Facilitation of laryngeal mask airway insertion Effects of remifentanil administered before induction with target‐controlled propofol infusion

Eighty‐six adult day‐case patients were recruited into a prospective, randomised study and allocated to one of two groups. Patients received either intravenous remifentanil 0.3 µg.kg−1 or an equivalent volume of sodium chloride 0.9% followed by induction of anaesthesia with propofol target‐controlled infusion until the effect (brain) site calculated concentration was 2 µg.ml−1. Jaw opening and ease of laryngeal mask insertion were assessed immediately after mask insertion. A higher incidence of failure of induction of anaesthesia was observed in the control group compared with the remifentanil group [15 (35%) vs. 3 (7%); p < 0.01] and addition of remifentanil significantly increased the ease and success of laryngeal mask insertion, with grade 1 (no coughing/gagging) conditions observed in 29 (68%) of the remifentanil group and 21 (49%) of the control group (p < 0.01).The doses of remifentanil and propofol used were not associated with any significant cardiorespiratory instability. In conclusion, when combined with propofol target‐controlled infusion, remifentanil 0.3 µg.kg−1 facilitates laryngeal mask insertion with minimal adverse haemodynamic changes.