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ANESTHETIC PHARMACOLOGY

The Use of Remifentanil to Facilitate the Insertion of the Laryngeal Mask Airway

Department of Anaesthesia and Intensive Care, Pamela Youde Nethersole Eastern Hospital, Hong Kong Special Administrative Region, China

Address correspondence to Dr. Monica P. L. Lee, Department of Anaesthesia and Intensive Care, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Hong Kong Special Administrative Region, China. Reprints will not be available.

Propofol is often used as an IV induction drug for anesthesia and the insertion of a laryngeal mask airway (LMA). As a sole anesthetic, it may be associated with undesirable airway responses such as coughing and gagging. We conducted a randomized, double-blinded study to compare the conditions during insertion of the LMA in 120 patients who received normal saline (Group P), remifentanil 0.25 µg/kg (Group R1), or remifentanil 0.5 µg/kg (Group R2) before the induction of anesthesia with IV propofol. The addition of remifentanil significantly improved the conditions of insertion; in Group R1, 82.5% (33 of 40 patients), and in Group R2, 85.0% (34 of 40 patients) had excellent insertion conditions as compared with the Control group P, 32.5% (13 of 40 patients). Patients in Group P were apneic for a mean (SD) time of 85 (38) s, 186 (75) s in group R1, and 284 (130) s in group R2. There was a lesser decrease in mean arterial blood pressure in group R1. We conclude that remifentanil 0.25 µg/kg, when administered after IV propofol 2.5 mg/kg, provides excellent conditions for insertion of the LMA with minimal hemodynamic disturbances.

IMPLICATIONS: Small-dose remifentanil can provide excellent conditions for laryngeal mask airway insertion with minimal hemodynamic disturbances.

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