airway management is one of the important skills and inability to secure the airway , can cause catastrophic results . the laryngeal mask airway ( lma ) is a device , which allows both spontaneous , as well as positive pressure ventilation . as propofol lacks analgesic property , opioids are added but , they failed to prevent laryngospasm in spite of normocapnia and dose - dependent depression of airway reflexes . dexmedetomidine is a pharmacologically active dextro isomer of medetomidine , which displays specific and selective 2 adrenoceptor agonism . it has both anesthetic and analgesic effects in addition to its sedative effects at doses of 0.5 - 2 mcg / kg iv . dexmedetomidine also causes a reduction in doses of propofol both during induction and maintenance . in this study , we compared dexmedetomidine and fentanyl , in combination with propofol for insertion of lma . after obtaining institutional ethical committee approval and with informed consent of all patients , a prospective randomized double - blind study was conducted on 80 patients of american society of anesthesiologists ( asa ) physical status 1 and 2 . the study period lasted 10 months . we included patients of the age group 18 - 60 years , weighing between 30 and 80 kg , undergoing various elective minor surgical procedures under general anesthesia . patients with risk of aspiration , smokers , undergoing oral surgeries , weighing more than 80 kg and asa physical status 3 and 4 were excluded from the study . informed consent was taken and patients were randomly assigned using computerized randomization table into two groups of 40 each . group d or dexmedetomidine - propofol group received injection dexmedetomidine 1 mcg / kg iv over 2 min . in group f or fentanyl - propofol group , the patients were given fentanyl 1 mcg / kg over 2 min . in both the groups , 30 s later , propofol 2 mg / kg was given over 30 s for induction without any neuromuscular blocking agents . ninety seconds after the propofol injection , lma was inserted by an anesthesiologist who was blinded to the choice of induction and adjuvant anesthetic agents . the correct lma placement was confirmed with expansion of the chest wall with bag compression with slight outward movement of the tube with lma cuff inflation . lma insertion conditions were evaluated by the same anesthesiologist . from the induction to insertion of lma , patients were given oxygen via mask and ventilated if apneic . if any movement occurred before lma insertion or after , propofol 0.5 mg / kg was administered , and we waited for 30 s before next attempt at lma placement . heart rate ( hr ) < 45 was considered as bradycardia and treated with atropine 0.01 mg / kg . parameters observed were , apnea time  the time from last spontaneous breath after propofol administration to first spontaneous breath , hr , respiratory rate ( rr ) , noninvasive blood pressure and oxygen saturation . these were recorded before induction , that is , baseline , 30 s after induction , 1 , 3 , 5 , 10 and 15 min after insertion of lma . patient 's response to lma insertion such as coughing , gagging or any movement were noted and scored according to the scoring system modified by muzi et al . jaw mobility was graded as : 1-fully relaxed , 2-mild resistance , 3-tight but , opens , 4-close . coughing / movement were graded as : 1-none , 2-one or two coughs , 3-three or more coughs , 4-bucking / movement . other events such as spontaneous ventilation , breath holding , expiratory stridor and lacrimation were noted . in each category , scores 2 were considered optimum for lma insertion . the sample size was calculated using statistical package software statistical analysis system software ( creative research systems ) with an alpha error of 0.05 , confidence of 95% for an infinite population . statistical analysis of data was performed using the student t - test ( z - test ) for parametric data , and nonparametric data was analyzed using chi - square test . the two groups were similar in terms of distribution of age ; sex and weight [ table 1 ] . insertion conditions with respect to jaw mobility , were appropriate in all patients of group d. in group f , 39 patients had relaxed jaw and 1 patient had tight jaw , for which additional propofol 0.5 mg / kg was supplemented , and the second attempt after 30 s to insert lma was successful . with respect to coughing / movement , in group d , 3 ( 7.5% ) all these patients were supplemented with additional propofol 0.5 mg / kg and the second attempt of insertion of lma was well tolerated [ table 2 ] . demographic distribution of patients observed parameters for lma insertion conditions summating the scores for insertion of lma , 37 ( 92.5% ) patients of group d and 35 ( 87.5% ) patients of group f had score of < 2 thus showing the acceptable conditions for insertion of lma and 5 ( 12.5% ) patients of group f had score > 2 . the patient , who had closed jaw , was different from the four patients who had bucking / movement . all these five patients received additional propofol 0.5 mg / kg , and the second attempt of insertion of lma was well - tolerated . the overall incidences of adverse events were comparable and statistically insignificant in both the groups [ table 3 ] . distribution of patients according to insertion conditions of lma when compared with basal values there was a statistically significant and comparable fall in the mean pulse rate , throughout the study in both the groups . the mean basal rr were comparable ( p > 0.05 ) in both the groups [ figure 1 ] . there was statistically significant ( p < 0.001 ) increase in the rr in group d from 5 min onwards after insertion of lma which got stabilized at 22/min by 15 min . in group f there was no increase in the rr further , which got stabilized at 12/min by 15 min after the insertion of lma . the duration of apnea was longer in group f ( 290 s ) than in group d ( 227 s ) . smooth insertion of lma needs sufficient depth of anesthesia to suppress the airway reflexes and relax the jaw muscles . previous studies have found that , propofol is superior to thiopentone as an induction agent for insertion of lma . however , when used alone , propofol provides less satisfactory conditions for lma insertion and causes cardiorespiratory depression . in order to decrease the adverse events of propofol , opioids or muscle relaxants were added . muscle relaxants were found to increase the risk of aspiration whereas opioids increased the incidence and duration of apnea . dexmedetomidine , a highly selective 2 adrenoceptor agonist , was shown to have sedative and analgesic properties . we have used iv glycopyrrolate as an antisialogogue , which aids insertion by causing the drying of airway . in accordance with the studies by belleville et al . and uzmcgil et al . , dose of dexmedetomidine used for intraoperative sedation , was 1 g / kg given over 2 min . the intention was both to achieve rapid sedation and avoid alpha-1 side - effect such as hypertension and tachycardia . the obstructive respiration pattern and irregular breathing seen with such doses are probably related to deep sedation as well as anatomical features of the patient , and this could be overcome by insertion of an oral airway . we did not encounter this problem to a major extent as our study was centered on insertion conditions of lma . previous studies showed that anesthesia with propofol alone does not greatly suppress the airway reflexes , and incremental doses of fentanyl depress the airway reflexes in a dose - related manner . propofol either may reset or inhibit the baroreflex , reducing the tachycardic response to hypotension . on the contrary , dexmedetomidine causes decrease in the hr by 27% after induction and returns to normal by 15 min . our study has shown mild reduction ( maximum of 12% ) in hr in both the groups . this might probably be because insertion of a bulky device like lma could have caused some sympathetic response negating the effects of dexmedetomidine ( bradycardia ) on hr . supporting the study by uzmcgil et al . , our study showed that the numbers of patients developing apnea were more in group f ( 23 ) than in group d ( 14 ) . breath holding / apnea was more in group f and spontaneous ventilation was more in group d indicating that respiration was better preserved in the dexmedetomidine group . in support of the study conducted by goh et al . , the duration of apnea was longer in group f ( 290 s ) than in group d ( 227 s ) . this might be because of potentiation of the depressant effect of propofol by fentanyl on respiration . the apnea developed in patients of group d however , as the respiratory depressant effect of propofol was not potentiated by dexmedetomidine the apnea times were significantly shorter . our study , as expected shows increase in rr in dexmedetomidine group compared to fentanyl group . previous studies have demonstrated increase in rr and decreased episodes of apnea with dexmedetomidine infusions . few studies have also shown that hypercapnic arousal phenomenon was not affected by dexmedetomidine , thus its sedation mimicking the natural sleep . as would be expected , the respiratory effects of dexmedetomidine is because , one of its sites of action is the locus caeruleus , which is known to play a role in both respiratory control and sleep modulation , and dexmedetomidine converges on the natural sleep pathway to exert its sedative effects , whereas natural sleep does result in ventilation modulation . dexmedetomidine is unique among sedatives as it is clinically safe from a respiratory point of view , even during doses high enough to cause unresponsiveness to vigorous stimulation and exhibiting hypercarbic arousal phenomenon similar to the ones described during natural sleep . our study has some limitations such as it has not included control group that is , propofol alone for insertion of lma , as it would be unethical because the propofol was reported several times , to be inadequate for lma insertion when used alone and the increase in dose to make it adequate were reported to be unsafe for hemodynamics and respiration . we have not used any inhalational agents from induction till insertion of lma , as it may affect the lma tolerance and underestimate the drug effects as well as its requirements . study was on single dose of dexmedetomidine for insertion of lma , and we have not included the study concerned with its analgesic effects . studies regarding different doses of the drug and its analgesia as iv injection and infusion may be needed further in the future . pain , recovery and sedation scale were not included anywhere in the study as a present study was designed on insertion conditions for lma . we hereby conclude that dexmedetomidine is a comparable alternative to fentanyl as an adjuvant when co - administered with propofol for insertion of lma . both of the drugs provide stable hemodynamic profile but
background and aims : laryngeal mask airway ( lma ) insertion requires anesthesia and suppression of airway reflexes . in search of an optimal drug , we compared dexmedetomidine and fentanyl , in combination with propofol for insertion of lma.material and methods : this study was a prospective double blind randomized study . 
 eighty patients of asa class 1&2 were randomly divided into two groups of 40 each . 
 group d received dexmedetomidine 1 mcg / kg and group f received fentanyl 1 mcg / kg intravenously ( iv ) over 2 minutes . for induction , 
 propofol 2mg / kg was given iv and 90 seconds later lma was inserted . 
 we observed apnea time , heart rate , respiratory rate , non invasive blood pressure and oxygen saturation before induction , 30 seconds after induction , 1 , 3 , 5 , 10 and 15 minutes after insertion of lma . 
 patient 's response to lma insertion like coughing , gagging or any movement were noted and scored . statistical analysis of data 
 was done using student t test for parametric data , chi - square test for non parametric data and spss 15.0 for windows software.results:37 ( 92.5% ) patients of group d and 35 ( 87.5% ) patients of group f had lma insertion score of < 2 and 5 ( 12.5% ) patients of group f had score > 2 . 
 adverse events to insertion of lma and hemodynamic variables were comparable in both the groups . 
 number of patients developing apnoea was larger and apnoea times were longer in group f compared to group d. when compared to group f , group d showed an increased respiratory rate.conclusion:dexmedetomidine can be a comparable alternative to fentanyl as an adjuvant to propofol for providing optimum insertion conditions for lma and preservation of respiration .