Leah Maria, Raju (2013) Low Dose Succinylcholine to Facilitate Laryngeal Mask Airway Insertion. Masters thesis, Christian Medical College, Vellore.
|
Text
201001113leah_maria_raju.pdf Download (4MB) | Preview |
Abstract
INTRODUCTION: Ambulatory surgery is upcoming in all parts of the world as life becomes more fast pace and time is a limited commodity. In this setting general anaesthesia using the Laryngeal Mask Airway is widely used. Laryngeal Mask Airway insertion is accomplished using Propofol as it helps blunt the laryngeal reflexes well, when compared to other induction agents. Often though it has been seen that Propofol as a sole agent is not sufficient to prevent patient movement, coughing and gagging. Additional doses of Propofol are required to prevent these undesirable airway reflexes and multiple insertion attempts needed. These can be associated with adverse haemodynamic changes and airway trauma. Numerous adjuvants have been studied and proven to aid insertion of the Laryngeal Mask Airway eg: Midazolam, low dose Rocuronium, Fentanyl and Remifentanyl ; thus reducing the Propofol requirements and avoiding the adverse haemodynamic changes that can occur with large doses of propofol. These also aid in smooth Laryngeal Mask Airway insertion, avoiding unnecessary airway trauma. Succinylcholine is a quick onset, short acting depolarizing muscle relaxant. It is a time tested drug, easily available and cost effective. The use of Succinycholine to aid insertion of the Laryngeal Mask Airway is advantageous as it avoids depression of the respiratory centre and has no influence on consciousness, unlike opiods and benzodiazepines. Use of Succinylcholine to facilitate Laryngeal Mask Airway insertion has been studied in the past. Succinycholine has been proven to facilitate Laryngeal Mask Airway insertion, with and without an additional agent such as Fentanyl or Midazolam. Most of these studies used a single arbitrary dose and did not compare two doses to get an ideal dose. This study compares two doses of Succinylcholine and placebo and aims to identify the ideal dose of Succinylcholine required to facilitate Laryngeal Mask Airway insertion. AIM OF THE STUDY: The aim of this study is to prove that low dose Succinylcholine facilitates Laryngeal Mask Airway insertion. OBJECTIVES: 1. To prove that low dose Succinylcholine facilitates Laryngeal Mask Airway insertion. 2. To ascertain the lowest acceptable dose of Succinylcholine that is needed for smooth LMA insertion. 3. To ascertain if use of Succinylcholine, decreases Propofol consumption. 4. To compare haemodynamics, in the three groups. METHODS: clinical and statistical. This is a prospective, double blinded, randomized control trial of 283 patients randomized into three groups- placebo, 0.1mg/kg and 0.25mg/kg of Succinylcholine. Patients excluded were ASA > II, age < 20 or > 65, BMI > 30, oral surgeries and difficult airways. Patients were induced with 2mg/kg of Propofol, after 2μgms/kg of Fentanyl. The study drug was given. After 60 seconds 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 haemodynamics were assessed. Statistical methods used were ANOVA with Bonferroni’s t test, chi square test and Fischer’s test. p value <0.05 was considered statistically significant. RESULTS: There was equal distribution of patients in all three groups. Demographically age, weight, height and BMI were equally distributed, though males were more than females. Jaw relaxation was significantly better in the 0.25mg/ 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 0.25mg/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 Laryngeal Mask Airway. CONCLUSIONS: This study concludes that a low dose of Succinylcholine does facilitate insertion of the Laryngeal Mask Airway. The ideal dose is 0.25mg/kg of Succinylcholine. 0.1mg/kg is not sufficient and is associated inadequate jaw relaxation and does not always provide smooth insertion conditions. There is decreased Propofol consumption with use of Succinylcholine. Haemodynamics were not affected adversely. Duration of apnoea is not unduly prolonged and was the same in all groups. Fasciculations were more in the 0.25mg/kg group but there was no relation between fasciculations and myalgia, reinstating the multifactorial basis behind myalgia.
| Item Type: | Thesis (Masters) |
|---|---|
| Uncontrolled Keywords: | Low Dose Succinylcholine ; Facilitate ; Laryngeal Mask Airway Insertion. |
| Subjects: | MEDICAL > Anaesthesiology |
| Depositing User: | Subramani R |
| Date Deposited: | 30 Apr 2018 02:55 |
| Last Modified: | 30 Apr 2018 02:55 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/7335 |
Actions (login required)
 |
View Item |
