News Release
FOR IMMEDIATE RELEASE
Which Anesthetic Combination is Best to Use for GA Induction during LMA Insertion? A Comparison
Anesthesia Progress – The use of general anesthesia (GA) is a standard practice in surgical operations; however, there are risk factors involved, including the need for a laryngeal mask airway (LMA) to maintain an open airway during GA administration or as an immediate life-saving measure if a patient is having difficulty breathing or a failed airway. Typically, GA is administered with a medication that induces relaxation, such as propofol. Still, propofol can have adverse effects that can be exacerbated by LMA insertion, and controlling those adverse effects is a top priority for clinicians.
To assess adverse outcomes during LMA insertion, researchers from the University of Toronto and Mount Sinai Hospital Toronto in Toronto, Ontario, Canada, recently published a study in the current issue of Anesthesia Progress. Lead author Cameron Goertzen, DDS, MSc, and colleagues state, “The aim of this study was to examine differences in adverse outcomes between anesthetic agents used during LMA insertion following GA induction. We performed a systematic review and network meta-analysis (NMA) comparing propofol as the sole anesthetic for GA induction with other anesthetic combinations used during LMA insertion.” A total of 53 randomized control trials that included 4695 patients and 28 anesthetic combinations during GA induction and LMA insertion were included in the NMA. Propofol was used as the only comparator against other anesthetics. The primary outcome analyzed was prolonged apnea, with secondary outcomes of adverse airway events, LMA insertion failure, inadequate depth of anesthesia, and hemodynamic events.
Researchers found an apnea incidence rate of 33.3% (mean time of 3.74 ± 3.56 minutes). When compared against all propofol combinations, other than the propofol and thiopental combination, propofol alone was found to be the least effective at reducing adverse effects; the propofol and dexmedetomidine combination was found to be the most effective for reducing adverse outcomes during LMA insertion.
The research presented in this study appears to be the first of its kind to compare and rank the effectiveness of all anesthetic combinations used for GA induction during LMA insertion, with the propofol and dexmedetomidine combination being the most effective. Goertzen and colleagues conclude, “The NMA method allows for direct and indirect comparisons of multiple treatments when head-to-head comparisons are not always available in the literature. In the studies that met our inclusion criteria, 48 different anesthetics and anesthetic combinations were identified. This study demonstrates that the comparison of different anesthetic combinations with an NMA is feasible and effective.”
The study results suggest that propofol, compared with remimazolam, has a lower incidence of early PONV but a higher incidence of intraoperative hypotension. “However, given that over 33% of patients still developed late PONV regardless of the anesthetic agent used, it is likely necessary to administer antiemetics prophylactically for orthognathic surgery.” Kaneko and colleagues go on to further state, “On the other hand, there was no significant difference in the average intraoperative systolic blood pressure between [total intravenous anesthesia] with propofol vs remimazolam during general anesthesia for orthognathic surgery in young, healthy adults.”
Full text of the article, “Comparison of Anesthetics for Laryngeal Mask Airway Insertion: A Network Meta-Analysis,”Anesthesia Progress, Vol. 71, No. 2, 2024, is now available at https://www.doi.org/10.2344/22-00033
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About Anesthesia Progress
Anesthesia Progress is the official publication of the American Dental Society of Anesthesiology (ADSA). The quarterly journal is dedicated to providing a better understanding of the advances being made in the science of pain and anxiety control in dentistry. The journal invites submissions of review articles, reports on clinical techniques, case reports, and conference summaries. To learn more about the ADSA, visit: http://www.adsahome.org/.
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