Effect of Head Elevation to Different Heights in Laryngeal Exposure with Direct Laryngoscopy.

BACKGROUND: The purpose of this study was to determine the optimal pillow height for the best laryngoscopic view in adult patients scheduled for elective surgery under general anaesthesia. METHODS: 150 adult patients undergoing surgery under general anaesthesia with endotracheal intubation with no features suggestive of difficult airway were enrolled for the study. After induction of anaesthesia the assessment of direct laryngoscopic views was done at head positions without a pillow and with non-compressible pillows of heights 5cm and 10cm. RESULTS: The laryngoscopic view with the 5cm pillow was significantly superior to other head position (p<0.01). The incidence of difficult laryngoscopy (Cormack and Lehane grade III) was 32.7% without a pillow which improved to (Cormack and Lehane grade III) 4% with 10cm pillow and there were no cases of difficult laryngoscopy with 5cm pillow. CONCLUSIONS: The use of 5cm pillow in the 'sniffing' position obtains the best laryngoscopic view during direct laryngoscopy.

Comparison between long- and short-axis techniques for ultrasound-guided cannulation of internal jugular vein.

CONTEXT: Real-time ultrasound guidance for internal jugular (IJ) vein cannulation enhances safety and success. AIMS: This study aims to compare the long- and short-axis (LA and SA) approaches for ultrasound-guided IJ vein cannulation. SUBJECTS AND METHODS: Patients undergoing surgery and in intensive care unit requiring central venous cannulation were randomized to undergo either LA or SA ultrasound-guided cannulation of the IJ vein by a skilled anesthesiologist. First pass success, the number of needle passes, time required for insertion of guidewire, and complications were documented for each procedure. RESULTS: The IJ vein was successfully cannulated in all patients. There are no significant differences between the two groups in terms of gender, diameter of IJ vein, margin of safety, and time required for insertion of guidewire. There was also no significant difference between the two groups in terms of side of IJ vein cannulated, patient on mechanical ventilation, number of skin puncture, number of needle redirections, first pass success, and carotid puncture. However, there is a significant relationship between the diameter of IJ vein with first pass (18.18 ± 4.72 vs. 15.21 ± 4.24; P < 0.004) and margin of safety with of incidence of carotid puncture (12.15 ± 4.03 vs. 6.59 ± 3.13; P < 0.016). CONCLUSIONS: Both techniques have similar outcomes when used for IJ vein cannulation.