This study compared the use of propofol versus sevoflurane for induction of general anesthesia and insertion of a laryngeal mask airway in 100 adult patients. Patients were randomly assigned to receive either propofol or sevoflurane, with fentanyl also administered to both groups. Induction was faster with propofol but it caused more episodes of apnea and lower blood pressure compared to sevoflurane. Sevoflurane provided a smoother induction with fewer complications and more hemodynamic stability, making it the preferred induction agent for laryngeal mask airway insertion according to this study.

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AJ Univ. R Vol. 3 (2013)
A COMPARATIVE STUDY OF SEVOFLUORANE AND PROPOFOL
FOR INDUCTION OF GENERAL ANAESTHESIA IN ADULTS FOR
LARYNGEAL MASK AIRWAY INSERTION
B. Chaurasia, I.J.Namazi, S.S.Patil
Dept. of Anaesthesiology, Dr D. Y. Patil Medical College, D.Y. Patil University Kolhapur- 416006, (INDIA).
Email id: drbasantc@gmail.com
ABSTRACT
We performed a prospective, randomized study to compare better conditions for Laryngeal Mask
Airway insertion, by using Propofol or Sevofluorane along with Fentanyl in both groups as a co-
induction agent. After approval from institutional ethical committee, 100 ASA I–II patients, aged 18-60
years, undergoing elective surgical procedures were included and randomly allocated to Group P
(Propofol) and Group S (Sevofluorane) for LMA insertion. IV Propofol allowed fast induction when
compared with Sevofluorane (95.26± 14.59 vs 118.30± 8.18 sec) but associated with more incidence of
apnoea (64% vs 0%). Complications in both groups i.e. coughing, gagging, biting, laryngospasm etc
were not reached to statistical significance. MAP was found to be significantly lower in Propofol group
after induction and persistent till the 5th
min. Present study conclude that induction with Sevofluorane
for LMA insertion is more efficacious in terms of smooth induction, rapid recovery, low incidence of
apnoea and better hemodynamic stability.
KEYWORDS: Laryngeal Mask Airway, Sevofluorane, Intravenous Propofol.
INTRODUCTION
Now a day’s Intravenous Propofol is considered to
be the most preferable induction agent of choice
for insertion of LMA, due to its rapid onset and
depressant effect on airway reflexes, however
Propofol induction is associated with frequent and
more prolonged apnoea. Furthermore,
Sevofluorane5
is a halogenated, volatile, non-
pungent anaesthetic agent which allows rapid,
smooth induction and early emergence.
LMA is a Supraglottic airway device1
which is less
stimulating to patients’ then endotracheal tube and
is now considered the first choice for diagnostic
and minimally invasive surgical procedures.
Hereby, we conducted a study to assess better
LMA insertion conditions following Propofol and
Sevofluorane.
METHODOLOGY
A prospective, randomized, observer blinded study
conducted on ASA I and II, aged 18-60 years,
undergoing elective surgical procedures.
Institutional ethical committee approval and
written informed consent were obtained from all
patients. Patients were randomly allocated in
Group P (Propofol) and Group S (Sevofluorane) of
50 each and both group received Fentanyl
Intravenously as co-induction agent.

2. 140 B. Chaurasia, I.J.Namazi, S.S.Patil
AJ Univ. R Vol. 3 (2013)
All patients underwent pre-anaesthetic check-up and
routine investigations were carried-out. Tab.
Diazepam 10 mg orally given on previous night and
kept NPO for at least 8 hours. On the day of
surgery, every patient received Inj. Glycopyrolate
0.2 mg IV, 20 min before induction and Inj.
Midazolam 0.03 mg/kg IV, 2 min before induction
with basal vital monitoring consisted of ECG,
NIBP, Spo2 and EtCo2. After an IV access with 20
G indwelling cannula was established, a slow
infusion of Ringer Lactate solution was started.
Each patient received Inj.Fentanyl 2mcg/kg IV, 2
min prior to induction.
Group P (Propofol) – After pre-oxygenation for 3
min, patients received Propofol 2 mg/kg over 30
seconds, followed by 20 mg increments as necessary
to achieve induction of anaesthesia.
Group S (Sevofluorane) – After pre-oxygenation
for 3 mins, patients were instructed to exhale to
residual and then to inhale a vital capacity of
Sevofluorane 8% in 100% oxygen by Using an
Ohmeda Sevotec 5 vaporiser and a circle system,
Sevofluorane 8% in 100% oxygen was delivered at
a fresh gas flow of 6 L/min. Patient was asked to
hold vital capacity breath for as long as possible. If
necessary, a second breath was taken.
The time to loss of eyelash reflex and jaw relaxation
was noted, when relaxed, the anaesthetist attempted
to insert a LMA (LMA No. 3 for 30-50 kg and LMA
No.4 for 50-70 kg). Correct placement of LMA was
confirmed by –
 B/L equal air entry
 B/L equal chest movement
 Gel displacement test
If the first attempt was failed, second attempt was
tried after repeat administration of Propofol or
Sevofluorane. Total number of attempts and time
noted. The NIBP and PR were measured before and
at induction, at 1st
, 2nd
and 5th
min after start of
induction. All adverse effects associated with
induction were noted (i.e. apnoea, coughing,
gagging, laryngospasm, involuntary movements).
Statistical analysis was performed by computer
assisted software, SPSS ver. 16.0. For estimating the
significance of difference between proportions, the
test used was Chi-square test and Yate,
s correction
factor was applied wherever the expected value was
less than 5. The 5% level of probability (P<0.05)
was taken as significantly.
RESULTS
The patients in both groups were comparable in
means of age, sex and weight and ASA grade
(Table 1) but found to be statistically insignificant.
In our hypothesis we noted, HR initially increased
and then decreased compared to baseline in
Sevofluorane group (Fig.1). Significant decrease in
HR was noted in Propofol group at induction, 1 and
2 min (1 min, 77.44±8.04 vs 83.96±10.14 bpm,
P=0.00).
Variables Group P
N=50
Group S
N=50
Age(Yrs) 36.30±12.72 34.94±13.36
Sex(M/F) 19/31 20/30
Weight(kg) 52.6 52.22
ASA Grade I- 37
II- 13
I-38
II-12
Table 1 : Demographic Data

3. A COMPARATIVE STUDY OF SEVOFLUORANE AND PROPOFOL FOR INDUCTION OF GENERAL ANAESTHESIA IN ADULTS FOR LARYNGEAL MASK AIRWAY 141
AJ Univ. R Vol. 3 (2013)
*** highly significant P value.
TABLE 2 : Induction Characteristics
We noted decrease in systolic blood pressure in both
groups (Fig 2) but comparatively greater in Propofol
group which was statistically significant at 5th
min of
induction (111.28±7.03 vs 106.46±8.44). Induction
of anaesthesia was associated with a decrease in
MAP compared with baseline in both groups (fig
no.3). This was significantly more in Propofol
compared with Sevofluorane group (5 min,
78.18±5.90 and 81.87±5.36, P=0.001).
Group P Group S
Involuntary movement 0% 0%
Gagging 0% 0%
Coughing 0% 4%
Laryngospasm 0% 0%
TABLE 3 : Adverse events during LMA insertion
The induction was much faster with Propofol
comparatively to Sevofluorane for successful LMA
insertion. The mean time to successful LMA
placement in group P was 95.26 ± 14.59 sec. and in
group S 118.30 ± 13.54 sec. which was statistically
significant (Table 2).
HEMODYNAMIC DATA
A) COMPARISON OF HEART RATE
BETWEEN THE TWO GROUPS
Fig. 1 : Comparison of HR in two groups.
B) COMPARISON OF SYSTOLIC BLOOD
PRESSURE BETWEEN TWO GROUPS -
Fig.2- Comparison of systolic blood pressure in two
groups.
C) COMPARISON OF MAP BETWEEN THE
TWO GROUPS -
Fig.3 : Comparison of MAP in both groups.
10
20
30
40
50
60
70
80
90
Propofol Mean Sevofluorane Mean
90
100
110
120
130
Propofol Mean Sevofluorane Mean
70
75
80
85
90
95
Propofol
Mean
Sevofluorane
Mean
Group P Group S P
value
Loss of
eyelash
reflex(sec)
70.42±12.83 82.38±7.75 0.00
***
Jaw
relaxation
(sec)
84.60±14.24 98.22±9.88 0.00
***
Time to
LMA
insertion
(sec)
95.26±14.59 118.30±8.1
8
0.00
***
Incidence
of apnoea
64% 0%

4. 142 B. Chaurasia, I.J.Namazi, S.S.Patil
AJ Univ. R Vol. 3 (2013)
In this study inadequate jaw relaxation was found in
one patient in Sevofluorane group in the same
patient ease of LMA insertion was difficult and
requiring second attempt. The statistical analysis
revealed no significant difference between the two
groups. Coughing was found in two patients in
Sevofluorane group but was statistically
insignificant (Table 3). We found 64% incidence of
apnoea with Propofol but Sevofluorane induction
was associated with 0% incidence of apnoea (Table
2).
DISCUSSION
In this study, we demonstrated that induction with
Sevofluorane compares favourably with Propofol
for insertion of LMA in adults. Sevofluorane and
Propofol both successfully induced anaesthesia in
all patients. The hemodynamic responses were more
stable with Sevofluorane group. Insertion of LMA
after Sevofluorane induction was associated with
second attempt in one patient probably due to
tightness of jaw and two patients had coughing
during LMA insertion, comparatively with Propofol
the insertion of LMA was achieved in one attempt
in all patients without any complications but
associated with significant decrease in
hemodynamic parameters and higher incidences of
apnoea.
Anaesthetic induction and LMA insertion using
Sevofluorane have several advantages.
Sevofluorane allows a smoother transition to the
maintenance phase without a period of apnoea.
Apnoea occurred in 64% of the patients in Propofol
group but did not occur in Sevofluorane group. The
presence of apnoea requires the anaesthesiologist to
assist the ventilation. Sevofluorane prevents the
pain on injection associated with Propofol. MAP
was better maintained with Sevofluorane induction
comparatively to IV Propofol, relative hypotension
with Propofol may be disadvantageous for
compromised patients.
In a related study, Lian Kah Ti et al2
inserted LMA
faster by using IV Propofol in 74±29 sec whereas,
in our study it took much more time 95.26±14.59
sec. They found 32% incidence of apnoea, coughing
in two patients and there were four failures of LMA
insertion in Propofol group whereas, in our study
we noted 64% incidence of apnoea in Propofol
group and no patient had coughing. In our study we
noted coughing in two patients in Sevofluorane
group but we were able to insert LMA successfully
in all patients in both groups. Both groups had
stable hemodynamic profile in their study but we
noted significant decrease in MAP and in HR with
IV prpofol.
In another study, Sahar M Siddik-Sayyid et al7
,
compare Sevofluorane-Propofol vs Sevofluorane
or Propofol alone. They achieved rapid LMA
insertion with Propofol in 73±18 sec
comparatively to Sevofluorane and
Sevofluorane-propofol (140±42 vs 91±15 sec)
respectively, whereas in our study, we were able
to insert LMA much earlier in 118.30±8.18 sec
in Sevofluorane group comparatively to their
study. The incidence of apnoea was more with
Propofol alone (84%) in their study which was
higher than our study (64%). They noted apnoea
in Sevofluorane and Sevofluorane-propofol (7%
vs 16%) groups also whereas in our study,
induction with Sevofluorane had 0% incidence
of apnoea. In this study Sevofluorane required
more attempt for successfully LMA insertion as
similar to our study and hemodynamic
parameters were found to be stable in all groups
in their study whereas we noted more stable
hemodynamic parameters in only Sevofluorane
group.
A. Thwaites et al3
, achieved faster induction with
Propofol in comparison to Sevofluorane (57±11
vs 84±24 sec) in our study we noted, rapid
insertion of LMA with IV Propofol but it took
more time, comparatively to their study
(95.26±14.59 vs 118.30±8.18). Induction of
anaesthesia with Propofol was associated with
decrease in MAP comparatively to Sevofluorane
and was associated with more incidence of
apnoea (65% vs 0%) which correlates with our
study.

5. A COMPARATIVE STUDY OF SEVOFLUORANE AND PROPOFOL FOR INDUCTION OF GENERAL ANAESTHESIA IN ADULTS FOR LARYNGEAL MASK AIRWAY INSERTION 143
AJ Univ. R Vol. 3 (2013)
CONCLUSION
In conclusion, we found that using high inspired
concentration inhalational induction with
Sevofluorane is efficient for LMA insertion without
apnoea but requires more time than with IV
Propofol.
REFERENCES
1. Brain AIJ: A new concept in airway management;
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2. Lian Kah Ti et al, “Comparison of Sevoflurane with
propofol for laryngeal mask airway insertion in
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3. A Thwaites, S. Edmends and I. Smith “Inhalation
induction with sevoflurane: a double – blind
comparison with propofol” British Journal of
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4. Dorsch JA, Dorsch SE. (eds). Laryngeal Mask
Airway. Understanding anaesthesia equipment
(4thEdn), Williams and Wilkins 1999; 15: 463-504.
5. Stoelting RK. Volatile anaesthetic agents. In
Stoelting RK editors, Pharmacology and Physiology
in Anesthetic practice. 3rd edition. Philidelphia,
Lippincott Raven; 1999.P. 140 – 57.
ACKNOWLEDGEMENTS
I would like to thank my Prof. Dr K.R.Kulkarni
Asst. Prof. Dr Anupama S. for their continuous and
valuable support & finally all my anaesthesia staff,
colleague & juniors without whom this would not
be possible.
6. Muzi M, Robinson BJ, Ebert TJ, O’Brien TJ.
Induction of anesthesia and tracheal intubation with
sevoflurane in adults. Anaesthesiology 1996; 85: 536
43.
7. Sahar M Siddik-Sayyid, A Comparison of
Sevoflurane-Propofol versus Sevoflurane or Propofol
for Laryngeal Mask Airway Insertion in Adults.
(AnesthAnalg 2005;100: 1204–9).
8. J. E. Hall et al, Sevofluorane anaesthesia with or
without N2O, Anaesthesia 1997,52,pages 410-415.
9. Ismail Kati et al, Comparison of Propofol and
Sevofluorane for Laryngeal Mask Airway Insertion,
Tohoku J. Exp. Med,2003,200,111-118.