Isoflurane Versus Propofol for Removal of LMA in Children

• Study will be start after confirming the approval of institutional ethical review committee and after fulfilling the study inclusion criteria. The detailed study protocol will be explain to the parent/guardian and written & informed consent will be taking on his/her will.
• Inclusion Criteria

• Age between 2 to 10 years,
• American Society of Anaesthesiologists (ASA) physical status I & II,
• Patient is not contraindicated to Laryngeal Mask Airway insertion,
• Elective below umbilical general surgical procedures
• patient is planned for general anesthesia with spontaneous breathing.
• Fifty patients will participate in both study groups.
• All patients will be premedicated with oral midazolam 0.3mg/kg, 45 to 60 minutes prior to induction.
• After arrival of patients in operating room, routine anesthesia monitoring will be applied and baseline blood pressure, heart rate, respiratory rate and oxygen saturation will be recorded.
• Patient will be induced with anesthetic induction inhalational agent (sleeping drug) sevoflurane 8% with oxygen by pediatric anesthesia circle system. The sevoflurane concentration will be adjusted to 3% to 4% once the adequate depth of anesthesia achieved, as evident by jaw relaxation and tolerance of an oral airway.
• The LMA will be placed after the insertion of intravenous line.
• The LMA size will be determined as per manufacturer's recommendation; which suggest 1.5 LMA size for 5-10 kg, size 2 for 10-20 kg and size 2.5 for 20-30 kg.
• The anesthesia will be maintained with isoflurane in 60% nitrous oxide and 40% oxygen. Patients will be ventilated by spontaneous mode by 'Mapleson F anesthesia circuit' and for above 25 Kg patient, the circle system will be used.
• Caudal analgesia was standardised in both study groups.
• Prior to LMA removal in group-I, isoflurane MAC awake (MAC less than 0.5) will be achieved in expiratory gases with 60% nitrous oxide and 40% oxygen. Propofol 1 mg/Kg will be combined with Isoflurane MAC awake and LMA will be removed after 20 seconds of propofol administration in group-I.

The group-II LMA will removed at end expiratory isoflurane MAC of 1.2% with 60% nitrous oxide and 40% oxygen. In both groups; LMA will be removed with inflated cuff, throat was suctioned and patients were turned into lateral recovery position.

Isoflurane and nitrous oxide were turned off and 100% oxygen supplemented till the patient had regained consciousness. All participants were transported to Post Anesthesia Care Unit (PACU) once ensured airway patency and peripheral oxygen saturation (Sp02) greater than 93% on room air. Children were allowed to wake up effortlessly in PACU at oxygen 5 litters/minutes via Hudson mask.

• The following study variables will be recorded;

• Emergence time ( patient awakening time),
• Duration of recovery room stay (Post anesthesia care unit),
• Smooth Laryngeal Mask Airway removal will be assessed by

• Cough,
• Hypersalivation,
• 02 desaturation < 90%,
• Teeth clenching,
• Airway obstruction requiring jaw support,
• Laryngospasm,
• Bronchospasm,
• Retching,
• Vomiting,
• Confounding variables will be assessed like;

• Patients demographics,
• Duration of surgery,
• Duration of anesthesia,
• Type of surgery,
• Mode of analgesia
• Number of Laryngeal Mask Airway insertion attempts:

Inclusion criteria

• American Society of Anesthesiologist class-I & II patients.
• mallampatis class I & II.
• Age from 2 years to 10 years.
• Elective surgical patients for below umbilical general surgical procedures.

Exclusion criteria

• Congenital disorders
• Airway or facial abnormalities
• Reactive airway disease/asthma
• Anticipated difficult airway
• History of Upper respiratory tract infection in last 3 weeks
• History of gastroesophageal reflux disorders
• Known allergic to isoflurane and propofol