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Supreme™ laryngeal mask airway insertion requires a lower concentration of sevoflurane than ProSeal™ laryngeal mask airway insertion during target-controlled remifentanil infusion: a prospective randomised controlled study.
BMC Anesthesiol. 2020 01 07; 20(1):5.BA

Abstract

BACKGROUND

ProSeal (PLMA) and Supreme (SLMA) laryngeal mask airways are effective ventilator devices with distinctive designs that may require different anaesthetics for insertion. Sevoflurane induction provides acceptable conditions for laryngeal mask insertion, and remifentanil significantly decreases the minimum alveolar concentration of sevoflurane required for that insertion. The study aimed to evaluate the optimal end-tidal (ET) sevoflurane concentration for successful insertion of PLMA versus SLMA in patients receiving a remifentanil infusion without a neuromuscular blocking agent.

METHODS

Altogether, 45 patients ASA (American Society Anaesthesiologists) physical status I-II, aged 18-60 years were scheduled for elective ambulatory surgery. Exclusion criteria were a difficult airway, recent respiratory infection, reactive airway, obstructive sleep apnoea syndrome, gastric aspiration's risk factors, pregnancy, and lactation. Patients were randomly allocated to receive the SLMA or the PLMA. Sevoflurane induction with co-administration of remifentanil was performed at an effect-site concentration of 4 ng mL- 1. ET50 was calculated with a modified Dixon's up-and-down method (starting at 2.5% in steps of 0.5%). Predetermined sevoflurane concentration was kept constant during the 10 min before LMA insertion. Patient's response to LMA insertion was classified as "movement" or "no movement". Sevoflurane ET50 was determined as the midpoint concentration of all the independent pairs that manifested crossover from "movement" to "no movement".

RESULTS

The ET50 sevoflurane concentration co-administered with remifentanil required for PLMA insertion was 1.20 ± 0.41% (95% confidence interval 0.76 to 1.63%). For SLMA insertion, it was 0.55 ± 0.38% (95% confidence interval 0.14 to 0.95%) (p = 0.019).

CONCLUSIONS

The end-tidal sevoflurane concentration with co-administered remifentanil required to allow insertion of the SLMA was 54% lower than that needed for inserting the PLMA.

TRIAL REGISTRATION

Clinicaltrials.gov identifier: NCT03003377. Retrospectively registered. Date of registration: December 28, 2016.

Authors+Show Affiliations

Anaesthesia department, Hospital General Universitario Gregorio Marañón, C/ Doctor Esquerdo, N° 46, 28007, Madrid, Spain.Anaesthesia department, Hospital General Universitario Gregorio Marañón, C/ Doctor Esquerdo, N° 46, 28007, Madrid, Spain.Department of Legal Medicine, Psychiatry and Pathology Universidad Complutense, Madrid, Spain.Anaesthesia department, Hospital General Universitario Gregorio Marañón, C/ Doctor Esquerdo, N° 46, 28007, Madrid, Spain. mati@plagaro.net. Department of Legal Medicine, Psychiatry and Pathology Universidad Complutense, Madrid, Spain. mati@plagaro.net.

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31910822

Citation

Monteserín-Matesanz, Cristina, et al. "Supreme™ Laryngeal Mask Airway Insertion Requires a Lower Concentration of Sevoflurane Than ProSeal™ Laryngeal Mask Airway Insertion During Target-controlled Remifentanil Infusion: a Prospective Randomised Controlled Study." BMC Anesthesiology, vol. 20, no. 1, 2020, p. 5.
Monteserín-Matesanz C, González T, Anadón-Baselga MJ, et al. Supreme™ laryngeal mask airway insertion requires a lower concentration of sevoflurane than ProSeal™ laryngeal mask airway insertion during target-controlled remifentanil infusion: a prospective randomised controlled study. BMC Anesthesiol. 2020;20(1):5.
Monteserín-Matesanz, C., González, T., Anadón-Baselga, M. J., & Zaballos, M. (2020). Supreme™ laryngeal mask airway insertion requires a lower concentration of sevoflurane than ProSeal™ laryngeal mask airway insertion during target-controlled remifentanil infusion: a prospective randomised controlled study. BMC Anesthesiology, 20(1), 5. https://doi.org/10.1186/s12871-019-0921-5
Monteserín-Matesanz C, et al. Supreme™ Laryngeal Mask Airway Insertion Requires a Lower Concentration of Sevoflurane Than ProSeal™ Laryngeal Mask Airway Insertion During Target-controlled Remifentanil Infusion: a Prospective Randomised Controlled Study. BMC Anesthesiol. 2020 01 7;20(1):5. PubMed PMID: 31910822.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Supreme™ laryngeal mask airway insertion requires a lower concentration of sevoflurane than ProSeal™ laryngeal mask airway insertion during target-controlled remifentanil infusion: a prospective randomised controlled study. AU - Monteserín-Matesanz,Cristina, AU - González,Tatiana, AU - Anadón-Baselga,María José, AU - Zaballos,Matilde, Y1 - 2020/01/07/ PY - 2019/09/03/received PY - 2019/12/23/accepted PY - 2020/1/9/entrez PY - 2020/1/9/pubmed PY - 2021/1/12/medline KW - End-tidal sevoflurane concentration KW - Laryngeal mask airway Proseal KW - Laryngeal mask airway supreme KW - Remifentanil effect-site concentration KW - Supraglottic airway devices SP - 5 EP - 5 JF - BMC anesthesiology JO - BMC Anesthesiol VL - 20 IS - 1 N2 - BACKGROUND: ProSeal (PLMA) and Supreme (SLMA) laryngeal mask airways are effective ventilator devices with distinctive designs that may require different anaesthetics for insertion. Sevoflurane induction provides acceptable conditions for laryngeal mask insertion, and remifentanil significantly decreases the minimum alveolar concentration of sevoflurane required for that insertion. The study aimed to evaluate the optimal end-tidal (ET) sevoflurane concentration for successful insertion of PLMA versus SLMA in patients receiving a remifentanil infusion without a neuromuscular blocking agent. METHODS: Altogether, 45 patients ASA (American Society Anaesthesiologists) physical status I-II, aged 18-60 years were scheduled for elective ambulatory surgery. Exclusion criteria were a difficult airway, recent respiratory infection, reactive airway, obstructive sleep apnoea syndrome, gastric aspiration's risk factors, pregnancy, and lactation. Patients were randomly allocated to receive the SLMA or the PLMA. Sevoflurane induction with co-administration of remifentanil was performed at an effect-site concentration of 4 ng mL- 1. ET50 was calculated with a modified Dixon's up-and-down method (starting at 2.5% in steps of 0.5%). Predetermined sevoflurane concentration was kept constant during the 10 min before LMA insertion. Patient's response to LMA insertion was classified as "movement" or "no movement". Sevoflurane ET50 was determined as the midpoint concentration of all the independent pairs that manifested crossover from "movement" to "no movement". RESULTS: The ET50 sevoflurane concentration co-administered with remifentanil required for PLMA insertion was 1.20 ± 0.41% (95% confidence interval 0.76 to 1.63%). For SLMA insertion, it was 0.55 ± 0.38% (95% confidence interval 0.14 to 0.95%) (p = 0.019). CONCLUSIONS: The end-tidal sevoflurane concentration with co-administered remifentanil required to allow insertion of the SLMA was 54% lower than that needed for inserting the PLMA. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT03003377. Retrospectively registered. Date of registration: December 28, 2016. SN - 1471-2253 UR - https://www.unboundmedicine.com/medline/citation/31910822/Supreme™_laryngeal_mask_airway_insertion_requires_a_lower_concentration_of_sevoflurane_than_ProSeal™_laryngeal_mask_airway_insertion_during_target_controlled_remifentanil_infusion:_a_prospective_randomised_controlled_study_ L2 - https://bmcanesthesiol.biomedcentral.com/articles/10.1186/s12871-019-0921-5 DB - PRIME DP - Unbound Medicine ER -