Comparison of sevoflurane concentration for insertion of proseal laryngeal mask airway and tracheal intubation in children (correlation with BIS)

Mudakanagoudar, Mahantesh S.; Santhosh, M.C.B.

doi:10.1016/j.bjane.2014.07.011

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Scientific Articles • Rev. Bras. Anestesiol. 66 (1) • Jan-Feb 2016 • https://doi.org/10.1016/j.bjane.2014.07.011 copy

Comparison of sevoflurane concentration for insertion of proseal laryngeal mask airway and tracheal intubation in children (correlation with BIS)^☆ ☆ Study done at Department of Anaesthesiology, Medical College and SSG Hospital, Vadodara, India.

Authorship SCIMAGO INSTITUTIONS RANKINGS

BACKGROUND:

Sevoflurane is an inhalational agent of choice in paediatric anaesthesia. For management of airways in children a suitable alternative to ETT is a paediatric proseal laryngeal mask airway (benchmark second generation SAD). Various studies have shown that less sevoflurane concentration is required for LMA insertion in comparison to TI. BIS is a useful monitor of depth of anaesthesia.

AIMS:

To compare concentration of sevoflurane (end tidal and MAC value) required for proseal laryngeal mask airway insertion and tracheal intubation in correlation with BIS index.

METHOD:

The prospective randomised single blind study was done in children between 2 and 9 years of ASA I and II and they were randomly allocated to Group P (proseal laryngeal mask airway insertion) and Group TI (tracheal intubation). No sedative premedication was given. Induction was done with 8% sevoflurane and then predetermined concentration was maintained for 10 min. Airway was secured either by proseal laryngeal mask airway or endotracheal tube without using muscle relaxant. End tidal sevoflurane concentration, MAC, BIS, and other vital parameters were monitored every minute till insertion of an airway device. Insertion conditions were observed. Statistical analysis was done by ANOVA and Students t test.

RESULTS:

Difference between ET_LMI (2.49 ± 0.44) and ET_TI (2.81 ± 0.65) as well as MAC_LMI (1.67 ± 0.13) and MAC_TI (1.77 ± 0.43) was statistically very significant, while BIS_LMI (49.05 ± 10.76) and BIS_TI (41.25 ± 3.25) was significant. Insertion conditions were comparable in both the groups.

CONCLUSION:

We can conclude that in children airway can be secured safely with proseal laryngeal mask airway using less sevoflurane concentration in comparison to tracheal intubation and this was supported by BIS index.

Sevoflurane; Proseal laryngeal mask airway; Endotracheal tube; Bispectral index monitor

Wt in kg	Predetermined end tidal sevoflurane concentration
	Group P	Group TI
9–10	2%	2.5%
10–15	2.5%	3%
>20	3%	3.5%

	Group P	Group TI	p-Value
Age (yrs)	5.65 ± 3.10	4.6 ± 1.46	>0.05
Weight (kg)	14.40 ± 4.96	11.65 ± 1.76	>0.05

Gender
Male	19	18	>0.05
Female	1	2	>0.05

ASA grade
I	18 (90%)	17 (85%)	>0.05
II	2 (10%)	3 (15%)	>0.05

Stages	Group P	Group TI	p-Value
Induction	6.35 ± 1.06	5 ± 1.45	>0.05

After predetermined concentration
0 min	3.82 ± 1.41	3.97 ± 1.31	>0.05
1 min	2.71 ± 0.47	2.87 ± 0.67	>0.05
2 min	2.53 ± 0.43	2.81 ± 0.65	<0.01
3 min	2.47 ± 0.45	2.83 ± 0.65	<0.01
4 min	2.46 ± 0.46	2.81 ± 0.65	<0.01
5 min	2.43 ± 0.45	2.82 ± 0.64	<0.01
6 min	2.47 ± 0.44	2.82 ± 0.64	<0.01
7 min	2.47 ± 0.45	2.82 ± 0.4	<0.01
8 min	2.46 ± 0.47	2.81 ± 0.64	<0.01
9 min	2.47 ± 0.44	2.81 ± 0.64	<0.01
10 min (insertion)	2.49 ± 0.44	2.81 ± 0.65	<0.01

Stages	Group P	Group TI	p-Value
Induction	3.19 ± 0.66	2.77 ± 0.74	>0.05

After predetermined concentration
0 min	2.31 ± 0.61	2.47 ± 0.65	>0.05
1 min	1.79 ± 0.22	1.88 ± 0.46	<0.01
2 min	1.65 ± 0.15	1.78 ± 0.42	<0.01
3 min	1.64 ± 0.12	1.79 ± 0.42	<0.01
4 min	1.65 ± 15	1.78 ± 0.42	<0.01
5 min	1.63 ± 0.15	1.80 ± 0.42	<0.01
6 min	1.68 ± 0.16	1.78 ± 0.42	<0.01
7 min	1.65 ± 0.15	1.78 ± 0.42	<0.01
8 min	1.65 ± 0.14	1.76 ± 0.42	<0.01
9 min	1.67 ± 0.12	1.77 ± 0.42	<0.01
10 min (insertion)	1.67 ± 0.13	1.77 ± 0.43	<0.01

Stages	Group P	Group TI	p-Value
Pre induction	94.35 ± 2.50	93.60 ± 2.80	>0.05
Induction	81.05 ± 10.69	81.75 ± 7.95	>0.05

After predetermined concentration
0 min	38.80 ± 17.53	35.50 ± 12.71	>0.05
1 min	40.11 ± 16.25	35.40 ± 11.62	>0.05
2 min	43 ± 14.61	40.75 ± 7.59	>0.05
3 min	41.75 ± 14.06	45.30 ± 8.63	>0.05
4 min	40.45 ± 14.75	44.40 ± 6.41	>0.05
5 min	45.21 ± 14.14	43.85 ± 6.49	>0.05
6 min	46.47 ± 13.53	43.10 ± 6.79	>0.05
7 min	47.89 ± 12.6	43.15 ± 5.03	>0.05
8 min	47.37 ± 12.02	42.75 ± 5.64	>0.05
9 min	48.63 ± 11.07	41.95 ± 5.93	<0.05
10 min (insertion)	49.05 ± 10.76	41.25 ± 3.25	<0.05

Sociedade Brasileira de Anestesiologia R. Professor Alfredo Gomes, 36, 22251-080 Botafogo RJ Brasil, Tel: +55 21 2537-8100, Fax: +55 21 2537-8188 - Campinas - SP - Brazil
E-mail: bjan@sbahq.org

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[1] * Corresponding author. E-mail:drmontygoudar@yahoo.co.in (M.S. Mudakanagoudar).

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Comparison of sevoflurane concentration for insertion of proseal laryngeal mask airway and tracheal intubation in children (correlation with BIS)☆ ☆ Study done at Department of Anaesthesiology, Medical College and SSG Hospital, Vadodara, India.

BACKGROUND:

AIMS:

METHOD:

RESULTS:

CONCLUSION:

Comparison of sevoflurane concentration for insertion of proseal laryngeal mask airway and tracheal intubation in children (correlation with BIS)^☆ ☆ Study done at Department of Anaesthesiology, Medical College and SSG Hospital, Vadodara, India.