TAScope-guided rapid sequence intubation of a case of retrognathia with a history of failed intubation.

A 72-year-old female with symptomatic cholelithiasis was posted for laparoscopic cholecystectomy. She had been previously posted for the same surgery at a different center, but the surgery was not performed due to failed intubation. On airway examination, reduced thyromental distance, prominent incisors, and retrognathia were observed. We planned and executed rapid sequence intubation under videolaryngoscope guidance using The Anaesthetist Society Scope, and the surgery proceeded uneventfully. At the end of the surgery, she was extubated over a bougie, observed, and shifted out without complications.

Comparison of modified chin lift technique with EC technique for mask ventilation in adult apneic patients.

BACKGROUND: Mask ventilation (MV) is an essential basic life support skill. We used chin lift maneuver for MV and named as modified chin lift technique (MCL). EC technique is most common technique used for MV. AIMS: The aim of this study is to compare the efficacy of both techniques for MV in term of expired tidal volume (TV). Secondarily, we also assessed the effect of experience on the performance of these both techniques. SETTINGS AND DESIGN: The study area was operation theater of our hospital. This was a prospective, randomized, crossover study. METHODS: A total 108 adults undergoing elective surgery under general anesthesia were recruited. In all patients, operators (novice/anesthesiologist) randomly performed both techniques either to start with EC or MCL technique. Expired TV was measured for one minute for each technique. STATISTICAL ANALYSIS: Paired t-test was used to compare TV. RESULTS AND CONCLUSION: The mean TV was significantly higher in MCL group than EC group (528.08 [104.96] ml vs. 483.39 [103] ml; P < 0.001). The novice (521.89 [117.9] ml vs. 478.70 [130.29] ml; P < 0.001) as well as anesthesiologists (534.27 [110.85] ml vs. 488.08 [111.6] ml; P < 0.001) was able to generate significantly more TV with MCL technique than EC technique. The TV did not differ significantly between novice and anesthesiologist for EC technique (P = 0.474) or MCL technique (P = 0.187). Novices as well as anesthesiologist felt MCL technique more satisfactory (70%). CLINICAL TRIAL REGISTRATION: CTRI/2016/04/006874.

Depth of insertion of right internal jugular central venous catheter: Comparison of topographic and formula methods.

BACKGROUND: Central venous catheters (CVCs) are inserted in many critically ill patients, but there is no gold standard in estimating their approximate depth of insertion. Many techniques have been described in literature. In this study, we compare the topographic method with the standard formula technique. MATERIALS AND METHODS: 260 patients, in whom central venous catheterization was warranted, were randomly assigned to either topographic method or formula method (130 in each group). The position of the CVC tip in relation to carina was measured on a postprocedure chest X-ray. The primary endpoint was the need for catheter repositioning. RESULTS: The majority of the CVCs tips positioned by the formula method were situated below the carina, and 68% of these catheters required repositioning after obtaining postprocedure chest X-ray (P < 0.001). CONCLUSION: The topographic method is superior to formula approach in estimating the depth of insertion of right internal jugular CVCs.

Inaccurate level of intervertebral space estimated by palpation: The ultrasonic revelation.

BACKGROUND: Spinal cord injury resulting from spinal anesthesia is a rare, but an alarming scenario. The most likely cause is believed to be misjudged level of intervertebral space (IVS). We evaluated the accuracy of palpation method to locate IVS with the ultrasonography. MATERIALS AND METHODS: A total of 109 patients undergoing spinal anesthesia were included in this observational, double-blind study. First anesthesiologist was asked to mark IVS using palpation method. It was followed by ultrasonographic assessment by another anesthesiologist who was unaware of the level estimated for the mark. We evaluated the accuracy of palpation method in sitting and lateral position as well as the impact of the anesthesiologist's experience (Trainee/Consultant). STATISTICAL ANALYSIS USED: Association between the gender, anthropometric parameters, type of anesthesiologists assessing the IVS, and the level of agreement were identified using Chi-square test. The agreement between palpation method and ultrasound assessment of IVS was analyzed using kappa statistic. P < 0.05 was defined as statistical significance. RESULTS: The IVS located by palpation method was in agreement with ultrasound location in 37.14% of the patients. There were no statistically significant differences found in terms of demographic data (sex, age, height, weight, or body mass index [BMI]) between agreement and disagreement group. The rate of errors was found to be significantly higher (P = 0.01) among the trainees (74.51%) than the consultants (51.86%). The rate of errors was not different between the sitting and lateral position. The frequency of errors was more common in cephalad direction (53.31.5%) compared to caudal direction (9.52%). The misidentified spaces were as high as three spaces above the intended space while in caudal direction it differed by only one space. CONCLUSION: The accuracy of palpation method controlled by ultrasound is 37.14% and differs by 1-3 IVS in cephalad direction (53.31%). The accuracy is affected by anesthesiologist's experience but remains unaffected by age, sex height, BMI, and patient positioning.

Sonographic detection of tracheal or esophageal intubation: A cadaver study.

BACKGROUND: The correct position of the endotracheal tube is confirmed by various modalities, most of which are not entirely reliable. Ultrasound is now increasingly available to anesthesiologists in the operating theater and is an attractive alternative. To investigate the usefulness of sonography in identifying the correct tracheal tube position in human cadavers. MATERIALS AND METHODS: Endotracheal tubes placed randomly into trachea or esophagus was identified with a linear ultrasound probe placed transversely just above the suprasternal notch by a single anesthesiologist. RESULTS: Of the 100 intubations performed at random, 99 were correctly identified to give a sensitivity of 100% and a specificity of 97.9%. CONCLUSION: Sonography is a useful technique to identify correct position of the tracheal tube.

Lemierre's syndrome presenting with septic shock.

Lemierre's syndrome is a rare condition characterized by septic thrombophlebitis of the internal jugular vein and metastatic abscesses following oropharyngeal infection. Though classically caused by Fusobacterium necrophorum, a number of other causative organisms have been reported in literature. We report a case of Lemierre's syndrome following parapharyngeal abscess due to staphylococcus aureus which progressed to septic shock.

Dextrocardia and ventricular septal defect with situs inversus: Anesthetic implications and management.

The patients with complicated congenital heart diseases are reaching adulthood with advances in corrective surgeries and medical management. Impact of anesthetic agents on complex cardiac and extra cardiac anomalies and presence of previous palliative procedures can be a challenge for the anesthesiologist perioperatively, while these patients present for cardiac/noncardiac surgeries. We report the perioperative management of a patient with ventricular septal defect, dextrocardia, pulmonary hypertension, and situs inversus who underwent a successful hernioplasty and hydrocelectomy with a combined spinal epidural anesthesia. This discussion relates to the anesthetic management in such conditions with a special reference to Kartagener's syndrome.