The laryngeal mask airway (LMA) has become an essential supraglottic airway device in current anaesthesia practice, providing a secure airway without the need for tracheal intubation. Because of its simplicity of insertion, less airway damage, and low haemodynamic disturbance, it has been frequently utilised in brief elective operations, day care procedures, and challenging airway management since Brain introduced it in 1983 [1,2]. Successful insertion of an LMA depends on adequate depth of anaesthesia, optimal jaw relaxation, and suppression of airway reflexes such as coughing or gagging [3].

Propofol, an intravenous induction drug, is commonly regarded as the gold standard for LMA insertion due to its early start, smooth induction, and improved suppression of airway reflexes [4]. However, its use is associated with dose-dependent hypotension and bradycardia, which may limit its application in individuals with reduced cardiovascular reserve [5]. Sevoflurane, an inhalational anaesthetic drug, offers an alternate form of induction that is non-invasive, maintains spontaneous breathing, and provides acceptable airway conditions, particularly in recalcitrant or needle-phobic individuals [6]. Additionally, sevoflurane has been proven to cause less cardiovascular depression compared to propofol, making it acceptable for patients at risk of haemodynamic instability [5].

Propofol and sevoflurane have been compared for LMA insertion settings in a number of trials, with differing outcomes. Ti et al. observed faster insertion times and improved jaw relaxation with propofol, whereas sevoflurane gave superior cardiovascular stability [5]. Sivalingam et al. found that sevoflurane increased haemodynamic stability, whereas propofol better suppressed airway reflexes [6]. Propofol's efficacy in reducing coughing and gagging during LMA insertion was further demonstrated by Scanlon et al. [4]. Both agents had similar success rates, according to Sharma et al., with sevoflurane causing less hypotensive episodes and propofol facilitating faster insertion [7].

In addition to ease and success of LMA implantation, haemodynamic responses during induction are therapeutically relevant. Propofol is associated with considerable reductions in systemic blood pressure and cardiac output, but sevoflurane maintains more stable cardiovascular parameters, albeit with a slower onset to optimal insertion depth [5,6]. Adverse events such as coughing, gagging, or movement during insertion might impair patient safety and procedural efficiency, particularly in ambulatory anaesthesia settings.

Therefore, this study aims to systematically compare propofol and sevoflurane for LMA insertion in adult patients undergoing short elective surgeries, with primary emphasis on ease and success of insertion, and secondary evaluation of haemodynamic stability, adverse events, and time to successful placement.

This prospective comparative study was conducted in the Department of Anaesthesiology at Tertiary care hospital Tamilnadu over a eight month period from January 2025 to August 2025. The study included 60 adult patients of either sex, aged between 18 and 60 years, belonging to American Society of Anesthesiologists (ASA) physical status I and II, who were scheduled to undergo elective short surgical procedures of less than 60 minutes duration under general anesthesia with laryngeal mask airway (LMA) insertion. The study aimed to compare propofol and sevoflurane as induction agents for LMA placement.

Patients were allocated into two equal groups of 30 each using a convenience sampling method. Group P received intravenous propofol at a dose of 2–2.5 mg/kg for induction, while Group S received inhalational induction with 8% sevoflurane in 100% oxygen at a fresh gas flow of 6 L/min. All patients were kept nil per oral as per ASA guidelines, and standard intraoperative monitoring including electrocardiography, non-invasive blood pressure, and pulse oximetry was instituted.

After achieving adequate depth of anesthesia and jaw relaxation, an appropriately sized and well-lubricated LMA was inserted using the standard midline rotational technique by an experienced anesthesiologist. The start of induction was defined as the initiation of propofol injection in Group P or the commencement of sevoflurane administration in Group S. The effectiveness of LMA placement was confirmed by bilateral chest expansion and square-wave capnography.

Primary outcome measures included ease of LMA insertion and success rate on the first attempt. Secondary outcomes assessed were time taken for successful insertion, number of attempts, hemodynamic parameters such as heart rate and mean arterial pressure, and the incidence of adverse airway responses including coughing, gagging, biting, or laryngospasm. Hemodynamic variables and airway responses were monitored for up to 10 minutes following induction.

Ease of LMA insertion was graded by an independent observer using a standardized three-point scoring system.

Data were analyzed using Epi Info version 7, with continuous variables compared using the independent t-test and categorical variables using the chi-square test. A p value of less than 0.05 was considered statistically significant. The study was approved by the Institutional Ethics Committee, and written informed consent was obtained from all participants prior to enrollment

The results of above study is given below

Tab.1: Baseline data comparison

The age, gender, ASA and weight distribution is similar in both groups as results were non significant

Tab.2: LMA insertion characteristics comparison

In the present study, the number of attempts required for successful LMA insertion(Fig.1) was comparable between the propofol and sevoflurane groups, with most patients in both groups achieving placement on the first attempt . The mean time taken for insertion was similar in both groups, indicating no significant difference in procedural efficiency once adequate anesthesia depth was achieved. Ease of insertion, graded as excellent, satisfactory, or poor, did not differ significantly with the majority in both groups having excellent conditions. However, induction time was significantly shorter in the propofol group compared to the sevoflurane group reflecting propofol’s rapid onset of action.(Tab.2)

Tab.3 MAP and Heart rate comparison

In the present study, baseline MAP values were comparable between the propofol and sevoflurane groups indicating similar pre-induction hemodynamic status. Following induction, there was a significant fall in MAP in the propofol group compared to the sevoflurane group (78.12 ± 7.2 mmHg vs 85.34 ± 6.9 mmHg, p = 0.002). This difference persisted immediately after LMA insertion (p = 0.001) and at 1 minute post-insertion (p = 0.001), suggesting greater cardiovascular depression with propofol during the initial phase. At 3 minutes post-insertion, the difference narrowed and was not statistically significant. By 5 minutes and 10 minutes post-insertion, MAP values were almost identical in both groups (p > 0.5), indicating recovery of hemodynamic stability over time.(Tab.3) Baseline heart rates were comparable between the propofol and sevoflurane groups, with no statistically significant difference, indicating similar pre-induction cardiovascular status. Following induction, both groups demonstrated a mild decrease in heart rate; however, the differences between groups at this stage were not statistically significant. Immediately after LMA insertion and at subsequent intervals (1, 3, 5, and 10 minutes post-insertion), heart rate values remained stable in both groups without significant intergroup differences.(Tab.3)

The laryngeal mask airway (LMA) has become an essential supraglottic airway device since its introduction by Brain, offering effective airway management with minimal invasiveness and reduced hemodynamic response compared to tracheal intubation [1,2]. Optimal anesthetic induction is crucial for successful LMA insertion, requiring adequate depth of anesthesia, good jaw relaxation, and suppression of airway reflexes. This study compared propofol and sevoflurane as induction agents for LMA insertion, focusing on insertion characteristics, hemodynamic responses, and adverse events.

In the present study, first-attempt success rates for LMA insertion were high and comparable between the two groups (96.66% with propofol and 90% with sevoflurane), with no statistically significant difference. These findings are consistent with earlier studies demonstrating similar success rates with both agents [4,7]. The time taken for LMA insertion after achieving adequate anesthesia depth was also comparable, indicating that procedural efficiency is not significantly influenced by the choice of induction agent once optimal conditions are attained. Ease of insertion was predominantly graded as excellent in both groups, with no cases of poor insertion conditions, which aligns with the observations of Sivalingam et al. and Chavan et al. [6,8].

A significant difference was observed in induction time, with propofol providing a markedly faster onset compared to sevoflurane. This finding reflects the rapid pharmacodynamic profile of propofol and has been consistently reported in previous studies [4,7,8]. Faster induction with propofol may be advantageous in situations requiring rapid airway control, such as high-turnover ambulatory procedures.

Hemodynamic stability is an important consideration during induction and airway manipulation. In this study, baseline mean arterial pressure (MAP) was comparable between groups. However, propofol was associated with a significantly greater reduction in MAP during induction and in the immediate post-insertion period compared to sevoflurane. This observation is in agreement with Inomata et al., who attributed propofol-induced hypotension to systemic vasodilation and myocardial depression [5]. By 3 minutes post-insertion, MAP values between the two groups converged and remained comparable at 5 and 10 minutes, indicating that the hypotensive effect of propofol is transient.

Heart rate changes were minimal and comparable between the two groups throughout the study period. Although a mild decrease in heart rate was observed following induction in both groups, no statistically significant intergroup differences were noted at any time point. These findings are consistent with previous reports demonstrating stable heart rate responses with both propofol and sevoflurane in ASA I–II patients [5–7].

Regarding adverse events, coughing, gagging, and patient movement were less frequent in the propofol group, reflecting its superior suppression of airway reflexes. However, only patient movement showed a statistically significant increase in the sevoflurane group. Similar findings have been reported by Scanlon et al. and Sivalingam et al., highlighting propofol’s advantage in minimizing airway responses during LMA insertion [3,6]. Hypotension occurred more frequently with propofol, though the difference was not statistically significant, further emphasizing the need for careful patient selection.

Overall, both propofol and sevoflurane provide satisfactory conditions for LMA insertion. Propofol offers faster induction and better airway reflex suppression, while sevoflurane ensures superior early hemodynamic stability. The choice of induction agent should therefore be individualized based on patient profile and clinical priorities.,

Both propofol and sevoflurane are effective agents for LMA insertion in adult patients undergoing short surgical procedures. Propofol offers the advantage of faster induction whereas Sevoflurane, while slower to induce optimal insertion conditions, preserves hemodynamic stability better in the early peri-insertion period.

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