[Downloaded free from http://www.aeronline.org on Thursday, July 5, 2018, IP: 36.72.179.

156]

Original Article

Comparative Evaluation of Sevoflurane, Propofol, and

Combination of Sevoflurane and Propofol on Insertion
Characteristics of Reusable Classic Laryngeal Mask Airway
Yamini Gupta, Tek Chand Kriplani1, Vansh Priya2
Department of Cardiac Anaesthesia, L. P. S. Institute of Cardiology, GSVM Medical College, Kanpur, 2Department of Anaesthesia, T. S. Misra Medical College,
Lucknow, Uttar Pradesh, 1Department of Anaesthesia and Critical Care, NSCB Medical College, Jabalpur, Madhya Pradesh, India

Abstract
Background and Aim: Adequate depth of anaesthesia is needed for successful placement LMA.under lighter plane of anaesthesia inadequate
mouth opening,coughing,body movements can lead to rejection of LMA and may be associated with breath holding and bronchospasm.
Use of propofol in doses which allow adequqate jaw relaxation and prevent patient reaction to LMA commonly results in hypotension and
prolonged apnoea.Apart from minimal respiratory irritant properties sevoflurane as compared to propofol has the advantage of providing better
hemodynamic stability and a smoother transition to the maintainance phase without a period of apnea.However sevoflurane is associated with
delayed jaw relaxation and a longer time for the insertion of the LMA.Our hypothesis is that induction of anaesthesia with the combination
of sevoflurane and small dose of propofol may optimize the insertion conditions of LMA and decrease the side effects of individual drugs.
Methods: 90 patients aged 18-65 yrs ASA physical status I and II undergoing elective procedures were randomly allocated into 3 groups of
30 patients each. No patient had been given any premedication.Patients in group P were induced with iv inj propofol 3 mg/kg. Patients in
group S an SP were induced with tidal volume breathing induction technique using sevoflurane 8% along withN20: 02: 67:33 @ 6L/MIN
In addition, in group SP after loss of eye lash reflex patients were given IV propofol 1.5 mg/kg.An independent observer assessed insertion
characteristics. Results: our results showed that induction of anesthesia using the combination of sevoflurane and propofol resulted in the
most frequent successful LMA insertion at first attempt as compared with induction of anesthesia with either sevoflurane or propofol alone.

Keywords: Classic laryngeal mask airway, propofol, sevoflurane

Introduction of the LMA while preserving spontaneous ventilation. [5]

Sevoflurane as compared to propofol has the advantage
Propofol is a preferred induction agent for laryngeal mask
of providing better hemodynamic stability and a smoother
airway (LMA) insertion due to its propensity of suppressing
transition to the maintenance phase without a period of
oropharyngeal and cough reflexes.[1] Adequate jaw relaxation
apnea.[6] However, sevoflurane is associated with delayed jaw
is an absolute prerequisite for successful LMA placement.
relaxation and a longer time for the insertion of the LMA.[7,8]
However, use of propofol in dosages  (usually  >2.5  mg/kg)
This study was based on our hypothesis that induction of
required for adequate jaw relaxation and adequate depth
anesthesia with the combination of sevoflurane and small
of anesthesia for LMA insertion may result in arterial
hypotension, apnea, and collapse of upper airways.[1‑4]
Sevoflurane is a nonpungent inhalation anesthetic agent Address for correspondence: Dr. Vansh Priya,
which can be used as an induction agent. Its nonpungent 3/279, Vishwas Khand, Gomti Nagar, Lucknow ‑ 226 010,
odor with minimal respiratory irritant properties makes it Uttar Pradesh, India.
E‑mail: vanshkhr@gmail.com
suitable for inhalation induction of anesthesia and insertion

This is an open access journal, and articles are distributed under the terms of the Creative
Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to
Access this article online remix, tweak, and build upon the work non-commercially, as long as appropriate credit
Quick Response Code: is given and the new creations are licensed under the identical terms.
Website:
For reprints contact: reprints@medknow.com
www.aeronline.org

How to cite this article: Gupta Y, Kriplani TC, Priya V. Comparative

DOI: evaluation of sevoflurane, propofol, and combination of sevoflurane and
10.4103/aer.AER_30_18 propofol on insertion characteristics of reusable classic laryngeal mask
airway. Anesth Essays Res 2018;12:386-91.

386 © 2018 Anesthesia: Essays and Researches | Published by Wolters Kluwer ‑ Medknow

[Downloaded free from http://www.aeronline.org on Thursday, July 5, 2018, IP: 36.72.179.156]
Gupta, et al.: Effect of sevoflurane with propofol on insertion charactersitics of classic reusable LMA.
dose of propofol may optimize the insertion conditions of
LMA while reducing the incidence of associated side effects
of individual drugs.
In this prospective randomized study, a comparative evaluation
of anesthesia induction with combination of sevoflurane and
propofol, sevoflurane alone, or propofol alone on insertion
characteristics of reusable silicone classic LMA (CLMA)
(LMA North America, Inc.) in adult patients undergoing
elective surgery. We also compared the incidence of side
effects such as gagging, coughing, and laryngospasm and the
incidence of duration of apnea.
Patients and Methods
After institutional ethics committee approval and written
informed consent from patients, ninety adult American
Society of Anesthesiologists Physical Status I–II patients aged
18–65 years undergoing elective general surgery, orthopedics,
and plastic or gynecologic procedures were studied over a
period of 1 year.
Exclusion criteria
1. Patients with a history of difficult intubation or anticipated
difficult intubation
2. Allergy or sensitivity to volatile anesthetics or to propofol
3. Body mass index >1.5 times normal
4. Heavy smokers (>20 cigarettes/day)
5. Patients with diabetes, hypertension, cardiovascular
disease, ischemic heart disease, liver disease, and renal
impairment.
Routine preoperative preparation was followed. In the morning
of the surgery, patients were examined and blood pressure,
pulse rate, and respiratory rate were recorded for further
comparison.
The patients were then randomly allocated to the following
three groups by computer‑generated slips.
• Group S – Patients were induced with circuit primed with
sevoflurane 8%, nitrous oxide and oxygen  (67%:33%)
at fresh gas flow  (FGF) rate 8  L/min by tidal volume
breathing (TVB) technique
• Group SP – Patients were induced with circuit primed
with sevoflurane 8%, nitrous oxide and oxygen (67%:33%)
at FGF 8  L/min by TVB technique and injection
intravenous (IV) propofol (1.5 mg/kg)
• Group  P  –  Patients were induced with IV injection
propofol only (3 mg/kg).
Technique
All the CLMA insertion were performed by the same
anesthesia consultant well versed with LMA placement
(LMA classic >1000 procedures). All the patients in Group S
and Group SP were induced with inhalation anesthetic mixture
comprising sevoflurane 8% and N2O:O2 67%:33% and FGF
at 8 L/min employing TVB technique through Bain’s circuit.
The patients were instructed to continue breathing normally
through face mask during induction of anesthesia. The start
Anesthesia: Essays and Researches  ¦  Volume 12  ¦  Issue 2  ¦  April-June 2018
of the induction was taken as the time at which patient starts
breathing from the circuit (time zero). Patients were further
instructed to open their eyes every 10 s. Failure to do so was
taken as loss of consciousness, further confirmed by testing
for loss of eyelash reflex. In Group  S, 90 s into inhalation
induction, the ease of mouth opening was assessed as adequate
or inadequate. If mouth opening was inadequate, attempts were
made every 30 s up to a maximum of 4. In between attempts,
depth of anesthesia was maintained with sevoflurane at 8% in
67%:33% ratio of N2O‑O2 at 8 L/min.
Patients in Group  SP were induced with TVB technique
similar to that used in Group S. Time to loss of consciousness
was determined as it has been for Group S. In addition, at the
loss of eyelash reflex, the patients were given IV propofol
(1.5  mg/kg) over  15 s. Thirty seconds after completion of
propofol induction, ease of mouth opening was assessed. If
inadequate, attempt every 30 s up to a maximum of four were
made, each time preceded by IV propofol bolus of 0.5 mg/kg.
In between attempts, depth of anesthesia was maintained with
sevoflurane at 8% in 67%:33% ratio of N2O‑O2 at 8 L/min.
Patients in Group P were induced with IV propofol 3 mg/kg
given over 30 s. Midway through induction at 15 s, the patients
were asked if they were feeling any pain from the injection. Loss
of consciousness was assessed as for Group S and Group SP.
Time to loss of consciousness was calculated from the time of
start of injection of propofol until loss of eyelash reflex and
inability to open eyes upon verbal command. Thirty seconds
after the completion of propofol induction, i.e., 60 s after the
start of propofol injection, ease of mouth opening was assessed.
If inadequate, attempts every 30 s up to a maximum of four
were made, each time preceded by IV propofol bolus of 0.5 mg/
kg. In case of apnea during induction, ventilation was assisted
manually between LMA insertion attempts. Additional propofol
was given if there was any adverse response such as movement,
gagging, coughing, or laryngospasm. Noninvasive arterial
blood pressure, oxygen saturation, and heart rate were recorded
every minute for 5 min. An independent observer recorded:
1. Time taken to loss of eyelash reflex
2. Time taken to jaw relaxation
3. Time taken to completion of successful insertion of LMA
4. Successful insertion of LMA at first attempt
5. Apnea duration
6. Incidence of apnea.
The presence of complications related to anesthetic induction
was noted namely:
1. Excitatory movements during induction
2. Cough
3. Laryngospasm
4. Hiccup and insertion of the LMA were noted.
The presence of complications during LMA insertion was
noted namely:
1. Cough
2. Gagging.
387
[Downloaded free from http://www.aeronline.org on Thursday, July 5, 2018, IP: 36.72.179.156]

Gupta, et al.: Effect of sevoflurane with propofol on insertion charactersitics of classic reusable LMA.

Subsequent to CLMA placement, IV vecuronium was
administered and anesthesia was maintained on sevoflurane
and intermittent IV bolus of fentanyl.
Once fully awake, the patients were asked by a blinded
investigator for induction experience, sore throat, nausea,
and vomiting.
Postoperative assessment instead of post operative interview:
was shortest in Group P (93.50 ± 31.92 s) which was statistically
significant when compared to Group SP (115.73 ± 10.863 s)
and Group S (202.7 ± 20.405 s) [Table 6].
First pass success rate of CLMA insertion was found to be
highest in Group SP (90%), which was statistically significant
when compared to Group  P  (56.7%) and Group  S  (13%)
[Table 7].

1. Presence of sore throat (yes or no)
2. Pleasant induction (yes or no)
3. Repeat same technique (yes or no)
4. Postoperative nausea and vomiting (PONV) (yes or no).
The sample size was calculated after a pilot study of 20 patients
and was based on a difference of 20% between the groups for
insertion characteristics for a type 1 error of 0.05 and a power
of 0.8. Data analysis was done with the help of SPSS Software
Version 15 (IBM, Chicago, USA) and Sigma Plot Version 12
12 (windows 8,Richmond,Washington,USA). Quantitative data
were presented with the help of mean and standard deviation.
Comparison among the study groups was done with the help
of unpaired t‑test and Mann–Whitney test as per the results of
normality test. Qualitative data were presented with the help of
frequency and percentage table. Association among the study
groups was assessed with the help of Chi‑square test. P < 0.05
was considered statistically significant.
Results
All the three groups were comparable with respect to
age, sex, and weight  [Table  1]. The induction endpoint
(loss of eyelash reflex) was 47.63  ±  6 s, 35.67  ±  5.85 s,
and 44.93  ±  8.737 s in Group  SP, Group  P, and Group  S,
respectively. The difference between time taken for loss of
eyelash reflex between the three groups was found to be
statistically insignificant (P > 0.05) [Table 2]. In all the groups,
hemodynamic parameters were comparable at baseline and
thereafter every 60 s during induction and insertion of CLMA
[Tables 3 and 4].
Time taken for jaw relaxation was observed to be shortest in
Group P (68.67 ± 17.2 s) which was statistically significant
when compared to Group  SP  (96.73  ±  7.10) and Group  S
(145.93 ± 53.075 s) [Table 5]. Similarly, time to CLMA insertion
There was no significant difference between incidence of
laryngospasm and cough during induction between the three
groups. Group P was found to have the highest incidence of
apnea during induction (73.3%) followed by Group SP (16.7%)
and least in Group S (6.71%). Duration of apnea was found
to be longest in Group  P  (178.23  ±  42.29 s), followed by
Group SP (40.16 ± 7.05 s) and least in Group S (41.33 ± 10.07
s). No statistically significant difference was found between
the three groups with respect to patient acceptance to induction
technique.
83.3% in Group SP, 76.7% in Group P, and 83.3% in Group S
remarked their respective induction technique as pleasant
[Table 8].
93.3% patients in Group SP, 76.67% in Group P, and 73.3%
patients in Group S preferred repeating the same induction
technique [Table 9].
73.43% in Group SP, 80% patients in Group P, and Group S
had postoperative sore throat.
Incidence of PONV was highest in Group S (33.3%), followed
by Group SP (30%) and least in Group P (10%).
Discussion
Majority of studies evaluating LMA insertion characteristics
using sevoflurane or propofol have employed the use of
CLMA and in the pediatric population. Limited evidence in
the form of literature is available regarding CLMA insertion
characteristics using sevoflurane or propofol in adults, thereby
making this study unique. Chavan et  al. in their study on
sixty patients compared CLMA insertion characteristics
using sevoflurane or propofol. Insertion time in this study in
sevoflurane group was significantly shorter when compared
to our study, albeit the method of induction was similar.

Table 1: The age‑ and sex‑wise distribution of the cases in studied groups

Age (years) S P SP
Male (%) Female (%) Total (%) Male (%) Female (%) Total (%) Male (%) Female (%) Total (%)
20‑29 0 2 (11.8) 2 (6.7) 2 (12.5) 0 2 (6.7) 0 1 (6.25) 1 (3.3)
30‑39 6 (46.2) 10 (58.8) 16 (53.3) 7 (43.8) 8 (57.1) 15 (50) 8 (57.1) 7 (43.8) 15 (50)
40‑49 4 (30.8) 4 (23.5) 8 (26.7) 5 (31.3) 3 (21.4) 8 (26.7) 5 (35.7) 8 (50.0) 13 (43.3)
50‑59 1 (7.7) 1 (5.9) 2 (6.7) 1 (6.3) 3 (21.4) 4 (13.3) 1 (7.1) 0 1 (3.3)
60‑65 2 (15.4) 0 2 (6.7) 1 (6.3) 0 1 (3.3) 0 0 0
Total 13 17 30 16 14 30 14 16 30
Mean±2SD 43.46±10.26 37.76±7.02 40.23±8.89 38.19±8.03 40.64±9.17 39.33±8.52 38.71±6.73 37.81±6.03 38.23±6.27
No significant differences in mean age of males of all the three groups and as well as females of these groups were found (P>0.05). SD=Standard deviation

388 Anesthesia: Essays and Researches  ¦  Volume 12  ¦  Issue 2  ¦  April-June 2018
[Downloaded free from http://www.aeronline.org on Thursday, July 5, 2018, IP: 36.72.179.156]

Gupta, et al.: Effect of sevoflurane with propofol on insertion charactersitics of classic reusable LMA.

Reduced insertion time in sevoflurane group in this study
could be attributed to the use of vital capacity breath (VCB)
during inhalation induction as compared to TVB method of
inhalation induction in our study. The study also concluded
that the first pass success rate of CLMA insertion was high
and comparable in both sevoflurane and propofol group which
is in marked contrast to our study.[9]
Shao and Zhang in their study on 90 elderly patients evaluated
CLMA insertion characteristics by comparing IV induction
by propofol with inhalation induction using 8% sevoflurane
VCB technique or using 8% sevoflurane TVB technique. Their
observation that inhalation induction using 8% sevoflurane
TVB technique provides a stable hemodynamic profile, a
prolonged CLMA insertion time concurs well with our study.
Further incidence of apnea was more in propofol group when
compared to sevoflurane groups which further cement our
observation.[10]
Table 2: Time taken for loss of eyelash reflex (s)
Group Mean±2SD
SP 47.63±7.645
P 35.67±5.857
S 44.93±8.737
Group SP and S showed longer time taken for loss of eyelash reflex, as
compared with Group P which was found to be statistically very highly
significant (P<0.001). SD=Standard deviation
Siddik‑Sayyid et al. on comparing combination of sevoflurane
(8% by VCB induction technique) and IV propofol (1.5 mg/kg)
with sevoflurane or propofol (2.5 mg/kg) in terms of insertion
characteristics of CLMA, observed results similar to our
study.[11]
Insertion characteristics may be influenced by both induction
agent, method of induction, and type of LMA. Therefore,
“ease of insertion” is a highly subjective, operator‑dependent
assessment and thus subject to bias. Consequently, the first
insertion success rate and time taken to insert the LMA are
considered as surrogate markers of “ease of insertion.”
Molloy et  al. observed that anesthetic induction with
sevoflurane requires longer time to jaw relaxation and
even causes jaw tightness.[12] Dwivedi et  al. also reported
jaw tightness after sevoflurane anesthetic induction, which
resulted in failure to insert the LMA in several patients.[13]
However, in our study, LMA was successfully inserted in
all patients.
In a meta‑analysis comparing anesthetic induction between
sevoflurane and propofol, Joo and Perks found that
n sevoflurane induction was associated with more patient
30 dissatisfaction and increased PONV which is akin to our
30 observation.[14]
30
Smith and Thwaites compared target‑controlled infusion of
propofol with large initial concentration of sevoflurane for
LMA insertion.[15] Inhalation induction was associated with

Table 3: Mean heart rate in various groups after start of induction including laryngeal mask airway insertion (/min)
Group Baseline 1st 2nd 3rd 4th 5th
SP
Mean±SD 83.37±8.307 86.10±8.434 87.97±8.600 88.23±8.365 83.57±16.338 84.43±8.161
n 30 30 30 30 30 30
P
Mean±SD 83.23±8.169 86.47±7.995 88.00±8.120 88.60±7.762 86.90±7.783 84.83±7.639
n 30 30 30 30 30 30
S
Mean±SD 80.60±12.244 84.07±11.582 85.53±11.551 86.10±11.152 84.20±11.096 82.30±11.189
n 30 30 30 30 30 30
No statistically significant difference in heart rate. SD=Standard deviation

Table 4: Mean blood pressure (mmHg) in various groups after start of induction including laryngeal mask airway
insertion (/min)
Group Baseline 1st 2nd 3rd 4th 5th
SP
Mean±SD 93.10±9.561 89.10±9.248 87.40±8.985 86.63±6.790 84.63±5.684 84.60±5.587
n 30 30 30 30 30 30
P
Mean±SD 92.33±5.785 84.03±5.308 82.83±5.754 82.00±5.754 81.50±4.607 83.90±4.483
n 30 30 30 30 30 30
S
Mean±SD 90.27±5.471 88.70±8.371 87.23±9.269 84.97±6.672 82.37±5.720 83.73±5.681
n 30 30 30 30 30 30
No statistically significant difference in mean arterial pressure. SD=Standard deviation

Anesthesia: Essays and Researches  ¦  Volume 12  ¦  Issue 2  ¦  April-June 2018 389
[Downloaded free from http://www.aeronline.org on Thursday, July 5, 2018, IP: 36.72.179.156]

Gupta, et al.: Effect of sevoflurane with propofol on insertion charactersitics of classic reusable LMA.

Table 5: Time taken for jaw relaxation (s) Conclusion

Group Mean±2SD n In accordance with other similar studies, propofol owing to its
SP 96.73±7.100 30
quick onset is an excellent agent for LMA insertion. Rapidity
P 68.67±17.121 30 and ease of insertion it affords are better than sevoflurane or
S 145.93±53.075 30 its combination with propofol. Propofol was also associated
Time taken for jaw relaxation was found to be longest in Group S and with reduced incidence of nausea and vomiting. However,
statistically significant when compared to Group SP with t=5.033; the incidence and duration of apnea appear to be much more
P<0.0001 or Group P with t=7.589; P<0.0001. SD=Standard deviation longer with propofol induction.
Induction with sevoflurane was observed to be more
Table 6: Time taken for laryngeal mask airway time‑consuming as compared to propofol and was associated
insertion (s) with an increased number of attempts. Its use was also
Group Mean±2SD n associated with increased incidence of nausea and vomiting.
SP 115.73±10.863 30 The combination of sevoflurane and propofol appears to
P 93.50±31.921 30
be a better choice as it confers advantages of either agent.
S 202.70±20.405 30
Although time required for induction is considerably more
Time taken for LMA insertion at first attempt was found to be longest
in Group S and was statistically significant when compared to Group P with combination, the first attempt success rate is significantly
(t=15.787; P<0.0001) and Group SP (t=0.606; P<0.0001). LMA=Laryngeal more when compared to either agent alone. The combination
mask airway, SD=Standard deviation is associated with reduced incidence of apnea although it is
associated with nausea and vomiting. Our study did not observe
any statistically significant variation in hemodynamic variables
Table 7: Incidence of insertion of laryngeal mask airway
among the three groups.
at first attempt
Attempts SP (%) P (%) S (%) We did not measure the depth of anesthesia and this stands
1 27 (90.0) 17 (56.7) 13 (43.3) out as a limitation of our study as we employed two different
2 3 (10.0) 13 (43.3) 12 (40.0) methods of induction. Other limitation of this study is that we
3 0 0 5 (16.7) did not evaluate the three groups in terms of cost incurred.
Total 30 30 30
Financial support and sponsorship
Significant statistical difference was found in incidence of LMA insertion
at first attempt, between Groups SP and S (P<0.001) and Group P (P<0.01). Nil.
LMA=Laryngeal mask airway
Conflicts of interest
There are no conflicts of interest.
Table 8: Postoperative interview for pleasant induction
(yes/no) References
PI SP (%) P (%) S (%) 1. Taguchi M, Watanabe S, Asakura N, Inomata S. End‑tidal sevoflurane
Yes 25 (83.3) 23 (76.7) 25 (83.3) concentrations for laryngeal mask airway insertion and for tracheal
intubation in children. Anesthesiology 1994;81:628‑31.
No 5 (16.7) 7 (23.3) 5 (16.7)
2. Scanlon P, Carey M, Power M, Kirby F. Patient response to laryngeal
PI=Pleasant induction mask insertion after induction of anaesthesia with propofol or
thiopentone. Can J Anaesth 1993;40:816‑8.
3. Bilotta  F, Spinelli  F, Centola  G, Caramia  R, Rosa  G. A  comparison
Table 9: Postoperative interview for repeating same of propofol and sevoflurane anaesthesia for percutaneous trigeminal
technique ganglion compression. Eur J Anaesthesiol 2005;22:233‑5.
4. Hillman  DR, Walsh  JH, Maddison  KJ, Platt  PR, Kirkness  JP,
RST SP (%) P (%) S (%) Noffsinger WJ, et al. Evolution of changes in upper airway collapsibility
Yes 28 (93.3) 23 (76.67) 22 (73.3) during slow induction of anesthesia with propofol. Anesthesiology
No 2 (66.7) 7 (23.3) 8 (26.67) 2009;111:63‑71.
RST=Repeating same technique 5. Baker CE, Smith I. Sevoflurane: A comparison between vital capacity
and tidal breathing techniques for the induction of anaesthesia and
laryngeal mask airway placement. Anaesthesia 1999;54:841‑4.
more PONV (30% versus 3%) with delayed discharge; in our 6. Suzuki  KS, Oohata  M, Mori  N. Multiple‑deep‑breath inhalation
study, patients in Group S and Group SP had more frequent induction with 5% sevoflurane and 67% nitrous oxide: Comparison with
PONV than patients in Group P. This could be attributed to intravenous injection of propofol. J Anesth 2002;16:97‑101.
7. Ganatra SB, D’Mello J, Butani M, Jhamnani P. Conditions for insertion
antiemetic property of propofol, initial large concentration of of the laryngeal mask airway: Comparisons between sevoflurane and
sevoflurane, or swallowing of air and gases during inhalation propofol using fentanyl as a co‑induction agent. A  pilot study. Eur J
induction.[8] Anaesthesiol 2002;19:371‑5.

390 Anesthesia: Essays and Researches  ¦  Volume 12  ¦  Issue 2  ¦  April-June 2018
[Downloaded free from http://www.aeronline.org on Thursday, July 5, 2018, IP: 36.72.179.156]

Gupta, et al.: Effect of sevoflurane with propofol on insertion charactersitics of classic reusable LMA.

8. Yogendran S, Prabhu A, Hendy A, McGuire G, Imarengiaye C, Wong J,
et al. Vital capacity and patient controlled sevoflurane inhalation result
in similar induction characteristics. Can J Anaesth 2005;52:45‑9.
9. Chavan  SG, Mandhyan  S, Gujar  SH, Shinde  GP. Comparison of
sevoflurane and propofol for laryngeal mask airway insertion and
pressor response in patients undergoing gynecological procedures.
J Anaesthesiol Clin Pharmacol 2017;33:97‑101.
10. Shao  G, Zhang  G. Comparison of propofol and sevoflurane for
laryngeal mask airway insertion in elderly patients. South Med J
2007;100:360‑5.
11. Siddik‑Sayyid  SM, Aouad  MT, Taha  SK, Daaboul  DG, Deeb  PG,
Massouh  FM, et  al. A  comparison of sevoflurane‑propofol versus
sevoflurane or propofol for laryngeal mask airway insertion in adults.
Anesth Analg 2005;100:1204‑9.
12. Molloy ME, Buggy DJ, Scanlon P. Propofol or sevoflurane for laryngeal
mask airway insertion. Can J Anaesth 1999;46:322‑6.
13. Dwivedi  R, Dwivedi  S, Chourasia  HK. A  comparative study of
sevoflurane and propofol for laryngeal mask airway insertion in adults.
Int J Sci Study 2015;3:67‑71.
14. Joo HS, Perks WJ. Sevoflurane versus propofol for anesthetic induction:
A meta‑analysis. Anesth Analg 2000;91:213‑9.
15. Thwaites A, Edmends S, Smith I. Inhalation induction with sevoflurane:
A double‑blind comparison with propofol. Br J Anaesth 1997;78:356‑61.

Anesthesia: Essays and Researches  ¦  Volume 12  ¦  Issue 2  ¦  April-June 2018 391