Title: Study of Effect of Midazolam on the Dose of Propofol for Laryngeal Mask Airway Insertion in Children

Author(s) - Dr. Gayatri Kumari*1, Dr. Anoop Kumar Singh2, Dr. Gandhi Jha3, Dr. Aditi Yadav4

 DOI: - 10.23958/ijirms/vol02-i06/07


Introduction:

The major responsibility of an anesthesiologist is to provide adequate respiration for the patient and the most vital element is providing respiration is the airway. No anesthetic is safe unless diligent efforts are devoted to maintain an intact function airway. In studies it has been found that adverse respiratory episodes were mainly due to inadequate ventilation, esophageal intubation and insufficient tracheal intubation.

With the induction of anesthesia and onset of apnea, ventilation and oxygenation are supported by traditional methods; facemasks and end tracheal tubes. Recent supralaryngeal airway support devices are Laryngeal Mask Airway (LMA) and Combined Or pharyngeal Airway (COPA)

LMA was designed by Dr. Archie Brain as a novel concept in airway management by establishing end to end circumferential seal around laryngeal intlet with inflatable cuff. It is a till for managing emergency airway as an aid to intubation and as a bridge filling the niche between facemask and tracheal tubes in terms of both anatomical position and degree of invasiveness. The device does not, however, provide a water tight seal around the larynx, and should not be used in patients at risk of regurgitation. There is a risk of gastric inflation during positive pressure ventilation.

LMA in children is becoming increasingly common and it has been noticed that placement may be more difficult may be more difficult in children. It has been suggested that the standard insertion technique recommended by Brain may be sub-optional infants and children may be due to their different anatomy (large tongue in relation to mandible; glottis lies higher and anterior than adult; vocal cords are angled more forwards and downwards and large and floppy epiglottis)

Insertion of LMA is accompanied by smaller cardiovascular responses than those after larryngoscopy and intubation an its use may be indicated in those patients in whom a marked pressor response would be deleterious. Insertion of LMA soon after induction is facilitated by propofol, which depresses pharyngeal and laryngeal reflexes. The larger central compartment volume is consistent with higher induction dose requirement in children. Propofol has been shown to be superior to thiopental when these agents are used along for facilitating insertion of LMA and has been recommended as induction agent of choice for its insertion. However, bolus intravenous propofol may cause proloned apnoea, is more expensive than thiopental and often causes pain on injection.

Midazolam is an effective sedative premedicant in children which is synergistic with propofol and may reduced dose required for LMA insertion.

Midazolam is less expensive than propofol and has a relatively short elimination half-life (1-4 hrs). In this study we will determine the dose of propofol for LMA insertion in children with and without premedication with intravenous midazolam and also observe the haemogynamic and respiratory changes.


How to Cite this Article?

"Dr. Gayatri Kumari, Dr. Anoop Kumar Singh, Dr. Gandhi Jha, Dr. Aditi Yadav" ‘Study of Effect of Midazolam on the Dose of Propofol for Laryngeal Mask Airway Insertion in ChildrenInternational Journal of Innovative Research in Medical Science(IJIRMS), http://ijirms.in/index.php, Volume 2 Issue 6, June 2017, p. No. 820-856

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SJIF Impcat Factor - 4.102

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