Introduction: Alone or various combinations of propofol with either etomidate or sevoflurane have been used to enhance placement quality of laryngeal mask airway and reduce the incidence of hypotension. In this prospective trial we compared the placement characteristics of classic LMA (CLMA) and hemodynamic variations with 3 mg/kg propofol alone or with 1.5 mg/kg propofol followed by one minute of 6% sevoflurane in 50% oxygen+50% N2O with patient breathing spontaneously. Our hypothesis was that a combination of smaller doses of propofol with sevoflurane would be associated with better CLMA placement characteristics and lesser changes in hemodynamic parameters. Material and Methods: After obtaining ethical approval, 51 consenting patients were randomly allocated into two groups, Propofol Group (p Group n = 26) or Sevoflurane-Propofol Group (SP Group n = 25). No muscle relaxant was used to aid CLMA placement in either group. Six different parameters (number of attempts, jaw relaxation, ease of insertion, patient movement, coughing and laryngospasm) were assessed with Lund and Stovner grading system. In addition, the hemodynamic parameters were also recorded during induction of anesthesia and following CLMA insertion. Results: In either group, significant decrease in HR, systolic BP and diastolic BP was observed 4-6 min after placement of CLMA. None of the patients in either group had coughing or laryngospasm during CLMA insertion (p = 0.0). No significant difference was observed in jaw relaxation (p = 0.263), ease of insertion (p = 0.789), patient movement (p = 0.999), coughing (p = 0.0), gagging (p = 0.322) and or laryngospasm (p = 0.314). Conclusion: Propofol 3mg/kg (P Group) provides almost equal conditions for CLMA insertion as compared to Propofol (1.5mg/kg)-Sevoflurane (6%) combination (PS Group) and both induction techniques demonstrated nearly identical hemodynamic instability.

Introduction: Pain from propofol injection can be severe and distressing in some patients. Various methods and agents has been used to alleviate this pain. One of the agents is ketamine which has been used in different sub-anaesthetic doses to reduce propofol injection pain in comparison with different agents. None of the studies till date have used ketamine in dose less than 0.1 mg/kg. The aim of the present study was to compare ketamine in doses of 0.05 and 0.1 mg/kg to attenuate propofol injection pain. Material and Method: 48 ASA I and II adult patients undergoing different elective surgical procedures under general anaesthesia were randomised into 3 groups of 16 patients each. Group A patients received ketamine 0.05 mg/kg in 2 mL while group B patients received ketamine 0.1mg/kg in 2mL. Group C patients served as placebo control and were administered 2mL 0.9% normal saline intravenously. The venous drainage was occluded manually by rubber tourniquet at mid-arm. Subsequently the study drug or the placebo was administered as per group allocation. One minute later, 25% of calculated propofol induction dose was injected over 5 seconds. VAS score for pain of propofol injection was assessed at 0, 1 and 2 minutes after the propofol injection. Thereafter, general anaesthesia technique was continued as per standard technique giving the remaining 75% of propofol. Patient’s heart rate and blood pressure were recorded at 0, 1 and 2 minutes after the administration of 25% of the calculated dose of propofol. Any evidence of hallucination was observed in the recovery room. Results: Demographic profile and the ASA grade of the patients in the 3 groups was uniformly distributed. The mean VAS score for pain perception in group B patients at 1 and 2 minutes was 0.56 and 1.06 respectively. In contrast, the mean VAS for pain was 3.88 and 5.06 at 1 and 2 minutes respectively in group C. The VAS score of patients belonging to group A was closer to that seen in group B patients. This difference in VAS score was statistically highly significant between the groups at 1 and 2 minutes. A significant fall in systolic blood pressure was noted at 2 minutes after administering 25% of the propofol induction dose in all the 3 groups. In contrast, no significant changes were noted at one minute when compared to baseline. There was insignificant fall in the heart rate at 1 and 2 minutes following the administration of 25% propofol in group A & B. In contrast, an insignificant rise in heart rate was noted at 1 and 2 minutes in group C. Conclusion: The results of this study demonstrate that 0.01 mg/kg of ketamine administered one minute prior to propofol injection is effective and superior to 0.05 mg/kg of ketamine in relieving propofol injection pain without any side effects.