Effect-site concentration of propofol required for LMA-Supreme™ insertion with and without remifentanil: a randomized controlled trial

Matilde Zaballos, Emilia Bastida, Salomé Agustí, Maite Portas, Consuelo Jiménez, Maite López-Gil, Matilde Zaballos, Emilia Bastida, Salomé Agustí, Maite Portas, Consuelo Jiménez, Maite López-Gil

Abstract

Background: A new supraglottic device, the LMA-Supreme™, has recently become available for clinical use. Information on anaesthetic and co-adjuvant requirements for insertion of the LMA-Supreme™ is limited. The present study aimed to evaluate the optimal effect-site concentration of propofol in 50 % (EC50) of adults necessary for successful insertion of the LMA-Supreme™ and to examine remifentanil's effect on propofol requirements.

Methods: Fifty-eight elective patients (aged 18-60 years; ASA (American Society Anaesthesiologists) physical status classification I and II) scheduled for day surgery were randomly assigned to one of two groups: propofol with saline or propofol with remifentanil. Anaesthesia was induced by target-controlled infusion according to predetermined effect-site concentrations of propofol and remifentanil (5 ng.mL(-1)). The EC50 was calculated using Dixon's up-and-down method. Ten minutes following drug administration, LMA-Supreme™ insertion was attempted without the use of muscle relaxant drugs.

Results: In the propofol + saline group, the EC50 of propofol required for LMA-Supreme™ insertion was 6.32 ± 0.67 μg.mL(-1) (95 % CI, 5.69-6.94 μg.mL(-1)). With the addition of remifentanil at an effect-site concentration of 5 ng.mL(-1), the EC50 of propofol required for LMA-Supreme™ insertion was 2.50 ± 0.80 μg.mL(-1) (95 % CI, 1.82-3.17 μg.mL(-1); p < 0.0001).

Conclusions: The propofol requirement for smooth insertion of the LMA-Supreme™ was 60 % less when remifentanil (5 ng.mL(-1)) was co-administered.

Clinical trial registration: Identified as NCT01974648 at www.clinicaltrials.gov .

Figures

Fig. 1
Fig. 1
Flow-diagram of patient progress through the phases of the trial. Patients were recruited until a sample size of seven crossovers was reached in each group
Fig. 2
Fig. 2
Patients’ responses to Laryngeal Mask Airway Supreme™ insertion in the propofol + saline group. Arrows indicate the midpoint of the effect-site concentration of all independent pairs of patients involving crossover from device insertion failure to successful Laryngeal Mask Airway Supreme™ insertion
Fig. 3
Fig. 3
Patients’ responses to Laryngeal Mask Airway Supreme™ insertion in the propofol + remifentanil group. Arrows indicate the midpoint of the effect-site concentration of all independent pairs of patients involving crossover from device insertion failure to successful Laryngeal Mask Airway Supreme™ insertion
Fig. 4
Fig. 4
Dose–response curves plotted from logistic analysis of individual propofol concentrations illustrating reactions to LMA-Supreme™ insertion. EC50 in propofol + saline group: 6.09 μg.mL−1; EC50 in propofol + remifentanil group: 2.11 μg.mL−1; EC95 in propofol + saline group: 12.09 μg.mL−1; EC95 in propofol + remifentanil group: 4.33 μg.mL−1

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