• Muhammad Adnan Multan Institute Of Kidney Diseases Multan
  • Aamir Furqan Multan Institute Of Kidney Disease Multan
  • Muhammad Kaleem Sattar Nishtar Medical College Multan


Background: Propofol is a widely-accepted medication for the successful insertion of laryngeal mask airway (LMA). When propofol is used alone, larger doses are required which can lead to cardiorespiratory distress resulting in hypotension and prolonged apnoea. The objective of this study was to evaluate the effect of premedication of midazolam on different doses of propofol for LMA insertion. Methods: In this randomized clinical trial, eighty-six (86) patients who were scheduled to undergo elective surgery is supine position not requiring the need for tracheal intubation from September 2015 to 6 March 2016 were included. In group I (n=43), the LMA was introduced after induction of anaesthesia with Propofol alone. In Group II (n=43, the patient was premeditated with midazolam (0.05 mg/kg) before induction of anaesthesia with propofol. Each group was divided into three subgroups depending upon the dose of propofol used for LMA insertion. Results: In this study, there were 53.5% females in group I and 48.8% females in group II. The mean age of Children in group I was 7.30±2.55 years and 7.47±2.46 years in group II. Incidence of incomplete Jaw relaxation, coughing and limb movements was significantly high in in Group I patients (p-values <0.001, <0.001 and <0.001 respectively). Effectiveness of anaesthesia was compared among different subgroups. On comparison of subgroup Ia and IIa, the effectiveness rate was significantly high in subgroup IIa 50% versus only 7.1% in subgroup Ia (p-value 0.012). Similarly, in subgroup IIb effectiveness was achieved in 100% patients as compared to only 64.3% patients in subgroup IIb (p-value 0.014). There was no significant difference in effectiveness rate in subgroup Ic and IIc (p-value 0.309). Conclusion: With midazolam pre-medication, the dose of propofol for LMA insertion is decreased. The incidence of adverse events during LMA insertion is also low with midazolam premedication.Keywords: Laryngeal mask airway; Propofol; Midazolam


Campo SL, Denman WT. The laryngeal mask airway: its role in the difficult airway. Int Anesthesiol Clin 2000;38(3):29–45.

Nakayama S, Osaka Y, Yamashita M. The rotational technique with a partially inflated laryngeal mask airway improves the ease of insertion in children. Pediatr Anesth 2002;12(5):416–9.

Begec Z, Demirbilek S, Onal D, Erdil F, Ilksen Toprak H, Ozcan Ersoy M. Ketamine or alfentanil administration prior to propofol anaesthesia: the effects on ProSeal laryngeal mask airway insertion conditions and haemodynamic changes in children. Anaesthesia 2009;64(3):282–6.

Jarineshin H, Kashani S, Vatankhah M, Abdulahzade Baghaee AA, Sattari S, Fekrat F. Better hemodynamic profile of laryngeal mask airway insertion compared to laryngoscopy and tracheal intubation. Iran Red Crescent Med J 2015;17(8):e28615.

Hui JK, Critchley LA, Karmakar MK, Lam PK. Co-administration of alfentanil-propofol improves laryngeal mask airway insertion compared to fentanyl-propofol. Can J Anesth 2002;49(5):508–12.

Dwivedi MB, Nagrale M, Dwivedi S, Singh H. What happens to the hemodynamic responses for laryngeal mask airway insertion when we supplement propofol with butorphanol or fentanyl for induction of anesthesia: A comparative assessment and critical review. Int J Crit Illn Injury Sci 2016;6(1):40–4.

Salem WT. A comparison of midazolam and mini-dose succinylcholine to aid laryngeal mask airway insertion during propofol anesthesia. J Egypt Nat Cancer Inst 2000;12:65–9.

Bhaskar P, Malik A, Kapoor R, Kohli M, Agarwal J, Harjai M. Effect of midazolam premedication on the dose of propofol for laryngeal mask airway insertion in children. J Anaesthesiol Clin Pharmacol 2010;26(4):503–6.

Amrein R, Hetzel W, Allen SR. Co-induction of anaesthesia: the rationale. Eur J Anaesthesiol Suppl 1995;12:5–11.

Wali D, Mehta A, Gupta AK, Gupta V, Darswal P, Khanna J, et al. A prospective, randomized, controlled trial study of comparison of two techniques for laryngeal mask airway insertion. Anaesth Pain Intens Care 2010;14(2):93–8.

Blake DW, Dawson P, Donnan G, Bjorksten A. Propofol induction for laryngeal mask airway insertion: dose requirement and cardiorespiratory effects. Anaesth Intens Care 1992;20(4):479–83.

Short TG, Chui PT. Propofol and midazolam act synergistically in combination. Brit J Anaesth 1991;67(5):539–45.

Mohamad RL, Tang S, Yahya N, Izaham A, Yusof AM, Manap NA. Comparison between effects of ketamine and midazolam as co-induction agents with propofol for prosealTM laryngeal mask insertion. Sri Lankan J Anaesthesiol 2016;24(1):16–21.

Goyagi T, Tanaka M, Nishikawa T. Fentanyl decreases propofol requirement for laryngeal mask airway insertion. Acta Anaesthesiol Scand 2003;47(6):771–4.