Comparative evaluation of C-MAC and McGrath MAC videolaryngoscopes with Macintosh direct laryngoscope for endotracheal intubation in adult patients undergoing elective surgeries.

Background and Aims: Videolaryngoscopes have an undisputed role in difficult airway management, but their role in routine intubation scenarios remains underappreciated. McGrath MAC is a lightweight laryngoscope with a disposable blade. It remains to be proven if it performs as efficiently as the reusable videolaryngoscopes like C-MAC and whether it has an advantage over standard Macintosh laryngoscope in predicted normal airways. Material and Methods: We recruited 180 adult patients and randomly divided them into three groups for intubation with either Macintosh laryngoscope (Group-A), C-MAC (Group-B), and McGrath (Group-C). The primary objective was to compare the first attempt success rate. Secondary objectives included Cormack-Lehane (CL) grades, laryngoscopy time, intubation time, ease of intubation, need for optimization manoeuver, and the number of passes to place the endotracheal tube. Results: The two videolaryngoscopes provided a superior first attempt success rate as compared to Macintosh laryngoscope (P = 0.027). The CL grade-I was 100% in group B, 41.7% in group-A and 90% in group-C (B vs C; P = 0.037). Laryngoscopy time was 9.9 ± 2.5 s, 12.6 ± 0.8 s, and 13.1 ± 0.8 s for groups A, B, and C, respectively (B vs C; P = 0.001). Intubation time was 24.4 ± 12 s, 28.3 ± 1.9 s, and 37.3 ± 5.8 s for groups A, B, and C, respectively (P < 0.0001). The number of tube passes was highest in group C. Conclusion: Videolaryngoscopes provided a superior glottic view and resulted in a superior first attempt success rate as compared to Macintosh laryngoscope. When comparing the two videolaryngoscopes, C-MAC resulted in better intubation characteristics (shorter intubation time, better glottic views, and higher first-attempt success rates) and should be preferred over McGrath for intubation in adult patients with normal airways.

Ultrasound-guided anterior suprascapular nerve block versus interscalene brachial plexus block for arthroscopic shoulder surgery: A randomised controlled study.

Background and Aims: The interscalene brachial plexus block (ISB) affects the phrenic nerve, resulting in hemi-diaphragmatic paresis (HDP) and, possibly, respiratory distress. Suprascapular nerve block via an anterior approach (SSB-A) is performed more distally at the level of the trunk of the brachial plexus and, thus, may spare the phrenic nerve. This study compares the analgesic efficacy and decline of hemi-diaphragmatic excursion (HDE) following ultrasound (US)-guided SSB-A versus ISB for arthroscopic shoulder surgery. Methods: This study was conducted on 60 adult participants undergoing arthroscopic shoulder surgery under general anaesthesia. Both US-guided SSB-A (n = 30) and ISB (n = 30) were performed with a combination of 10 ml bupivacaine (0.5%) and 4 mg dexamethasone. The primary objective was to compare the duration of analgesia (time to first rescue analgesia), and secondary objectives were to compare 24-h postoperative numerical rating scale (NRS) scores, 24-h morphine consumption and post block change in HDE, and pulmonary function tests (PFTs) between the two groups. For analysing intergroup differences of NRS, HDE and PFT; Pearson's Chi-squared test or Fisher's exact test, unpaired t test, and Mann-Whitney U test were used. For intragroup differences, paired t test was used. A P value <0.05 was considered significant. Results: The duration of analgesia (mean ± Standard Deviation) was similar in two groups (SSB-A = 1,345 ± 182 min, ISB = 1,375 ± 156 min; P = 0.8). The reduction in HDE was significantly greater in the ISB group (44%) than in the SSB-A group (10%). Pulmonary function was better preserved in the SSB-A group. Conclusion: Compared to ISB, SSB-A has a similar analgesic efficacy for arthroscopic shoulder surgeries, but it is superior in preserving diaphragmatic function and pulmonary function.

An Analysis of the Comparative Efficacy Between a Third-Generation and a Second-Generation Supraglottic Airway Device in Patients Undergoing Laparoscopic Cholecystectomy.

Background and objective Supraglottic airway devices are extensively used nowadays to secure the airway and minimize postoperative airway-related complications. This study aimed to evaluate whether the Baska® mask (BM) provides higher seal pressure and a better first-time insertion compared to the laryngeal mask airway (LMA) ProSeal™ (LMA-P) in adult laparoscopic cholecystectomy. Methodology This prospective, randomized, single-blinded interventional study was performed after obtaining ethical approval from the Institutional Ethics Committee at the Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi. Sixty adult patients of both genders scheduled for laparoscopic cholecystectomy under general anesthesia were divided into two groups, with 30 patients in each group. Our study observed the number of insertion attempts, time of insertion, oropharyngeal seal pressure (OSP), number of patients requiring manipulation for proper placement of supraglottic airway devices, and ease of insertion. Results There were no significant differences in terms of insertion attempts, ease of insertion, and laryngopharyngeal morbidity between the groups. The mean OSP at five minutes was 31.55 ±2.23 cm H2O, and that at 30 minutes was 35.86 ±3.70 cm H20 in the BM group, while in the LMA-P group, it was 24.17 ±3.74 cm H20 and 25.97 ±3.79 cm H20 respectively (p<0.001). In our study, the trend of OSP continued to increase in the BM group more than in the LMA-P group during surgery. Conclusion The BM provided better OSP than the LMA-P, which was observed throughout the surgery.

Comparative Evaluation of C-MAC Videolaryngoscope with Macintosh Direct Laryngoscope in Patients with Normal Airway Predictors.

Background: Video laryngoscopes (VL) assist in securing the airway faster and more accurately in difficult airways. However, data regarding its usefulness in patients with normal airways are sparse. Aim: We designed this study to compare the ease and success of endotracheal intubation between C-MAC and Macintosh direct laryngoscope (DL) in adult patients with no anticipated airway difficulty. Settings and Design: The design involves prospective randomized case - control study. Subjects and Methods: One hundred and twenty adult patients with predicted normal airway were randomized into two groups and were intubated using VL (C-MAC VL) and DL (Macintosh DL), respectively. The Cormack-Lehane (CL) grade, time taken for intubation, attempts taken (number), and need for laryngeal maneuvers or stylets were recorded and analyzed for statistical significance. Results: Thirty-eight patients in the DL group and 48 patients in the VL group had CL I view, 20 patients in the DL group and 16 patients in the VL group had CL II, and two patients in the DL group had CL III view. None of the patients in Group VL had CL III view. In seven out of 60 cases in the DL group, difficulty was experienced during insertion of the laryngoscope blade as compared to two cases out of 60 in the VL group. The mean time taken for intubation was lesser in Group DL (28.48 s) as compared to 39.3 s in Group VL. Nine patients in Group DL and 16 patients in Group VL required external laryngeal manipulation. Stylets were used, in seven patients in group DL and in 11 patients in group VL. Conclusions: In patients with a predicted normal airway, C-MAC provides a better glottic view compared to Macintosh DL. Time taken for intubation using the C-MAC video laryngoscope was more. However, success rates on the first attempt at endotracheal intubation and the number of intubation attempts with either laryngoscope were similar.

Hemodynamic, Airway Pressure, and Capnometric Changes and Perioperative Outcome in Pediatric Laparoscopic Inguinal Herniorrhaphy: A Comparison with Open Inguinal Herniorrhaphy.

BACKGROUND: Laparoscopic procedures which are now established in pediatric population as well exposes the child to supplemental cardiorespiratory changes due to increase in intraabdominal pressure (IAP) and hypercarbia. AIMS: This study aims to analyze the effects of pneumoperitoneum and postural modifications on cardiorespiratory system (primary outcome) during pediatric laparoscopic herniorrhaphy (LH) and its comparison with open herniorrhaphy (OH) and assessment of overall perioperative outcome (secondary outcome). SETTINGS AND DESIGN: A prospective, observational study conducted in a tertiary care hospital. MATERIALS AND METHODS: Fifty children undergoing either LH (n = 25) or OH (n = 25) were included in the study. Anesthetic procedure was standardized. Parameters monitored were heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressures (MAP), electrocardiogram lead-II, end-tidal CO2 (ETCO2), airway pressures PPeak, PPlateau, PMean, pulse oximetry, IAP, minute ventilation/respiratory rate alterations. STATISTICAL ANALYSIS USED: Student's t-test and Chi-square test were applied to compare different variables between the two groups. Intragroup analysis was done using the analysis of variance test. RESULTS: The HR was comparable in both groups. The rise in SBP, DBP, and MAP was 9% (102.88 ± 6.91-121.32 ± 6.63), 19% (60.88 ± 4.94-77.00 ± 9.75), and 14.8% (73.92 ± 4.65-90.40 ± 8.42), respectively, in group LH. The rise in peak, plateau, and mean airway pressures was 19.4% (14.20 ± 2.00-18.00 ± 2.54), 20.1% (13.32 ± 1.89-16.89 ± 2.60), and 16.1% (6.20 ± 1.00-7.47 ± 0.96), respectively, in group LH. ETCO2 showed a maximum rise of 19.4% (34.52 ± 3.61-41.21 ± 3.99) in group LH. In laparoscopic group, recurrence was seen in 3 patients. CONCLUSIONS: We found significant hemodynamic, airway pressure, and capnometric changes during pediatric LH with comparable perioperative outcome among the two groups.

Cervical Vagal Schwannoma: Anesthetic Concerns.

Schwannomas arising from cervical vagus nerve is an extremely rare benign neoplasm. The majority of patients present with insidiously growing lateral neck mass without neurological deficit. We report a case of symptomatic cervical vagal nerve schwannoma in a 32-year-old female. Complete surgical resection is the treatment of choice. However, anesthetic management of these tumors can be challenging. We describe here the complications experienced during the management of the patient.

Granisetron versus ondansetron for post-operative nausea and vomiting prophylaxis in elective craniotomies for brain tumors: A randomized controlled double-blind study.

CONTEXT: Post-operative nausea and vomiting (PONV) pose unique challenges in neurosurgical patients that warrant its study separate from other surgical groups. SETTING AND DESIGN: This prospective, randomized, double-blind study was carried out to compare and to evaluate the efficacy and safety of three antiemetic combinations for PONV prophylaxis following craniotomy. MATERIALS AND METHODS: A total of 75 anesthesiologist status I/II patients undergoing elective craniotomy for brain tumors were randomized into three groups, G, O and D, to receive single doses of dexamethasone 8 mg at induction with either granisetron 1 mg, ondansetron 4 mg or normal saline 2 ml at the time of dural closure respectively. Episodes of nausea, retching, vomiting and number of rescue antiemetic (RAE) were noted for 48 h post-operatively. STATISTICAL ANALYSIS: Analysis of variance with post-hoc significance and Chi-square test with fisher exact correction were used for statistical analysis. P <0.05 was considered to be significant and P < 0.001 as highly significant. RESULTS: We found that the incidence and number of vomiting episodes and RAE required were significantly low in Group G and O compared with Group D; P < 0.05. However, incidence of nausea and retching were comparable among all groups. The anti-nausea and anti-retching efficacy of all the three groups was comparable. CONCLUSIONS: Single dose administration of granisetron 1 mg or ondansetron 4 mg at the time of dural closure with dexamethasone 8 mg provide an effective and superior prophylaxis against vomiting compared with dexamethasone alone without interfering with post-operative recovery and neurocognitive monitoring and hence important in post-operative neurosurgical care.

Hemodynamic changes after administration of mannitol measured by a noninvasive cardiac output monitor.

Mannitol is the most commonly used hyperosmotic agent in neurosurgery. Being an agent that increases intravascular volume by withdrawing water from the brain, it may cause significant changes in stroke volume (SV), cardiac output (CO), systemic vascular resistance and blood pressure. In this study, we monitored the hemodynamic changes in response to a single dose of mannitol by using a noninvasive CO monitor based on the thoracic electrical bioimpedance technique, in patients undergoing craniotomy. Eleven adult patients undergoing elective craniotomy received mannitol 1.0 g/kg 15 minutes before dural opening. The following hemodynamic variables were recorded: heart rate, systolic blood pressure, diastolic blood pressure, SV, CO, and cardiac index. The measurements were made before the administration of mannitol, at 1, 2, 5, 10, 15, 20, 25, 30, 35, 40, and 45 minutes after the termination of the mannitol infusion. Urine output was measured at 10, 20, 30, 40, 50, 60, 90, and 120 minutes after termination of the mannitol infusion. Heart rate values from 25 to 45 minutes were significantly lower compared with the premannitol values (P<0.05). All the postmannitol systolic blood pressure values were significantly lower than the premannitol value (P<0.05). SV increased significantly for 15 minutes after administration of mannitol (P<0.05). SV at 45 minutes was significantly lower than that from 1 to 30 minutes (P<0.05). Cardiac index also showed a similar change with a significant increase at 1 to 10 minutes and a decrease at 40 to 45 minutes compared with 1 to 15 minutes.The rate of urine secretion was higher during the first 10 minutes (40+/-15 mL/kg/ h) than during the rest of the study period. The overall fluid balance at the end of 120 minutes was -370+/-987 mL. In this study using noninvasive measurement of CO by thoracic bioimpedance plethysmography during craniotomy, a single bolus dose of mannitol 1.0 g/kg caused a significant but short duration changes in the hemodynamic variables. The changes in SV, and CO, lasted for only 15 minutes after the infusion.