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Co-administration of alfentanil-propofol improves laryngeal mask airway insertion compared to fentanyl-propofol

[La co-administration d'alfentanil et de propofol, comparée à celle de fentanyl et de propofol, améliore l'insertion du masque laryngé]

Jacqueline K.L. Hui, MBBS^*, Lester A.H. Critchley, MD, FFARCSI^*, Manoj K. Karmakar, MBBS, FCRA^* and Patrick K.K. Lam, MBBS, FANZCA

^* From the Department of Anaesthesia Intensive Care, The Chinese University of Hong Kong Prince, of Wales Hospital, Shatin, and
Department of Anaesthesia and Intensive Care, Tuen Mun Hospital, Tuen Mun, New Territories, Hong Kong, Peoples Republic of China.

Address correspondence to: Dr. Lester A.H. Critchley, Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, SAR, Peoples Republic of China. Phone: 852-2632-2735; Fax: 852-2637-2422; E-mail: hcritchley{at}cuhk.edu.hk

Purpose: Insertion of the laryngeal mask airway (LMA) requires sufficient depth of anesthesia to relax the jaw and obtund airway reflexes. Recent studies suggest that the short-acting opioid alfentanil provides the best insertion conditions. We therefore compared the insertion conditions following co-administration of alfentanil-propofol with more commonly used fentanyl-propofol.

Methods: One hundred forty ASA I or II patients, age 18–81 yr, requiring minor surgery were recruited. They were randomized to receive either alfentanil (10 µg•kg^-1; n = 73) or fentanyl (1 µg•kg^-1; n = 67) with propofol (2.5 mg•kg^-1) 90 sec prior to LMA (size 3 or 4) insertion. A six variable (mouth opening, ease of insertion, swallowing, coughing, movement and laryngospasm) three-point (nil / partial / total) score was used to assess insertion conditions. Duration of postinsertion apnea was recorded. Insertion conditions were compared using Chi-square for trends.

Results: The two groups were demographically similar. Mouth opening and ease of insertion were not improved with alfentanil co-administration. Alfentanil-propofol reduced the incidence of swallowing, gagging, movement and laryngospasm (P < 0.05), with 29% (alfentanil) compared to 45% (fentanyl) of patients responding (P = 0.05) to LMA insertion. Apnea [mean (SD)] following alfentanil lasted 154 (139) sec compared to 82 (61) sec following fentanyl (P = 0.001).

Conclusion: Co-administration of alfentanil-propofol provided better insertion conditions than fentanyl-propofol, though apnea was prolonged by 72 sec.

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