Comparison of I-Gel insertion conditions with two different induction methods in children: a prospective observational study

Year 2023, Volume: 6 Issue: 2, 330 - 335, 27.03.2023

Hülya Kaşıkara , Sengül Özmert

https://doi.org/10.32322/jhsm.1220132

Abstract

Aim: Insufficient depth of anesthesia is one of the important causes of laryngospasm in pediatric patients undergoing surgery. Propofol is a widely used anesthetic agent for induction of anesthesia in children. Its use alone in induction may be insufficient to suppress laryngeal reflexes during laryngeal mask insertion and may lead to complications such as cough, hiccups, and laryngospasm. In this study, the effects of fentanyl-ketamine mixture and remifentanil used as co-induction in anesthesia induction in children on I-gel insertion conditions and hemodynamic stability were compared. In addition, the evaluation of propofol injection pain after the use of coinduction agent was made.
Material and Method: The study included 60 patients aged 2-10 years, of ASA I-III class, who underwent ambulatory surgery. For anesthesia induction, the KF group (n:30) were administered intravenous (iv) 1 mcg/kg fentanyl + 0.5 mg/kg ketamine followed by 3 mg/kg propofol, and the R group (n:30) were administered iv 0.5 mcg/kg remifentanil followed by 3 mg propofol. The I-gel insertion conditions were evaluated by scoring the six variables of mouth opening, ease of insertion, swallowing, coughing, movement, and laryngospasm. Pain during propofol injection was graded using a four-point scale.
Results: No statistically significant difference was determined between the groups in terms of I-gel insertion conditions total score values (p>0.05). The pain of the propofol injection was determined at a significantly higher level in Group R (p<0.05).
Conclusion: Both induction methods were seen to be easy to apply and provide sufficient success in I-gel insertion. No laryngospasm was observed in either group. More effective relief of propofol injection pain in the fentanyl-ketamine group provided calmer and more stable induction conditions. In this respect, it may be preferable to use fentanyl and low-dose ketamine together as co-induction.

Keywords

remifentanil, ketamine, fentanyl, co-induction, child

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