Original Article

Comparison of Propofol and Sevoflurane for Laryngeal Mask Airway Insertion in Elderly Patients

Authors: GuiQian Shao, MD, GuoHua Zhang, MD

Abstract

Background: Sevoflurane and propofol have been widely used for anesthesia induction. This study compared the efficacies of sevoflurane and propofol inductions for laryngeal mask airway (LMA) insertion in elderly patients.


Methods: Ninety patients, aged 60 or more, received anesthesia induction with propofol and with sevoflurane 8% using the vital capacity breath (VCB) or tidal volume breath (TVB) techniques. Hemodynamic changes, induction time, complications, and the quality and ease of LMA insertion were observed.


Results: LMA was inserted most, less or least rapidly with propofol (89 ± 28 s), sevoflurane 8% using the VCB (163 ± 34 s) or TVB (205 ± 44 s) techniques, respectively. Anesthesia induction with propofol or sevoflurane 8% using the VCB technique produced either more frequent apnea or greater reduction in mean blood pressure than with sevoflurane 8% using the TVB technique.


Conclusions: Sevoflurane 8% using the TVB technique provides a smoother induction with a stable hemodynamic profile, less apnea and technical demand, but requiring longer time for LMA insertion in unpremedicated elderly patients.


Key Points


* Anesthesia inductions with propofol and with sevoflurane 8% using the vital capacity breath (VCB) or tidal volume breath (TVB) techniques can all provide clinically accepted conditions for laryngeal mask airway (LMA) insertion in elderly patients.


* Propofol induction offered more rapid LMA insertion with fewer attempts, but also greater reduction in mean blood pressure and more frequent apnea, compared with the two sevoflurane induction methods.


* Although sevoflurane 8% plus VCB technique took less time for insertion of LMA, it resulted in more pronounced hemodynamic changes and required extra patient cooperation and anesthesia circuit priming as compared to sevoflurane 8% plus TVB technique.


* Sevoflurane 8% plus TVB technique was able to provide smoother anesthesia induction for LMA insertion in elderly patients with fewer untoward events at the cost of longer induction time.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Kati I, Demirel CB, Huseyinoglu UA, et al. Comparison of propofol and sevoflurane for laryngeal mask airway insertion. Tohoku J Exp Med 2003;200:111–118.
 
2. Gupta A, Stierer T, Zuckerman R, et al. Comparison of recovery profile after ambulatory anesthesia with propofol, isoflurane, sevoflurane and desflurane: a systematic review. Anesth Analg 2004;98:632–641.
 
3. Conzen PF, Kharasch ED, Czerner SF, et al. Low-flow sevoflurane compared with low-flow isoflurane anesthesia in patients with stable renal insufficiency. Anesthesiology 2002;97:578–584.
 
4. Nieminen K, Westerèn-Punnonen S, Kokki H, et al. Sevoflurane anaesthesia in children after induction of anaesthesia with midazolam and thiopental does not cause epileptiform EEG. Br J Anaesth 2002;89:853–856.
 
5. Dhdhia KN, Kudalkar A. Comparison of sevoflurane and halothane for induction of anaesthesia and laryngeal mask airway insertion in paediatric patients. I J Anaesth 2004;48:465–468.
 
6. Hall JE, Stewart JI, Harmer M. Single-breath inhalation induction of sevoflurane anaesthesia with and without nitrous oxide: a feasibility study in adults and comparison with an intravenous bolus of propofol. Anaesthesia 1997;52:410–415.
 
7. Chawathe M, Zatman T, Hall JE, et al. Sevoflurane (12% and 8%) inhalational induction in children. Paediatr Anaesth 2005;15:470–475.
 
8. Walpole R, Logan M. Effect of sevoflurane concentration on inhalation induction of anaesthesia in the elderly. Br J Anaesth 1999;82:20–24.
 
9. Jin F, Chung F. Minimizing perioperative adverse events in the elderly. Br J Anaesth 2001;87:608–624.
 
10. Baker CE, Smith I. Sevoflurane: a comparison between vital capacity and tidal breathing techniques for the induction of anaesthesia and laryngeal mask airway placement. Anaesthesia 1999;54:841–844.
 
11. Ti LK, Chow MY, Lee TL. Comparison of sevoflurane with propofol for laryngeal mask airway insertion in adults. Anesth Analg 1999;88:908–912.
 
12. Thwaites A, Edmends S, Smith I. Inhalation induction with sevoflurane: a double-blind comparison with propofol. Br J Anaesth 1997;78:356–361.
 
13. Yamaguchi S, Ikeda T, Wake K, et al. A sevoflurane induction of anesthesia with gradual reduction of concentration is well tolerated in elderly patients. Can J Anesth 2003;50:26–31.
 
14. Siddik-Sayyid SM, Aouad MT, Taha SK, et al. A comparison of sevoflurane-propofol versus sevoflurane or propofol for laryngeal mask airway insertion in adults. Anesth Analg 2005;100:1204–1209.
 
15. Sivalingam P, Kandasamy R, Madhavan G, et al. Conditions for laryngeal mask insertion: a comparison of propofol versus sevoflurane with or without alfentanil. Anaesthesia 1999;54:271–276.
 
16. Dundee JW, Robinson FP, McCollom JS, et al. Sensitivity to propofol in the elderly. Anaesthesia1986;41:482–485.
 
17. Hatakeyama N, Ito Y, Momose Y. Effects of sevoflurane, isoflurane and halothane on mechanical and electrophysiologic properties of canine myocardium. Anesth Analg 1993;76:1327–1332.
 
18. Schlack W, Heck Z. Is a single vital capacity breath a suitable method for preoxygenation? Can J Anesth 2001;48:423–424.
 
19. Campbell IT, Beatty PCW. Monitoring preoxygenation. Br J Anaesth 1994;72:3–4.