. Ease of insertion of LMA and airway quality at first attempt was assessed. Number of attempts of LMA insertion, apnea time, additional propofol requirement and hemodynamic changes were recorded.

Results: There were no significant differences in demographic data among the patients. Apnea time (mean +/- SEM) was significantly shorter in P group (34.09 +/- 5.5 sec) compared to R1 (82.5 +/- 12.7 sec) and R2 (87.2 +/- 6.6 sec) groups (p = 0.01 and p = 0.001). Ease of LMA insertion was assessed as grade 1 in 100% of patients in R2 group while 65% in R1 and 30% in P groups. Undesirable responses following LMA insertion were observed in 54% of patients in P group.

Conclusion: Propofol given 2.5 mg kg(-1) alone is not a good agent for LMA insertion. Remifentanil used in both doses combined with propofol provides good and excellent conditions for insertion of LMA with minimal hemodynamic disturbances.