Comparison of I-gel insertion using propofol-fentanyl vs propofol-dexmedetomidine in pediatric day surgery

Objective: Supraglottic airway devices are pivotal tools for airway management in anesthesia. The I-gel, a widely used second-generation airway device, is recognized for ease of insertion and low complication rate. This study aims to compare the ease of insertion of I-gel and associated insertion conditions when used with Fentanyl and Dexmedetomidine in combination with Propofol. Methods: After obtaining approval of ethical committee, a total of 60 patients were enrolled a tertiary care hospital and divided into two groups. Group F received 2 mcg/kg of intravenous fentanyl and propofol; Group D received 1 mcg/kg of intravenous dexmedetomidine infusion in 10 minutes and propofol. The ease of I-gel insertion and jaw relaxation was assessed using the modified Lund and Stovener criteria and Young’s criteria, respectively. The physiologic variables, adverse events like apnea, desaturation, cough, jaw movement; and additional requirement of propofol bolus doses were recorded at baseline, first, third, fifth and tenth minutes after insertion. Results: No significant differences were observed in jaw relaxation, ease of I-gel insertion, and adverse events. The apnea duration was shorter in Group D (12.1±2.3 min vs 15.1±2.8, p<0.001). Respiratory rate was significantly lower in Group F. It was easier to insert I-gel in Group D (p=0.213). Ramsay Score was higher and Aldrete score was lower in Group D (p<0.001). Conclusion: Dexmedetomidine as an adjuvant to propofol is a safe alternative to combination of propofol and fentanyl in pediatric surgeries. Although both drugs maintain a stable hemodynamic profile, dexmedetomidine demonstrates superior efficacy in preserving respiratory stimulus.