Comparison of the LMA BlockBuster and intubating LMA as a conduit to blind tracheal intubation.

Background and Aims: Primary aim of the study was to evaluate the performance of Intubating LMA (ILMA) and blockbuster LMA in terms of first pass success rate, ease and duration taken for blind tracheal intubation. Material and Methods: The present prospective randomised study was conducted on 70 patients of either sex aged 18-60 years belonging to ASA physical status I or II. Patients were randomly allocated to either, group I and group B of n = 35 each. In group I and B patients were intubated using ILMA and LMA BlockBuster respectively. Insertion time and ease of placement of supraglottic device, total time taken for successful intubation, number of attempts for endotracheal tube (ETT) placement, and ease of placement of ETT, were recorded. Results: In both groups, the supraglottic device was placed on the first attempt in 88.6% patients. The first-attempt success rate for ETT placement was 71.4% in group I versus 94.3% in group B, (P = 0.01) with an overall success rate of 88.5% in group I and 100% in group. More failure rate was observed in group I (11.4%) compared to group B (0%). The total time taken for successful intubation in group I was 11.53 ± 6.410 sec and 9.17 ± 2.749 sec in group B (P = 0.04). Conclusion: We conclude that the modifications in the design of LMA Blockbuster (>95° angle, availability of the parker flex tube 27-30°angle of the emergence of airway tube) make it a more convenient, effective, simpler, and faster intubating device than ILMA.

A comparative study to evaluate the cervical spine movements during laryngoscopy using Macintosh and Airtraq laryngoscopes.

Background and Aim: Intubation with Macintosh requires flexing the lower cervical spine and extending the atlanto-occipital joint to create a "line of sight." Primary aim of study was to compare the extent of cervical spine movement during laryngoscopy using conventional Macintosh laryngoscope and Airtraq. Material and Methods: A total of 25 patients of either sex between the age group of 18 and 60 years, having American Society of Anesthesiologists (ASA) physical status of Grade-I and Grade-II, scheduled for elective surgery under image control requiring general anesthesia and intubation were enrolled. A baseline image of the lateral cervical spine including the first four cervical vertebrae was taken by an image intensifier. After administration of general anesthesia, laryngoscopy was first performed using a Macintosh laryngoscope and a second X-ray image of the lateral cervical spine was taken. The second laryngoscopy using a Airtraq laryngoscope was done and the third image of the lateral cervical spine was taken. Angles between occiput and C1; C1 and C2; C2 and C3; C3 and C4; and occiput and C4 were calculated. Atlanto-occipital distance (AOD) was calculated as the distance between occiput and C1. Results: Macintosh showed greater cervical movement as compared with Airtraq but a significant difference in the movement was observed at C2-C3 and C0-C4. Baseline mean AOD was 2.21 ± 1.25 mm, after Macintosh and Airtraq laryngoscopy was found to be 1.13 ± 0.60 and 1.6 ± 0.78 mm, respectively, and was found to be significant (P < 0.05). Conclusion: We conclude that Airtraq allows intubation with less movement of the upper cervical spine makes Airtraq preferred equipment for intubation in patients with a potential cervical spine injury.

Assessment of airway parameters in obstetric patients and comparing them at different phases in the perinatal period: A prospective observational study.

Background and Aims: Airway changes occur in different stages of pregnancy. We aimed to evaluate the changes in the upper airway in obstetric patients during pregnancy, labour and after delivery using multiple airway indices and identify the predictive factors of these changes. Methods: This observational study was conducted on 90 parturients aged >20 years, having monofoetal pregnancy. The patient's weight was noted, airway assessment including Mallampati grading (MPG), and thyromental distance (TMD), sternomental distance (SMD), neck circumference (NC) and Wilson's risk score were measured in the second trimester of pregnancy (T0), between 32 and 34 weeks of gestation (T1), at the time of admission for safe confinement, between 38 and 40 weeks of gestation (T2), 2 h after delivery of baby (T3) and, 24 h after delivery (T4). Unpaired t-test and analysis of variance test were applied. Results: Changes in mean (standard deviation [SD]) weight, recorded from T0 to T2, were from 56.96 (10.77) to 65.322 (11.49) kg (P = 0.001). A rise of one or two grades in MPG was detected as the pregnancy progressed, and a decrease of one grade was noted after delivery. A significant decrease in mean (SD) TMD was noted from 6.88 (0.65) to 6.36 (0.62) cm from T0 to T2 (P = 0.001). SMD also decreased in a similar manner as TMD. NC increased from T0 to T3 and then decreased at T4 (P = 0.004). Conclusion: Following the second trimester of pregnancy, MPG increased by either one or two grades, with a decrease in TMD and SMD and an increase in NC.

Comparison of oropharyngeal leak pressure of LMA Protector and LMA ProSeal in anaesthetised paralysed patients - A randomised controlled trial.

Background and Aims: In the present study, we hypothesised that the laryngeal mask airway (LMA) Protector would provide higher oropharyngeal leak pressure (OLP) than LMA ProSeal. Thus, we planned this study to compare the clinical performance of LMA Protector and LMA ProSeal in terms of OLP as a primary objective and insertion characteristics as secondary objectives. Methods: Ninety patients of either gender, aged 18-70 years, were randomised into groups PS (LMA ProSeal) and P (LMA Protector). Following anaesthetic induction, the device was inserted as per group allocation. OLP of both devices was taken as a primary objective. Secondary objectives such as insertion time, ease of insertion, number of attempts required, fibre-optic view grading, amount of air (mL) required to get a cuff pressure (CP) of 60 cm H2O, and CP adjustment required and complications, if any, were also noted. Data were analysed using coGuide statistics software, Version 1 (BDSS Corp. Bangalore, Karnataka, India). Results: The median (interquartile range) OLP was significantly higher with LMA protector than with LMA ProSeal [33.00 (27.0, 36.0) versus [29.50 (26.0, 32.0) (P = 0.009)]. First-attempt success rate was 95.4% (42/44) in group PS and 93% (40/43) in group P. Insertion time, ease of insertion, and fibre-optic view grading were not different between the groups. Gastric tube placement failed in one patient in group PS and in three patients in group P (P = 0.606). The median amount of air (mL) required to get a CP of 60 cm H2O was 26.5 (20, 28) in group PS and 12 (8,13) in group P (95% confidence interval [CI] =10.808-14.575) (P < 0.001). At all time points, CP was significantly higher, and more CP adjustments were needed in group PS than in group P (P < 0.001). Incidence of blood staining and post-operative sore throat at 1 and 24 h were not different between the groups. Conclusion: LMA Protector provided a significantly higher OLP and less requirement of CP adjustments but comparable first-attempt success rate, mean insertion time, fibre-optic view, and gastric tube insertion as compared to LMA ProSeal.

A prospective randomised trial to compare three insertion techniques for i-gel™ placement: Standard, reverse, and rotation.

BACKGROUND AND AIMS: This prospective randomised study was done to compare standard, reverse, and rotation techniques of i-gel™ placement in terms of insertion characteristics and success rate. MATERIAL AND METHODS: After institutional ethics committee approval, 135 patients aged 18-50 years, ASA I and II undergoing elective surgery under general anesthesia were included. After induction of anesthesia, i-gel™ was inserted by standard, reverse, and rotation technique in Groups I, II, and III, respectively. The primary objective was mean time of insertion. Secondary variables included ease of insertion, first attempt success rate, manoeuvres required, fiberoptic view of placement, oropharyngeal leak pressure, ease of placement of nasogastric tube, and complications if any. RESULTS: Mean time of insertion was 18.04 ± 5.65 s, 15.00 ± 5.72 s and 16.12 ± 5.84 s for groups I, II, and III, respectively. Time taken for insertion was shortest and significantly lower (P = 0.048) for group II compared to group I. Insertion time was comparable between rest of groups. The overall success rate in groups I, II, and III were 91.1%, 95.6%, and 93.3% respectively (P = 0.7). The first attempt success rate was 82.2%, 89%, and 84.4% in groups I, II and III, respectively (P = 0.07). Manoeuvres were required in five (12.19%) patients in group I, four (9.30%) patients in group II, and three (7.14%) patients in group III (P = 0.602). Complications occurred in eight, three, and three patients in groups I, II, and III, respectively. CONCLUSION: All techniques of i-gel insertion are equally good and choice of technique depends upon the experience and comfort of the investigator with the particular technique.

Oral clonidine versus gabapentin as premedicant for obtunding hemodynamic response to laryngoscopy and tracheal intubation.

BACKGROUND: We compared the effects of oral clonidine and gabapentin as premedicant in obtunding hemodynamic response to laryngoscopy and intubation in normotensive patients undergoing elective surgery. METHODS: A total of 100 patients of either sex enrolled in the study were randomly divided into two groups of 50 each. Group A patients received oral clonidine 200 µg and Group B patients received oral gabapentin 900 mg, 90 min prior to induction of anesthesia. RESULTS: Both groups were matched for age, sex weight and intubation time. Anxiety score and sedation scores before induction were significantly better in Group A as compared with Group B. Heart rate rise was obtunded in Group A except at 1 min, as compared with Group B in which tachycardia persisted even at 3 and 5 min following intubation. Mean arterial pressure was maintained below baseline at all times in Group A as compared with Group B in which significant rise (+7.55%, P < 0.001) was seen at 1 min after intubation. CONCLUSION: Oral clonidine provided good attenuation of hemodynamic response to laryngoscopy and intubation as compared with oral gabapentin.

Penetrating abdomino-thoracic injury with an iron rod: An anaesthetic challenge.

Penetrating abdomino-thoracic injuries are potentially life-threatening due to the associated haemorrhagic shock and visceral injury. The management of these injuries poses specific challenges in pre-hospital care, transport, and management strategies. We report a 35-year-old male having impalement injury of the left thorax and left upper arm with a metallic rod used for construction of the house after a fall from height. One rod penetrated thorax from left shoulder and exit point was present just above the iliac crest and second rod was seen piercing left upper arm. Patient was successfully managed without any intraoperative, post-operative surgical complications, neurological damage or permanent injuries.

Neurocysticercosis as an important differential of seizures in pregnancy: two case reports.

INTRODUCTION: Seizures in pregnancy usually result from eclampsia, epilepsy or central nervous system disorders. Neurocysticercosis is a rare, but an important, cause of first-time convulsions in pregnancy. CASE PRESENTATIONS: We report the cases of two Indian women, aged 20 and 24 years old respectively, with neurocysticercosis presenting in the second trimester of pregnancy with convulsions. Both had marginally raised blood pressure with 1+ urine albumin and neither had a past history of convulsions. The neurocysticercosis was diagnosed on magnetic resonance imaging of the head, which showed spherical ring-enhancing lesions in the brain. In one woman, pregnancy was terminated due to spina bifida in the fetus and she was discharged on albendazole and phenytoin. The second woman was put on carbamazepine: she had an emergency Cesarean section at term for fetal distress and delivered a healthy baby. Her postnatal period was uneventful. CONCLUSION: Neurocysticercosis should be considered in pregnant women presenting with seizures which cannot be explained by eclampsia, especially in early pregnancy.