Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018




Prof. Somashekhar Nimbalkar

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Prof. Somashekhar Nimbalkar
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Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
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Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




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Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




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Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : May | Volume : 16 | Issue : 5 | Page : UC14 - UC17 Full Version

A Comparison of Dexmedetomidine and Fentanyl as Co-induction Agents to Propofol for Insertion of Proseal Laryngeal Mask Airway: A Randomised Clinical Study


Published: May 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/56233.16353
Rashmi Pal, Koti Prem, KK Arora, Rashpal Singh Gill

1. Professor, Department of Anaesthesiology, Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh, India. 2. Postgraduate Student, Department of Anaesthesiology, Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh, India. 3. Professor and Head, Department of Anaesthesiology, Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh, India. 4. Assistant Professor, Department of Anaesthesiology, Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh, India.

Correspondence Address :
Dr. Koti Prem,
Flat No. 504, Morya Daisy, Morya Gardens, Kannada Road, Indore-452016, Madhya Pradesh, India.
E-mail: drkotiprem@gmail.com

Abstract

Introduction: The Supraglottic Airway Devices (SAD) are bridges between a face mask and Endotracheal Tubes (ETT). Various induction agents like sevoflurane and propofol were used till date for smooth insertion. Propofol causes dose-dependent cardiorespiratory depression while opioids may increase the haemodynamic instability.

Aim: To investigate the role of dexmedetomidine and fentanyl as co-induction agents to propofol for Proseal Laryngeal Mask Airway (PLMA) insertion conditions.

Materials and Methods: The present study was a randomised clinical study in which 60 patients of American Society of Anaesthesiologists (ASA) grade I-II, 20-60 years of age were divided into two groups. Group P+D received 2.5 mg/kg propofol+1 μg/kg dexmedetomidine while Group P+F received 2.5 mg/kg propofol+1 μg/kg fentanyl. A Bispectral Index (BIS) value of 50-45 was taken as desired end point for insertion of PLMA. Induction time, insertion time, ease of insertion, number of attempts, total propofol requirement and various haemodynamic changes were taken into consideration.

Results: Mean induction time with dexmedetomidine (8.28±0.81 min) was lower as compared to that with fentanyl (9.28±0.83 min) (p<0.0001). Total propofol requirement was also less with dexmedetomidine (93.66±15.64 mg) as compared to that with fentanyl (135.8±10.95 mg). Dexmedetomidine also provided better insertion score for PLMA (p=0.044) with less number of attempts (p=0.044), when compared with fentanyl.

Conclusion: Dexmedetomidine, as an adjuvant to propofol can be considered as an attractive choice for insertion of PLMA.

Keywords

Adjuvant, Bispectral index, Cardiorespiratory, Haemodynamic, Laryngeal mask

For many years, airway management stressed for successful tracheal intubation (1). However in 1981, by the invention of Laryngeal Mask Airway (LMA), the focus of airway management modified from intubation to oxygenation and ventilation. The SAD are bridges between a face mask and ETT. They provide hands free airway, easier placement even by inexperienced personnel (2), less invasive and are better tolerated by the patients. SAD typically do not require neuromuscular blockade, thereby avoiding any side-effects of the medication or its antagonists. In General Anaesthesia, as the loss of protective airway reflexes and obstruction of the upper airway can be life threatening, these SAD such as the PLMA provide a secured airway and prevents aspiration as they have gastric port for drainage of gastric contents (3).

Various induction agents like sevoflurane, thiopentone sodium and propofol were used till date for smooth insertion of PLMA. Propofol having short duration of action causes dose-dependent cardiorespiratory depression when used alone, so different co-induction agents such as low dose muscle-relaxants, opioids, benzodiazepines, etc., have been used along with it to decrease the unwanted events while inserting PLMA (4). However, opioids on other hand may increase the respiratory depression and increase the haemodynamic instability (5).

They may even be used as an emergency airway, where a practitioner skilled in intubation is not available (e.g., paramedic crews) or as in “can’t intubate, can’t ventilate” ventilate situation where timely management of airway is very critical, this type of SAD plays a very important role. So, aiming to fill this vital gap, the present study was conducted to compare dexmedetomidine, a non opioid and a recently introduced highly selective α2-adrenoceptor agonist with analgesic and sedative properties as an attractive alternative to fentanyl, an opioid for smooth insertion of PLMA.The primary objective was to compare induction time, insertion time, ease of insertion and number of attempts, and the secondary objectives were to compare total propofol requirement and haemodynamic responses.

Material and Methods

This randomised clinical study was conducted in Department of Anaesthesiology, Mahatma Gandhi Memorial Medical college and M.Y. Hospital, Indore, Madhya Pradesh, India, after approval from Institutional Ethics Committee (IEC) (EC/MGM/Feb-20136) and obtaining informed consent from the participants. The study was conducted for a period of one year from June 2020 to July 2021.

Inclusion criteria: ASA I-II patients aged from 20-60 years of either gender were included and divided into two groups of 30 each, scheduled for elective surgery under general anaesthesia.

Exclusion criteria: Patients with pre-existing diseases like, cardiopulmonary diseases, hepatic dysfunction, renal dysfunction, psychiatric illness, pregnant and lactating women and patients at risk of aspiration with reduced mouth opening were excluded from study.

Sample size calculation: Sample size was calculated using the formula , where ni is the sample size required in each group (i=1 ,2), α is the selected level of significance and Z1-α/2 is the value from the standard normal distribution holding 1- α/2 below it, and 1-β is the selected power and Z1-β is the value from the standard normal distribution holding 1-β below it (6). ES is the Effect Size, The sample size obtained at 95% confidence interval with an 80% power of the study. α (type-I error rate)=0.05, β (power of the study)=0.8. A total of 60 patients were included in the present study.

Allocation: A thorough pre-anaesthetic evaluation was performed and patients were randomly allocated (using closed envelop technique) to one of the two groups, comprising 30 patients each. Group P+D received 2.5 mg/kg propofol+1 μg/kg dexmedetomidine while Group P+F received 2.5 mg/kg propofol+1 μg/kg fentanyl (Table/Fig 1).

Procedure

On arrival to operating room, intravenous line was secured and baseline vital parameters like Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Respiratory Rate (RR), oxygen saturation (SpO2) and End Tidal CO2 (ETCO2) were recorded. Patients were premedicated with Inj. glycopyrrolate 0.004 mg/kg intravenously and inj. midazolam 0.05 mg/kg intravenously. After preoxygenation for 3 minutes with 100% oxygen on mask, study drugs were administered intravenously over 10 min with a syringe. Thirty seconds after administration of the study drugs, propofol was administered intravenously in a dose of 2.5 mg/kg mixed with 1 mL of 2% lidocaine for induction of anaesthesia in a titrated manner to achieve a BIS value of 50-45 (7) as desired end point for insertion of PLMA. Ninety seconds later a lubricated PLMA was inserted using standard or classical insertion technique and cuff was inflated to the pressure just to seal adequately and patient was connected to breathing circuit (8),(9). After ensuring the correct placement of PLMA, Ryles tube was advanced from the gastric port and its position was ensured by insufflating some air and auscultating over the epigastrium. Patients were kept on assisted spontaneous ventilation and anaesthesia was maintained with N2O:O2=50%:50%, and sevoflurane (1-1.5%).

If mouth opening was not adequate or excessive cough or gag reflexes prevented proper placement of PLMA, anaesthetic depth was further increased by giving an additional dose of propofol 0.5 mg/kg. The second attempt for PLMA insertion was taken and if not successful, the case was excluded from the study. Other events such as apnoea, breath holding, expiratory stridor, and tearing were observed. HR, SBP, DBP, MAP, RR, SpO2 and ETCO2 were recorded at preinduction and 1, 3, 5, 10, 15 min after PLMA insertion. Induction time, insertion time, ease of insertion, number of attempts required for PLMA insertion and additional doses of propofol were also taken into consideration and noted down. The period of observation for the study ended when the patient was considered to have reached adequate depth of anaesthesia and was well settled after insertion of PLMA.

Induction time was defined as the time interval between the administration of induction agent and loss of consciousness to reach a BIS value between 50-45 which is the appropriate level for general anaesthesia. Insertion time was defined as the time interval from the moment the tip of PLMA crossed the incisors till the confirmation of its placement by waveform capnography, which is a gold standard parameter.

The following criteria were used for grading the insertion condition (10):

Scores for jaw mobility: Score 1 for fully relaxed jaw, score 2 for mild resistance of jaw opening, score 3 for tight but opened jaw and score 4 for closed jaw.

Scores for coughing/bucking: Score 1 for no coughing, score 2 for 1-2 coughs, score 3 for ≥3 coughs and score 4 for bucking.

A combined score of ≤2 was considered optimal (easy) for PLMA insertion, scores between 3-5 considered as ‘difficult’ to insert and score of 6-8 considered as ‘impossible’ to insert.

Statistical Analysis

The data was initially entered into the Microsoft excel from the customised proforma for analysis. Statistical Software Mini Tab Version 17.0 was used for calculating the p-values. Comparison of means between the two groups was done using unpaired ‘t’ test, association between two non parametric variables was done using Pearson’s Chi-square test and comparison of proportions was done using Fisher’s-Exact test. A p-value of <0.05 was taken as statistically significant.

Results

Both the groups were comparable demographically (Table/Fig 2). The induction time was statistically lower in the P+D group than with P+F group. However, the difference in insertion time was not significantly different. The mean total propofol requirement was statistically lower in P+D group than in P+F group (Table/Fig 3).

The ease of insertion was better in the P+D group, with more number of patients with ‘easy’ insertion in this group than that in P+F (Table/Fig 4). More number of patients could be inserted with PMLA in first attempt, in the P+D group than P+F (Table/Fig 5).

There was significant reduction in mean HR in the P+D group, when compared to P+F group till the end of 15 minutes (A15) after PLMA insertion (p<0.001) (Table/Fig 6).

There was statistically significant decrease in mean SBP seen in the P+D group, post-PLMA insertion, starting from 1 min (A1) till the end of 15 minutes (A15); as compared to P+F group with (p value <0.05) (Table/Fig 7). However, changes in DBP, RR, SpO2, ETCO2 were not significant (p-value >0.05) (Table/Fig 8).

In P+D group, 29 patients and 24 patients in P+F group had NO adverse events while insertion of Proseal LMA. One patient in P+D group and six patients in P+F group had coughing/bucking/breath holding as side-effects while insertion of PLMA. Thus, the mean adverse effects was found to be statistically significant (p=0.044, Chi-square test applied) between both the groups, showing a lower adverse events in the P+D group than with P+F group.

Discussion

Various inhalation and intravenous agents have been used to suppress airway reflexes and to achieve good relaxation of jaw muscles for adequate insertion conditions. But patient compliance has been found to be better with intravenous agents. Among them, propofol has been preferred the most, but it also leads to cardiorespiratory suppression (11). So to avoid this side-effects of propofol, opioids like fentanyl were added to reduce the propofol requirement (12). Since these drugs increase the incidence of apnoea, another promising adjuvant dexmedetomidine, an α-2 agonist with both sedative and analgesic property has shown to attenuate haemodynamic stress responses more effectively. So, this randomised clinical study has been conducted to compare dexmedetomidine and fentanyl as co-induction agents to propofol for PLMA insertion conditions.

The study findings showed that patient in dexmedetomidine group required less induction time, lower total propofol dose, had better insertion score with less number of attempts as compared to those in fentanyl group. HR and SBP were more stable in dexmedetomidine group as compared to fentanyl group.

Tan ASB and Wang CY (13) reported, that fentanyl produces prolonged apnoea as the dose is increased and they concluded that optimal dose of 1 μg/kg of fentanyl is recommended for LMA insertion along with 2.5 mg/kg propofol, hence 1 μg/kg of fentanyl has been used in present study. The study done by Uzumcugil F et al., concluded that dexmedetomidine, at 1 μg/kg when used before induction, with propofol provided successful laryngeal mask insertion while preserving respiratory function (14). Thus, in the present study, 1 μg/kg of dexmedetomidine for PLMA insertion was considered.

One of the primary objectives was to compare and evaluate the induction time. Results in the study showed a significant lower mean induction time in the P+D group as compared with in P+F group (p<0.0001) (Table/Fig 2). This finding was similar to the study done by Ali AR and El Ghoneimy MN, where desired BIS level was achieved earlier in dexmedetomidine group as compared to fentanyl group (p<0.05) (15).

Overall, 29 patients out of 30 had easy insertion score in P+D group as compared to 24 patients in P+F group. Only one patient had difficult insertion score in P+D group in comparison to four patients in P+F group. This finding was similar to the study done by Launde SA et al., where 29 patients out of 30 patients had easy insertion score in dexmedetomidine group, as compared to 22 patients in fentanyl group (16).

The mean insertion time in the dexmedetomidine and fentanyl group of the present study were compatible and showed no statistical significance (p=0.357). Overall, 29 patients out of 30 had single attempt of in P+D group as compared to 24 patients in P+F group. This finding was similar to the study done by Nellore SS et al., where it was found that 27 patients out of 30 in dexmedetomidine group vs 24 patients out of 30 in fentanyl group required single attempt (17).

Ali AR and El Ghoneimy MN concluded that the propofol requirement was significantly lower with dexmedetomidine group than in fentanyl group during induction and maintenance (15). The results of the index study coincide with these results, on total propofol requirement (Table/Fig 2).

There was statistically significant decrease in the mean HR in the P+D group, after PLMA insertion starting from preinduction (A0) till the end of 15 minutes (A15) as compared to P+F group (Table/Fig 5). A statistically significant decrease in mean SBP, also was seen in the P+D group, in post PLMA insertion starting from 1 min (A1) till the end of 15 minutes (A15) in comparison to P+F group (Table/Fig 6). In a study done by Launde SA et al., the HR and SBP remained stable in dexmedetomidine group as compared to fentanyl group, after LMA insertion (16).

Limitation(s)

Only fixed doses of both the drugs were used and the desired effect may have been attained in lesser doses in some of the patients. The level of norepinephrine in the blood also could not be measured which could reflect attenuation of stress response.

Conclusion

From the above observation and results, it may be concluded that dexmedetomidine, significantly reduced the induction time, provided greater ease of insertion for PLMA with less number of attempts, less total propofol requirement and few adverse events such as apnoea, breath holding, expiratory stridor, and tearing as compared to fentanyl group. Thus, dexmedetomidine, as an adjuvant to propofol, can be considered as an attractive choice for insertion of PLMA.

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DOI and Others

DOI: 10.7860/JCDR/2022/56233.16353

Date of Submission: Mar 10, 2022
Date of Peer Review: Mar 30, 2022
Date of Acceptance: Apr 05, 2022
Date of Publishing: May 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Mar 16, 2022
• Manual Googling: Apr 04, 2022
• iThenticate Software: Apr 07, 2022 (19%)

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