Efficacy of propofol-fentanyl-sevoflurane anesthesia under spontaneous respiration with nasopharyngeal airway-face mask for pediatric minor surgery: a comparison with laryngeal mask airway / 中华麻醉学杂志

ABSTRACT

Objective To compare the efficacy of combined intravenous-inhalational anesthesia with propofol-fentanyl-sevoflurane in children undergoing minor surgery under spontaneous breathing with nasopharyngeal airway-face mask versus laryngeal mask airway (LMA).Methods Seventy-two children,scheduled for elective high ligation of indirect inguinal hernia,were randomly divided into 2 groups (n =36 each):nasopharyngeal airway-face mask group (group M) and LMA group (group L).Propofol 1.0 mg/kg and fentanyl 2.0μg/kg were injected intravenously.The spontaneous breathing was kept.After lass of consciousness,a face mask was placed for inhalation of pure oxygen at 2 L/min and 3 ％ sevoflurane.When BIS value reached 50-60,a size 2 LMA was inserted in group L and a nasopharyngeal airway was placed via the left nasal cavity and the face mask was held tightly and connected to the anesthesia machine in group M.Anesthesia was maintained with inhalation of 2％-4％ sevoflurane.Fentanyl 1 μg/kg was injected intravenously 5 min before skin incision.The concentration of sevoflurane was adjusted to maintain BIS value at 40-60 during surgery.Mean arterial pressure,heart rate,partial pressure of end-tidal carbon dioxide and pulse oxygen saturation were recorded before induction,at 3 min during induction,immediately after successful insertion of the airway,at skin incision,3 min after skin incision,and immediately after removal of the airway.The airway insertion time,success rate of insertion at first attempt,emergence time,and adverse reactions were recorded.Results Compared with group L,mean arterial pressure and heart rate were significantly decreased during airway insertion or removal,nasopharyngeal airway insertion time was shortened and the success rate of nasopharyngeal airway insertion at first attempt (100％) was increased,and the agitation score and incidence of obstruction of the upper respiratory tract were decreased in group M (P ＜ 0.05).Conclusion Combined inravenous-inhalational anesthesia with propofol-fentanyl-sevoflurane is easy to establish the airway,can maintain spontaneous breathing,has little influence on circulatory function and reduce complications during recovery from anesthesia in children undergoing minor surgery under spontaneous breathing with nasopharyngeal airway-face mask,and the efficacy is better than that with LMA.