The Impact of Using Muscle Relaxants and Laryngeal Local Anesthetics for Laryngeal Mask Airway (LMA) Insertion on Hemodynamics and Induction Anesthetics Dosage in Elderly
Overview
- Phase
- Not Applicable
- Intervention
- 10% lidocaine spray
- Conditions
- Anesthesia, General
- Sponsor
- Chang Gung Memorial Hospital
- Enrollment
- 96
- Locations
- 1
- Primary Endpoint
- Propofol requirement
- Status
- Completed
- Last Updated
- 2 years ago
Overview
Brief Summary
Laryngeal mask airway (LMA) is currently the most widely used supraglottic airway device with advantages of simple and fast placement, reduced anesthesia drug use, more stable hemodynamics, and less throat discomfort after anesthesia compared to endotracheal intubation. Some studies claimed the use of muscle relaxants or local anesthetics (sprays or lubricants containing local anesthetics) for the throat before LMA placement can reduce the dosage of induction agents and postoperative throat complications.
In modern society, more and more elderly people undergo elective surgery with the need of general anesthesia. However, they are the more vulnerable population with tendency of greater hemodynamic changes with more induction agent usage. Propofol is one of the most used induction agents which may lead to a drop in blood pressure. The objective of this study is to observe whether the dose of propofol and the changes in hemodynamics can be reduced by using muscle relaxants or laryngeal local anesthetics in elderly who receiving general anesthesia with LMA insertion.
Investigators
Yu-Ting, Hung
Principal Investigator
Chang Gung Memorial Hospital
Eligibility Criteria
Inclusion Criteria
- •American Society of Anesthesiologists (ASA) physical status I-III
- •Age: over 65 years
- •Elective orthopedic surgery undergo general anesthesia in supine position
Exclusion Criteria
- •Anticipated difficult airway (Mallampati score 3-4), limited mouth opening, intra-oral and pharyngeal pathology
- •Risk of pulmonary aspiration of gastric contents (full stomach)
- •Obesity (Body mass index \> 35)
- •Significant lung abnormalities (low lung compliance, high airway resistance, impaired oxygenation)
- •Loosening teeth
- •Allergic to Cisatracurium or Lidocaine
- •Failure in successful LMA insertion after second attempts
Arms & Interventions
10% lidocaine spray and cisatracurium group
The subjects received laryngeal local anesthetics (10% lidocaine spray), intravenous cisatracurium 0.12 mg/kg, and propofol before laryngeal mask airway placement. The predetermined dosage of propofol for the first subject is 1 mg/kg.
Intervention: 10% lidocaine spray
10% lidocaine spray and cisatracurium group
The subjects received laryngeal local anesthetics (10% lidocaine spray), intravenous cisatracurium 0.12 mg/kg, and propofol before laryngeal mask airway placement. The predetermined dosage of propofol for the first subject is 1 mg/kg.
Intervention: Cisatracurium
10% lidocaine spray and cisatracurium group
The subjects received laryngeal local anesthetics (10% lidocaine spray), intravenous cisatracurium 0.12 mg/kg, and propofol before laryngeal mask airway placement. The predetermined dosage of propofol for the first subject is 1 mg/kg.
Intervention: Propofol
10% lidocaine spray and placebo of cisatracurium group
The subjects received laryngeal local anesthetics (10% lidocaine spray), intravenous normal saline as a substitute for cisatracurium, and propofol before laryngeal mask airway placement. The predetermined dosage of propofol for the first subject is 1.25 mg/kg.
Intervention: 10% lidocaine spray
10% lidocaine spray and placebo of cisatracurium group
The subjects received laryngeal local anesthetics (10% lidocaine spray), intravenous normal saline as a substitute for cisatracurium, and propofol before laryngeal mask airway placement. The predetermined dosage of propofol for the first subject is 1.25 mg/kg.
Intervention: Placebo of cisatracurium
10% lidocaine spray and placebo of cisatracurium group
The subjects received laryngeal local anesthetics (10% lidocaine spray), intravenous normal saline as a substitute for cisatracurium, and propofol before laryngeal mask airway placement. The predetermined dosage of propofol for the first subject is 1.25 mg/kg.
Intervention: Propofol
Placebo of lidocaine spray and cisatracurium group
The subjects received normal saline spray as a substitute for laryngeal local anesthetics (10% lidocaine spray), intravenous cisatracurium 0.12 mg/kg, and propofol before laryngeal mask airway placement. The predetermined dosage of propofol for the first subject is 1 mg/kg.
Intervention: Placebo of lidocaine spray
Placebo of lidocaine spray and cisatracurium group
The subjects received normal saline spray as a substitute for laryngeal local anesthetics (10% lidocaine spray), intravenous cisatracurium 0.12 mg/kg, and propofol before laryngeal mask airway placement. The predetermined dosage of propofol for the first subject is 1 mg/kg.
Intervention: Cisatracurium
Placebo of lidocaine spray and cisatracurium group
The subjects received normal saline spray as a substitute for laryngeal local anesthetics (10% lidocaine spray), intravenous cisatracurium 0.12 mg/kg, and propofol before laryngeal mask airway placement. The predetermined dosage of propofol for the first subject is 1 mg/kg.
Intervention: Propofol
Placebo group
The subjects received normal saline spray as a substitute for laryngeal local anesthetics (10% lidocaine spray), intravenous normal saline as a substitute for cisatracurium, and propofol before laryngeal mask airway placement. The predetermined dosage of propofol for the first subject is 2 mg/kg.
Intervention: Placebo of lidocaine spray
Placebo group
The subjects received normal saline spray as a substitute for laryngeal local anesthetics (10% lidocaine spray), intravenous normal saline as a substitute for cisatracurium, and propofol before laryngeal mask airway placement. The predetermined dosage of propofol for the first subject is 2 mg/kg.
Intervention: Placebo of cisatracurium
Placebo group
The subjects received normal saline spray as a substitute for laryngeal local anesthetics (10% lidocaine spray), intravenous normal saline as a substitute for cisatracurium, and propofol before laryngeal mask airway placement. The predetermined dosage of propofol for the first subject is 2 mg/kg.
Intervention: Propofol
Outcomes
Primary Outcomes
Propofol requirement
Time Frame: one minute after propofol infusion
The minimal propofol requirement dose was defined as the median effective dose (ED50) of movement or increased mean arterial pressure (MAP) to no movement or stable MAP. The ED50 is the average of the crossover midpoints found during conducting the Dixon's up-and-down method.
Secondary Outcomes
- Coughing or gagging(Within 1 minute after LMA placement)
- Oxygen saturation (SpO2)(0 minute, 1 minute, 2 minute, 3 minute, 4 minute, 5 minute, 10 minute after LMA placement)
- Ease of LMA insertion(Procedure (At the same time of LMA placement))
- Non-invasive blood pressure (NIBP)(0 minute, 1 minute, 2 minute, 3 minute, 4 minute, 5 minute, 10 minute after LMA placement)
- Heart rate (HR)(0 minute, 1 minute, 2 minute, 3 minute, 4 minute, 5 minute, 10 minute after LMA placement)
- Head or body movement(Within 1 minute after LMA placement)
- Peak pressure (P peak) of the airway(0 minute after LMA placement)
- Hiccups(Within 1 minute after LMA placement)
- Mean pressure (P mean) of the airway(0 minute after LMA placement)
- Ease of jaw opening(Procedure (At the same time of LMA placement))
- Attempts for LMA insertion(Procedure (At the same time of LMA placement))
- Complications(One hour after LMA removal)
- Laryngospasm(Within 1 minute after LMA placement)