Comparison of Sevoflurane and Propofol-Fentanyl for Laryngeal Mask Airway Insertion in Pediatric cases.

Purpose: Laryngeal Mask Airway (LMA) is a commonly used minimally invasive supraglottic airway device used in pediatric anesthesia. Intravenous propofol is the commonly preferred anesthetic drug due to its favorable insertion conditions for LMA while inhalational sevoflurane offers a non-invasive induction with better hemodynamic stability. The addition of fentanyl to propofol may further optimize insertion conditions by enhancing analgesia and attenuating airway reflexes. Existing literature predominantly compares sevoflurane with propofol alone for LMA insertion whereas direct comparisons between sevoflurane and propofol-fentanyl combination are limited, hence the present study was undertaken. Methods: A prospective, single blinded randomized study was conducted in 60 pediatric patients aged 4-12 years with ASA physical status I and II undergoing elective surgical procedures. Using shuffle method, patients were randomly allocated to two groups Group P- Propofol with fentanyl group and Group S- Sevoflurane group. Group P received intravenous propofol (2 mg/kg) with fentanyl (2 µg/kg bolus) along with mask ventilation using a nitrous oxide-oxygen mixture (2:1), while Group S underwent inhalational induction with sevoflurane (7%) using nitrous oxide-oxygen mixture (2:1). Time to induction, jaw relaxation, and LMA insertion were recorded. Hemodynamic parameters and procedure-related complications were also monitored. Results: The time to jaw relaxation was significantly longer in the sevoflurane group compared to the propofol-fentanyl group (108.41 ± 6.90 vs 53.35 ± 4.12 seconds; p < 0.05). Similarly, the time to LMA insertion was significantly prolonged in the sevoflurane group (118.96 ± 6.65 vs 63.19 ± 4.31 seconds; p < 0.05), with sevoflurane demonstrating better hemodynamic stability. Conclusion: Propofol-fentanyl provides faster induction and LMA insertion, whereas sevoflurane offers superior hemodynamic stability with comparable safety profiles in pediatric patients.