Comparative Assessment of Propofol and Sevoflurane for Insertion of Laryngeal Mask Airway in Children

Abstract

Background: Optimal insertion conditions for laryngeal mask airway (LMA) are essential in pediatric anesthesia to reduce repeated attempts and airway reflex–mediated complications, yet the relative performance of intravenous propofol versus inhalational sevoflurane for LMA insertion remains clinically debated. Objective: To compare propofol and sevoflurane for first-attempt LMA insertion success, induction/insertion characteristics, hemodynamic changes, perioperative complications, recovery profile, postoperative agitation, and parental satisfaction in children. Methods: This comparative cross-sectional observational study included 66 ASA I–II children aged 2–12 years undergoing short elective surgery, allocated by routine clinical practice to propofol (2–3 mg/kg IV; n=33) or sevoflurane (8% in 100% oxygen; n=33). Standardized timings (induction to eyelash reflex loss, jaw relaxation, LMA insertion) and peri-induction hemodynamic changes were recorded; complications, emergence/recovery times, agitation, and parental satisfaction were assessed in PACU. Results: First-attempt LMA success was 90.9% (30/33) with propofol versus 78.8% (26/33) with sevoflurane (RR 1.15; p=0.18). Propofol shortened induction (35±8 vs 78±15 s), jaw relaxation (42±10 vs 65±14 s), and insertion time (18±5 vs 24±6 s) (all p<0.001) but produced larger SBP reductions (−18±6 vs −10±4 mmHg; p<0.001). Emergence and recovery were longer with propofol (320±60 vs 260±55 s; p<0.001; 18±4 vs 15±3 min; p=0.001), while agitation was lower (9.1% vs 27.3%; p=0.06). Conclusion: Propofol provided faster, more favorable LMA insertion conditions and less agitation, whereas sevoflurane preserved greater hemodynamic stability and faster emergence; agent selection should be individualized.