Comparing the posture and comfort of anaesthesiologists during laryngoscopy and tracheal intubation in the head-elevated laryngoscopy position in supine position and with a 25° backup: A randomised clinical crossover trial.

Background and Aims: The head-elevated laryngoscopy position (HELP) and a 25° backup have been proposed to enhance glottic visualisation, yet concerns about ergonomic discomfort hinder their widespread adoption. This study compares the comfort and posture adopted by anaesthesiologists while performing laryngoscopy and tracheal intubation with patients in HELP while in a supine position or with 25° backup. Methods: The study included 48 patients aged 18-60 years with normal airways and 12 experienced anaesthesiologists. Patients were randomised into two groups using permuted block randomisation. Anaesthesiologists performed laryngoscopy and intubation in supine HELP and 25° backup HELP positions. Anaesthesiologist's posture was determined by measuring the angles of neck, wrist, elbow, back and knee joints, which were compared using Student's t-test, and subjective comfort assessed on a Likert scale was compared using the Chi-square test. As mentioned by the anaesthesiologist, Cormack- Lehane grading was also noted and compared using a Chi-square test between groups, taking a P value <0.05 as significant. Results: Both positions demonstrated comparable anaesthesiologist posture (P = 0.919) and comfort (P = 0.644). However, the 25° backup HELP positions significantly improved Cormack-Lehane grades, with 68% achieving grade 1 compared to 31% in the supine HELP group (P = 0.012). Haemodynamic stability and tracheal intubation time showed no significant differences between the groups (P = 0.475 and 0.117, respectively), and no complications were reported in either group. Conclusion: Anaesthesiologists' posture and comfort during laryngoscopy and tracheal intubation are similar between supine and 25° backup in patients with easy airways.

Additional muscle fibers of brachioradialis with anomalous high origin and entrapment of radial nerve in an osseomuscular canal.

Normally, brachioradialis originates from the upper part of the lateral supracondylar ridge of the humerus. Variations in its origin are very rare. We observed the presence of an additional set of fleshy muscle fibers in the lateral part of the anterior compartment of the arm in addition to the other normal muscles. This unusual case was observed at the Mookambika Institute of Medical Sciences, Kulashekara, Tamil Nadu, India, during routine dissection of the upper limb. The anomalous fleshy fibers were attached proximally to the middle part of the shaft of the humerus, close to the insertion of deltoid. Some of its fibers continued further up to the acromian process of scapula. These fibers passed downwards along with deltoid and joined the fibers from the humerus before getting merged with the brachioradialis distally. These additional muscle fibers were compared with the brachioradialis accessorius and the uniqueness, functional significance and the clinical relevance werediscussed (Fig. 2, Ref. 6). Full Text in PDF www.elis.sk.

Persistent sacrococcygeus ventralis muscle in an adult human pelvic wall: a variation for surgeons to note.

Occurrence of abnormal muscles in the pelvic wall is very rare. During a routine dissection of the pelvic wall, an abnormal muscle referred to as sacrococcygeus ventralis was noted in a 65-year-old South Indian cadaver. The fleshy fibers of the muscle were arising from the lateral part of the ventral surface of the sacrum at the level of S3 segment. The muscle passed downwards in front of the S4 and S5 sacral segments, halfway through its course it became tendinous and finally became inserted in the ventral surface of the coccyx. Sacrococcygeus ventralis is a muscle which is well developed in animals where it acts on their tail. In human beings, sacrococcygeus ventralis is seen only during fetal life. A rare case of its persistence in an adult pelvic wall is reported and discussed here.