COMPARISON OF TOPICAL AND INTRAVENOUS LIGNOCAINE IN PATIENTS UNDERGOING LARYNGEAL MASK AIRWAY INSERTION UNDER PROPOFOL: A RANDOMIZED CONTROLLED TRIAL

A SULTAN; A ALI; EHH ALSAADI; MAM MAAN; R NASEEM; S HUSSAIN

doi:10.54112/bcsrj.v2024i1.1099

Authors

A SULTAN Department of Anesthesia, Peshawar General Hospital Peshawar, Pakistan
A ALI Department of Anesthesia, Hayatabad Medical, Complex Peshawar, Pakistan
EHH ALSAADI Department of Anesthesia, King Salman Bin Abdulaziz Medical City, Madina, Saudi Arabia
MAM MAAN Department of Anesthesia, Faisal Abad Medical University, Faisalabad, Pakistan
R NASEEM Department of Post-RN Nurse, Faisalabad Medical University, Faisalabad, Pakistan
S HUSSAIN Department of Anesthesia, DHQ Hospital Mirpur AJK, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v2024i1.1099

Keywords:

Laryngeal mask airway, topical lignocaine, intravenous lignocaine, propofol anesthesia, airway reflexes, hemodynamic response.

Abstract

Laryngeal mask airway (LMA) insertion is a common technique used in general anesthesia, but it may induce airway reflexes such as coughing, gagging, and laryngospasm. Lignocaine, whether administered topically or intravenously, is often used to suppress these reflexes. However, the comparative efficacy of these two routes remains unclear. Objective: This study aims to compare the effectiveness of topical versus intravenous lignocaine in facilitating LMA insertion and minimizing airway complications in patients undergoing propofol anesthesia. Methods: A randomized controlled trial was conducted on 62 patients undergoing elective surgeries under general anesthesia at a tertiary care hospital. Patients were randomly assigned into two groups: Group A (n = 31) received 40 mg of topical lignocaine aerosol, while Group B (n = 31) received intravenous lignocaine 1.5 mg/kg. Both groups were induced with propofol (2 mg/kg) prior to LMA insertion. Primary outcomes included the number of LMA insertion attempts, airway responses (coughing, gagging, laryngospasm), and hemodynamic parameters (systolic blood pressure, diastolic blood pressure, and heart rate) recorded at baseline and 1, 2, and 3 minutes post-insertion. Results: LMA insertion on the first attempt was successful in 93.5% of patients in the topical lignocaine group compared to 74.2% in the intravenous group (p = 0.03). Airway reflexes were significantly lower in the topical group, with coughing, gagging, and laryngospasm rates of 6.5%, 16.1%, and 9.7%, respectively, compared to 32.3%, 45.2%, and 29.0% in the intravenous group (p < 0.05). Hemodynamic parameters, including systolic and diastolic blood pressure and heart rate, showed no significant differences between the two groups at baseline or post-insertion. Conclusion: Topical lignocaine significantly improves conditions for LMA insertion compared to intravenous lignocaine, resulting in fewer airway complications while maintaining similar hemodynamic stability. Therefore, topical lignocaine is recommended for optimizing LMA insertion during propofol anesthesia.

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References

Schweiger T, Rodrigues IdFS, Roesner I, Schneider-Stickler B, Evermann M, Denk-Linnert D-M, et al. Laryngeal mask as the primary airway device during laryngotracheal surgery: data from 108 patients. The Annals of Thoracic Surgery. 2020;110(1):251-7.

Singh A, Bhalotra AR, Anand R. A comparative evaluation of ProSeal laryngeal mask airway, I-gel and Supreme laryngeal mask airway in adult patients undergoing elective surgery: A randomised trial. Indian journal of anaesthesia. 2018;62(11):858-64.

Armstrong L, Caulkett N, Boysen S, Pearson JM, Knight CG, Windeyer MC. Assessing the efficacy of ventilation of anesthetized neonatal calves using a laryngeal mask airway or mask resuscitator. Frontiers in Veterinary Science. 2018;5:292.

Zaballos M, Bastida E, Agustí S, Portas M, Jiménez C, López-Gil M. Effect-site concentration of propofol required for LMA-Supreme™ insertion with and without remifentanil: a randomized controlled trial. BMC anesthesiology. 2015;15:1-10.

Ashay NA, Wasim S, Anil TB. Propofol requirement for insertion of I-gel versus laryngeal mask airway: A comparative dose finding study using Dixon's up-and-down method. Journal of Anaesthesiology Clinical Pharmacology. 2015;31(3):324-8.

Nuhu SI, Ajogwu GA, Embu HY, Isamade ES. Ease of Laryngeal Mask Airway Insertion–Comparison of Propofol versus Thiopentone and Lignocaine in Adult Patients. Borno Med J(Online). 2020:1-11.

Naeem U, Waheed A, Azeem Y, Awan MN. Effects of body mass index on propofol-induced cardiovascular depression in the Pakistani population. Pakistan Journal of Medical Sciences. 2023;39(2):534.

Haque MM, Sarkar NC. A Comparative Study between Sevoflurane and Propofol for Ease of Laryngeal Mask Airway Insertion. British Journal of Medical & Health Sciences (BJMHS). 2020;2(8).

Gopinath M, Ravishankar M, Nag K, Kumar VH, Velraj J, Parthasarathy S. Estimation of effect-site concentration of propofol for laryngeal mask airway insertion using fentanyl or morphine as adjuvant. Indian Journal of Anaesthesia. 2015;59(5):295-9.

Hu S, Li Y, Wang S, Xu S, Ju X, Ma L. Effects of intravenous infusion of lidocaine and dexmedetomidine on inhibiting cough during the tracheal extubation period after thyroid surgery. BMC anesthesiology. 2019;19:1-8.

Hung K-C, Yew M, Lin Y-T, Chen J-Y, Wang L-K, Chang Y-J, et al. Impact of intravenous and topical lidocaine on clinical outcomes in patients receiving propofol for gastrointestinal endoscopic procedures: a meta-analysis of randomised controlled trials. British journal of anaesthesia. 2022;128(4):644-54.

Turgut K, Yavuz E, Gülaçtı U, Aydın İ, Sönmez C, Aktaş N, et al. Comparison of intravenous paracetamol, dexketoprofen trometamol, or topical lidocaine use for pain relief in scorpion stings: a placebo-controlled, randomized study. Wilderness & Environmental Medicine. 2022;33(4):379-85.

Ahmed S, Jain N, Saksena S. Comparative evaluation of topical and intravenous lignocaine for insertion of laryngeal mask airway with propofol. 2018.

Shazad M, Nadeem SM, editors. Topical and intravenous lignocaine comparison on laryngeal mask airway insertion conditions quality. Medical Forum Monthly; 2020.

Deshpande MA, Kulkarni S, Deshpande AM. Evaluation of combined efficacy of Lodhradi lep with Khadirashtakkwath in Mukhdushika. International Journal of Ayurvedic Medicine. 2023;14(1):260-7.