Usefulness of ultrasound in confirming the correct placement of Ryle's tube compared to the traditional method of auscultation in normal versus overweight and obese patients.

Background and Aims: Auscultation to verify Ryle's tube position is difficult in obese patients. We compared the usefulness of ultrasonography (USG) versus auscultation in confirming the correct Ryle's tube placement in normal versus overweight or obese patients, time taken for confirmation, and incidence of reinsertion. Material and Methods: A prospective, observational study was carried out on 80 patients. Patients with a body mass index (BMI)>25 kg/m2 formed group O and those with BMI <25 kg/m2 constituted group N. After Ryle's tube insertion correct placement was first confirmed by auscultation. The presence of a gurgling sound over the epigastrium was graded (definite/doubtful/absent). During USG evaluation, if Ryle's tube was not visualized at the subxiphoid region, 20mL of air was injected, looking for dynamic fogging in the stomach. If auscultation yielded doubtful or absent results and USG also failed to confirm, Ryle's tube was repositioned and confirmed. Results: Group O had a significantly higher BMI. Auscultation time and the time taken for USG confirmation were significantly longer in group O. The percentage of patients with definite auscultatory signs was significantly higher in group N. Significantly higher number of patients in group O had doubtful/absent auscultatory signs. Ryle's tube and fogging visualization with USG and the requirement of reinsertion were comparable in both groups. The percentage of patients with definite auscultatory confirmation and definite USG confirmation were comparable in group N. However, in group O, significantly lesser patients had definite auscultatory confirmation compared to definite USG signs. Conclusion: Confirmation of the correct placement of Ryle's tube using ultrasound is easier than auscultation in overweight and obese patients. In normal patients, both techniques are equally useful.

Comparison of Hemoglobin Values Obtained by Arterial Blood Gas Analysis versus Laboratory Method during Major Head-and-Neck Surgeries.

Background: Accuracy of hemoglobin (Hb) measured by arterial blood gas (ABG) analyzer is considered inferior to laboratory (lab) measurements as it could overestimate Hb levels. Aim of the Study: The study aims to compare Hb measured using ABG versus conventional lab method at the time of major blood loss and in the preoperative and immediate postoperative periods. Settings and Design: It was a prospective, nonrandomized observational study conducted in a tertiary care center. Materials and Methods: The study was conducted in 24 patients undergoing major head-and-neck surgeries. Simultaneous blood samples were sent for Hb measurement by ABG analysis and lab method at induction of anesthesia, when intraoperative blood loss exceeded maximum allowable blood loss, and in the immediate postoperative period. Statistical Analysis Used: Chi-square test, independent sample's t-test, and paired t-test were used for statistical analysis. Results: Mean Hb values obtained by both techniques were significantly different at all time points. Hb obtained by ABG analysis was significantly higher than lab value preoperatively (12.78 ± 2.51 vs. 12.05 ± 2.2, P = 0.038), at maximum blood loss (11.00 ± 2.57 vs. 9.87 ± 2.06, P = 0.006), and in the immediate postoperative period (11.96 ± 2.00 vs. 10.96 ± 2.24 P < 0.001). ABG Hb values were found to be approximately 1 g.dL-1 greater than lab values. Conclusion: Hb measured by ABG analysis was significantly higher than that measured by lab method at the time of major blood loss, preoperatively, and at the immediate postoperative period in patients undergoing major head-and-neck surgeries, with a good correlation of values obtained by both the techniques.

Safety and ease of awake fiberoptic intubation with use of oxygen insufflation versus suction to clear secretions during procedure.

Background and Aims: During awake fiberoptic intubation (AFOI), clearing secretions is usually done by suctioning. The study objectives were to assess the safety of AFOI with the use of oxygen insufflation versus suction to clear secretions from the field of vision during the procedure as assessed by incidence of desaturation <95%, ease of intubation, and time taken to secure the airway. Material and methods: This prospective randomized study was conducted in 40 adult patients with difficult airways requiring AFOI. All patients received dexmedetomidine 0.5mcg/kg intravenously, and the airway was topicalized. In Group-S suction and in Group-O oxygen was connected to the suction port of the bronchoscope to clear the secretions by activating the suction knob during bronchoscopy. Ease of intubation was scored as easy, moderate, and hard. Results: Incidence of desaturation to <95% and the need for oxygen supplementation were significantly high in Group S compared to Group O (60% vs. 10%). Incidence of easy intubation (80% vs. 75%) and time taken to intubate (50.1 ± 16.6 vs. 53.8 ± 21.0 s) were comparable. The number of times (median) suctioning was done in Group S was significantly high compared to the number of oxygen insufflations required in Group O [3 (1-6) vs. 2 (0-5), P 0.033]. Desaturation to <95% was significantly low in Group O compared to Group S during bronchoscopy (10% vs. 60%, P 0.002). Conclusion: The use of oxygen insufflation to clear secretions from the field of vision during AFOI is a safer alternative to suctioning as this technique reduces the chance of desaturation during the procedure without affecting ease of intubation, number of attempts, time taken for it, or patient comfort.

Efficacy of Baska mask as an alternative airway device to endotracheal tube in patients undergoing laparoscopic surgeries under controlled ventilation.

BACKGROUND AND AIMS: Newer supraglottic devices with an additional gastric channel offer greater protection from aspiration and avoidance of laryngoscopy for their insertion would result in attenuated hemodynamic responses.The primary objective was to assess hemodynamic responses to insertion of Baska mask as compared to tracheal intubation. The time and attempts taken to secure airway and evidence of regurgitation and pulmonary aspiration of gastric contents were also assessed. MATERIAL AND METHODS: This prospective, randomized study was conducted in 80 patients undergoing laparoscopic cholecystectomy. All patients received standardized anaesthesia protocol. Baska mask was used to secure airway in Group B, while tracheal intubation was done in group T. Methylene blue was injected through Ryle's tube into stomach in both groups. At end of surgery, fibreoptic bronchoscopy was performed to detect bluish staining of trachea and/or main bronchi as evidence of aspiration of gastric contents and bluish staining in oropharynx as evidence of regurgitation. Chi-square test and Independent sample t-test were applied. RESULTS: The time taken to secure airway was significantly longer in Group B as compared to Group T (45.3 ± 12.6 vs. 24.3 ± 9.1 sec) Percentage of patients who had oropharyngeal blue stain was comparable in both groups. No patient in both groups had tracheal blue stain. Group T had significantly higher HR and MAP after intubation till 10 min later. CONCLUSION: Baska mask insertion was associated with attenuated hemodynamic responses, though more time and attempts were required for securing the airway. It could be considered as an alternative to tracheal intubation during laparoscopic surgeries.

Ease and Safety of Securing Airway by Railroading ProSeal Laryngeal Mask Airway over Bougie versus Traditional Digital Insertion Technique.

Background: ProSeal insertion is usually more time-consuming with lower first-attempt success. Aim of the Study: We aimed to compare the incidence of successful placement of ProSeal laryngeal mask airway (PLMA) in the first attempt by railroading it over soft gum-elastic bougie introduced into esophagus versus traditional digital insertion technique. Time taken and ease of securing airway, associated hemodynamic responses, and trauma were also assessed. Settings and Design: This was a prospective randomized study conducted in a tertiary care institute. Subjects and Methods: Forty patients were recruited into two groups. Following induction in Group P, PLMA was introduced using digital technique, whereas in Group B, a soft gum-elastic bougie was introduced into esophagus and then PLMA was railroaded over the bougie. Correct placement was confirmed with end-tidal carbon dioxide waveform. Statistical Tests Used: Fisher's exact test and independent samples t-test were used for statistical analysis. Results: Successful first-attempt insertion was significantly higher in Group B compared to Group P (100% vs. 70%). Percentage of easy insertion was also significantly higher in Group B (95% vs. 65%). Time taken to insert ProSeal was significantly shorter in Group B (30.8 ± 7.8 vs. 59.5 ± 44.6 s). No patient in Group B had blood-stained secretion versus 70% in Group P. Mean arterial pressures at and after ProSeal insertion were significantly higher in Group P. However, heart rate remained comparable in both the groups. Conclusion: Bougie-guided ProSeal insertions had significantly higher first-attempt insertion success rates and were significantly faster and less traumatic with blunted blood pressure response compared to traditional digital insertion technique.

Is intraoperative supplementation of dextrose essential for infants undergoing facial cleft surgeries?

BACKGROUND AND AIMS: Dextrose is commonly added to the intraoperative maintenance fluids of pediatric patients. The primary objective was to evaluate the effect of addition of 1% dextrose to Ringer's lactate (RL) on blood glucose levels in infants undergoing facial cleft surgeries. MATERIAL AND METHODS: This prospective, randomized, single blinded study was conducted in forty infants undergoing either cheiloplasty or palatoplasty. Random blood sugar (RBS) was assessed using a glucometer after induction of anaesthesia, and at 1 and 2 hours later. Group R received RL and Group D received RL with 1% dextrose as intraoperative maintenance fluid. Hypoglycemia was defined as RBS <70 mg/dL and hyperglycemia as RBS >150 mg/dL. RESULTS: Baseline RBS levels and those at 60 min and 120 min post-induction were comparable in both groups. The increase in blood sugar levels from baseline to 60 min and to 120 min in each group was significant. Incidence of hyperglycemia was comparable in both groups. There were no episodes of hypoglycemia, intraoperatively. CONCLUSION: Use of Ringer lactate alone or with addition of 1% dextrose resulted in comparable intraoperative blood sugar levels when used as maintenance fluid in infants undergoing facial cleft surgeries.

Comparison of Hemodynamic Changes to Nasal Application of Lignocaine Jelly versus Lubricant Gel and Responses to Ryle's Tube Insertion Following Their Use in Patients Under General Anesthesia.

BACKGROUND: Awake patients complain of burning sensation following nasal application of lignocaine jelly. AIM OF THE STUDY: The aim of the study was to assess hemodynamic changes, ease of insertion, number of attempts taken, and time required for insertion of Ryle's tube following nasal application of 2% lignocaine jelly versus lubricant gel in patients undergoing surgeries under general anesthesia. SETTINGS AND DESIGN: This was a prospective, randomized, open-label study conducted in a tertiary care institute. SUBJECTS AND METHODS: Eighty patients undergoing surgeries under general anesthesia who required insertion of a Ryle's tube were included. In Group A, 2% lignocaine jelly was used, whereas in Group B, lubricant gel was used prior to Ryle's tube insertion, after induction of anesthesia. Hypertension and/or tachycardia were managed by increasing sevoflurane by 0.5%-1%, followed by propofol bolus of 0.5 mg.kg-1. STATISTICAL TESTS USED: Chi-square test and Independent samples t test. RESULTS: Both heart rate and mean arterial pressure were significantly higher at 1 min after nasal application of lignocaine jelly and 1 and 5 min after Ryle's tube insertion in Group A compared to Group B. Ease of insertion of Ryle's tube, number of attempts, and time taken for insertion were comparable in both groups. Significantly higher number of patients in Group A required sevoflurane to be increased and needed propofol boluses. CONCLUSION: Use of lubricant gel for aiding insertion of Ryle's tube in patients under general anesthesia was associated with attenuated heart rate and blood pressure responses without affecting the ease, number of attempts, or time taken for successful insertion of the Ryle's tube.

Incidence and Severity of Postoperative Pharyngolaryngeal Complications following Use of Baska Mask versus Endotracheal Intubation.

BACKGROUND: Use of Baska Mask, since a supraglottic airway device, could result in low incidence of postoperative pharyngolaryngeal complications. AIMS: The objectives were to compare the effect of Baska Mask versus endotracheal intubation on the incidence and severity of postoperative sore throat (POST), postoperative hoarseness of voice (POHV), and postoperative cough (POC). SETTINGS AND DESIGN: This prospective randomized study was conducted in a tertiary care teaching institute in 120 patients undergoing short laparoscopic surgeries. SUBJECTS AND METHODS: Airway was secured using with low-pressure, high-volume cuffed endotracheal tube in Group T and with Baska Mask in Group B. POST, POC, and POHV were assessed at 2, 6, 12, and 24 h after surgery. Those with Grade III score throat were managed by gargling with dispersible aspirin 75 mg. STATISTICAL ANALYSIS USED: Pearson's Chi-square test, Fisher's exact test, and independent sample t-test were used as applicable. RESULTS: Group B patients required significantly more attempts at securing airway. Incidence of POST was significantly higher in Group T as compared to that Group B at 2, 6, 12, and 24 h after surgery. POC was significantly more in Group T at 2, 6, and 12 h. No patient in Group B had POC at 12 and 24 h. POHV showed significantly higher incidence in Group T at 2 and 6 h. No patient in Group B had hoarseness at 6, 12, and 24 h. CONCLUSION: Use of Baska Mask as compared to endotracheal intubation significantly reduces the incidence and severity of pharyngolaryngeal complications such as POST, POC, and POHV in patients undergoing short laparoscopic surgeries.

Safety of Inhalational Anesthesia in Patients with Multiple Drug Allergies Presenting for Major Surgeries under General Anesthesia.

The prevalence of perioperative anaphylaxis is 1 in 1250-20,000 anesthetics. Inhalational anesthesia is considered safe in patients with multiple drug allergies, as there have been no reports of anaphylaxis to volatile inhalational agents. Anesthetic management of six patients with documented allergy to all commonly used anesthetic drugs who underwent major surgeries under general anesthesia is described as a case series. The plan of anesthesia in these patients was an anesthetic gas-based general anesthesia without using muscle relaxants but with the use of intravenous fentanyl if patient was not allergic to it. Sevoflurane 8% in oxygen was used for induction. Following cessation of breathing and on attaining an end-tidal concentration of >4% sevoflurane, direct laryngoscopy and intubation were performed. Anesthesia was maintained with sevoflurane in nitrous oxide and oxygen mixture maintaining a lower end-tidal carbon dioxide. Hypotension and/or bradycardia were managed with intermittent intravenous boluses of adrenaline 20 µg. At the end of surgery, all anesthetic gases were cutoff, and patients were extubated when awake. No muscle relaxant was used in any of the cases. Two patients received fentanyl before induction, whereas others were given oral paracetamol 2 h before induction. Postoperative analgesia was provided with oral paracetamol which was given 2-4 h after surgery. Intraoperative period was uneventful for these patients. In patients with multiple drug allergies, inhalational agent-based general anesthesia can be considered as a safe alternative to regular anesthetic practice involving polypharmacy, with a reduced risk of perioperative adverse events.

Comparison of Intraoperative Glycemic Levels in Infants with the Use of Ringer Lactate with Supplemental 1% versus 2% Dextrose as Maintenance Fluid.

CONTEXT: There is no consensus regarding the concentration of dextrose supplementation to be used in pediatric patients intraoperatively. AIMS: The primary objective was to assess the effect of using Ringer lactate (RL) with 1% versus 2% dextrose as maintenance fluid in infants on intraoperative blood glucose levels. The secondary objectives included assessment of incidence of hyperglycemia and hypoglycemia in both groups. SETTINGS AND DESIGN: This was a prospective randomized study conducted in a tertiary care teaching institute. SUBJECTS AND METHODS: Forty infants undergoing cheiloplasty or palatoplasty were included. All patients fasted 6 h for solids and formula feeds, 4 h for breast milk, and 2 h for clear fluids and received general anesthesia as per standardized protocol. Patients belonging to Group 1 received RL with 1% dextrose supplementation, whereas Group 2 received RL with 2% dextrose added to it as an intraoperative maintenance fluid. Random blood sugar (RBS) was checked preoperatively and then at 60 min and 120 min after induction. Hypoglycemia was defined as RBS <70 mg/dL and hyperglycemia as RBS >150 mg/dL. STATISTICAL ANALYSIS USED: Independent sample ttest and Pearson's Chisquare test were used for statistical analysis. RESULTS: Preoperative RBS was comparable in both groups. RBS at 60 and 120 min was significantly higher in Group 2 compared to Group 1. There was no incidence of hypoglycemia in both groups, and the incidence of hyperglycemia was similar in both groups. CONCLUSION: Use of RL with 2% dextrose as intraoperative maintenance fluid in infants resulted in significant increase in blood sugar levels as compared to addition of 1% dextrose although the incidence of hyperglycemia remained comparable in both groups.

Safety and Efficacy of Dexmedetomidine versus Propofol Infusion as an Adjunct to Transtracheal Block in Ensuring Patient Immobility During General Anesthesia without the Use of Muscle Relaxants.

BACKGROUND: In surgeries where nerve stimulation study is required intraoperatively, the use of long-acting muscle relaxants should be avoided. AIM OF STUDY: This study aimed to assess the efficacy of dexmedetomidine versus propofol infusion as an adjunct to transtracheal block to ensure patient immobility during general anesthesia without the use of muscle relaxants and to compare hemodynamics in both the groups. SETTINGS AND DESIGN: It was a prospective randomized controlled trial done at a tertiary care center. SUBJECTS AND METHODS: Forty adult patients undergoing brachial plexus surgeries were included in the study and all patients received a transtracheal block just before the induction. After standardized induction and intubation, Group D received intravenous (i.v.) bolus of dexmedetomidine 0.5 µg.kg-1 body weight followed by infusion at 0.5 µg/kg/h intraoperatively. In Group B, the infusion of propofol was started at 1 mg/kg/h after induction. In both the groups, if the patient moved, bucked on endotracheal tube, or if there were signs of inadequate depth of anesthesia, bolus of propofol 0.5 mg.kg-1 i.v. was given and repeated as required. STATISTICAL TESTS USED: Mann-Whitney U-test and Fisher's exact test were used for the statistical analysis. RESULTS: Number of times propofol bolus was required intraoperatively and hemodynamic parameters were comparable in both the groups at all-time points. Time to extubate was significantly higher in Group P compared to Group D (16.06 ± 5.78 vs. 9.61 ± 11.53 min). CONCLUSION: The use of dexmedetomidine infusion as an adjunct to transtracheal block is superior to propofol infusion in view of significantly shorter extubation time though both the agents provided comparable intraoperative hemodynamics and patient immobility.

Ease of intubation and hemodynamic responses to nasotracheal intubation using C-MAC videolaryngoscope with D blade: A comparison with use of traditional Macintosh laryngoscope.

BACKGROUND AND AIMS: Nasal intubation with traditional Macintosh laryngoscope usually needs the use of Magill's forceps or external laryngeal manipulation. The primary objective of this study was to assess the ease of intubation during C-MAC videolaryngoscope-assisted nasal intubation using D blade and to compare it with traditional Macintosh laryngoscope-aided nasal intubation. The secondary objectives were comparison of intubation time, attempts, trauma, and hemodynamic stress responses. MATERIAL AND METHODS: Sixty patients requiring nasal intubation were randomized into two groups, M and V. Patients in both the groups received general anesthesia as per a standardized protocol. Laryngoscopy was performed using the traditional Macintosh laryngoscope in group M and with Storz® C-Mac videolaryngoscope with D-blade in group V. Chi-square test, Mann-Whitney test, and independent samples t-test were used as applicable for data analysis. RESULTS: Intubation was significantly easy in 70% of the patients in group V compared to only 3.3% in group M. Time to intubate was significantly shorter in group V (24 vs 68 s). Though majority of patients were intubated in the first attempt in both groups, the number was more in group V (96.7 vs 70%). There was no case of esophageal intubation in group V, but 2 patients (6.7%) had esophageal intubation in group M. Mucosal trauma was significantly more frequent in group M. There was no statistically significant difference in hemodynamics in both groups. CONCLUSION: C MAC videolaryngoscope-aided nasotracheal intubation using D blade is superior in view of easier, quicker, and less traumatic intubation compared to the use of traditional Macintosh laryngoscope.

Efficacy of vaptans for correction of postoperative hyponatremia: A comparison between single intravenous bolus conivaptan vs oral tolvaptan.

BACKGROUND AND AIMS: Hyponatremia is one of the most common electrolyte abnormality encountered in postoperative patients especially in the elderly. We aimed to assess the efficacy of single-dose intravenous conivaptan vs. oral tolvaptan therapy for correction of hyponatremia in postoperative patients. MATERIAL AND METHODS: This prospective randomized study was conducted on 40 patients aged 20-70 years, who had undergone major head and neck surgeries with a serum sodium level of ≤130 mEq/L and were symptomatic. Patients were randomly allocated into two equal groups. Patients belonging to group C received single intravenous bolus dose of conivaptan 20mg, whereas group T received oral tolvaptan 15mg on the first day. At 24h, if sodium correction was <4mEq/L, dose of tolvaptan was increased to 30mg in group T or an infusion of conivaptan 20mg over next 24h was started in group C. RESULTS: Chi-square test, independent sample t-test, and paired t-test were used as applicable. Though there was no significant difference in the baseline sodium values in both groups, at 12 and 24 h group C had significantly high values. At 48h sodium values in both the groups were comparable. Intra-group analysis had shown that there was a significant increase in sodium values from the baseline at 12, 24, and 48 h in both the groups. CONCLUSION: Single-dose intravenous conivaptan as well as oral tolvaptan were safe and effective in correcting hyponatremia in postoperative patients. Conivaptan could be considered superior as it resulted in faster sodium correction with effective aquaresis.

Effect of Using Ringer's Lactate, with and without Addition of Dextrose, on Intra-Operative Blood Sugar Levels in Infants Undergoing Facial Cleft Surgeries.

BACKGROUND: Addition of glucose in the intraoperative fluid is a routine practice in infants. Under general anesthesia, due to neuroendocrine stress response, this could result in overt hyperglycemia. AIMS: The aim of this study was to find whether the addition of 2% dextrose to Ringer's lactate (RL) caused hyperglycemia compared to no addition of dextrose to RL. SETTINGS AND DESIGNS: This prospective randomized study was conducted in 100 infants undergoing facial cleft surgery at a tertiary care institution. SUBJECTS AND METHODS: Group D received RL with 2% dextrose and Group R received RL without the addition of dextrose. Blood sugars were measured at induction, 1 h and 2 h later. Hyperglycemia was defined as blood sugar >150 mg/dL and hypoglycemia as <70 mg/dL. STATISTICAL ANALYSIS USED: Pearson's Chi-square test, Paired t-test, Mann-Whitney test, and Independent sample t-test were used as applicable. RESULTS: Baseline blood sugar was comparable in both groups. A significant increase in blood sugar values from baseline was seen in both groups, but the increase was significantly more in Group D at 60 min (136.5 ± 41.9 vs. 109.2 ± 20.5) and at 120 min (150.1 ± 45.5 vs. 123.1 ± 31.7). The incidence of hyperglycemia was 50% in Group D and 12% in Group R. No patient developed hypoglycemia intraoperatively. No significant correlation between blood sugar and hours of fasting was established. CONCLUSION: Routine addition of dextrose to RL is not essential during short surgeries under general anesthesia in infants, provided preinduction blood sugar level is >70 mg/dL and intraoperative sugars are periodically monitored.

Hemodynamic Responses and Safety of Sedation Following Premedication with Dexmedetomidine and Fentanyl during Fiberoptic-assisted Intubation in Patients with Predicted Difficult Airway.

BACKGROUND: Awake fiberoptic intubation (AFOI) is the gold standard for the management of predicted difficult airway, and inappropriate sedation is a major cause leading to its failure. AIMS: The primary objective was to compare the heart rate (HR) changes that accompany AFOI following sedation with dexmedetomidine and fentanyl. Secondary objectives included comparison of changes in blood pressure, patient comfort, ease of intubation, and degree of sedation. SETTINGS AND DESIGNS: This prospective double-blinded randomized study was conducted in a tertiary care institution. SUBJECTS AND METHODS: Forty patients with anticipated difficult airway requiring AFOI were included in the study. Group A received dexmedetomidine 1 µg/kg whereas Group B received fentanyl 2 µg/kg. After topical anesthesia of the airway, AFOI was performed. STATISTICAL ANALYSIS USED: Fisher's exact test, independent two-sample t-test, and Mann-Whitney U-test were used as applicable. RESULTS: The hemodynamic parameters were comparable in both the groups except at 1 min postintubation when fentanyl group had significantly higher HR. There were lower alertness and muscle tone scores in dexmedetomidine group. Total comfort score was significantly higher in fentanyl group. Though more patients in dexmedetomidine group showed that no reaction to intubation and more patients in fentanyl had slight grimacing, the difference was insignificant. The ease of intubation was similar in both the groups. CONCLUSION: Though dexmedetomidine1 µg/kg and fentanyl 2 µg/kg premedication results in comparable hemodynamics and ease of intubation, in view of enhanced patient comfort, dexmedetomidine premedication is advantageous in patients with anticipated difficult airway undergoing AFOI.

Effect of C-MAC Video Laryngoscope-aided intubations Using D-Blade on Incidence and Severity of Postoperative Sore Throat.

BACKGROUND: Video laryngoscope-aided intubations require less force to align oral, pharyngeal, and laryngeal planes to visualize the glottis opening during intubation. AIM: The primary objective of the study was to assess the incidence and severity of postoperative sore throat (POST) in patients who were intubated with C-MAC video laryngoscope using D-blade versus traditional Macintosh laryngoscope. SETTINGS AND DESIGN: This prospective, randomized, open label study was conducted in a tertiary care institution. SUBJECTS AND METHODS: A total of 130 patients undergoing short elective laparoscopic surgeries lasting <2 h were recruited. All patients received general anesthesia as per a standardized protocol. Laryngoscopy was performed using traditional Macintosh laryngoscope in Group M and with Storz® C-MAC video laryngoscope using D-Blade in Group V. The endotracheal tube cuff pressure was maintained at 20-22 cm of H2O intraoperatively. STATISTICAL ANALYSIS USED: Pearson's Chi-square test, Fisher's exact test, and Independent sample t-test were used in this study. RESULTS: As compared to Group M, number of patients who had POST, hoarseness of voice, and cough was significantly low in Group V at 2, 6, 12, and 24 h. Severity, as well as the incidence of all these symptoms, showed a downward trend in both groups with time. Significantly more number of patients in Group M required rescue therapy for POST (44.6% as compared to 7.7%, P < 0.001). CONCLUSION: C-MAC video laryngoscope-aided intubations using D-blade significantly reduced the incidence and severity of POST, hoarseness of voice, and cough following orotracheal intubation as compared to use of traditional Macintosh laryngoscope.

Does Restrictive Fluid Strategy during Robotic Pelvic Surgeries Obtund Intraoperative Rise in Intraocular Pressure?

BACKGROUND: Robotic pelvic surgeries require steep Trendelenburg position which may result in rise in intraocular pressure (IOP). AIM: The aim of this study was to compare the changes that occur in IOP during robotic pelvic surgeries in steep Trendelenburg position with a restrictive intravenous fluid administration. SETTINGS AND DESIGN: This prospective observational study was conducted in a tertiary care institution. SUBJECTS AND METHODS: Twenty consenting patients scheduled for pelvic robotic gynecological surgeries were enrolled. All patients received general anesthesia following a standardized protocol. IOP was measured before induction of anesthesia, immediately after induction and intubation, at the end of surgery immediately after making the patient supine and immediately after extubation. Ringer's lactate was administered intravenously at a rate of 4 mL/kg/h targeting a mean arterial pressure of >65 mmHg and urine output of >0.5 mL/kg/h. STATISTICAL ANALYSIS USED: Paired t-test was used in this study. RESULTS: There was a fall in IOP soon after induction from baseline which was not significant. Immediately, following intubation, there was a significant rise in IOP. At the end of surgery, though IOP remained high, it was not statistically significant. However, following extubation, IOP rose further and the difference from the baseline became statistically significant. Although there was a moderate increase in peak airway pressure and highest EtCO2 levels during Trendelenburg from baseline values, the differences were statistically insignificant. CONCLUSION: During robotic pelvic surgeries, adopting a restrictive intravenous fluid strategy with the maintenance of normal end-tidal carbon dioxide levels could abate effects of steep Trendelenburg position on IOP.

Ease of Intubation with C-MAC Videolaryngoscope: Use of 60° Angled Styletted Endotracheal Tube versus Intubation over Bougie.

BACKGROUND: Although videolaryngoscopes improve glottic visualization, their actual usefulness in intubation is not yet established. AIMS: The primary objective was to compare the ease of oral intubation with the use of 60° angled styletted endotracheal tube versus that performed over bougie inserted under videolaryngoscopic guidance. The secondary objectives were assessment of incidence of airway loss, hemodynamic changes, and time and number of attempts at intubation. SETTINGS AND DESIGN: This prospective randomized study was conducted in a tertiary care institution. PATIENTS AND METHODS: Seventy surgical patients requiring oral intubation were randomly allotted to Group S or Group B. Laryngoscopy was performed with Storz® C-MAC videolaryngoscope using D-Blade. In Group S, patients were intubated with a 60° angled stylletted endotracheal tube. In Group B, a bougie was introduced into the trachea and endotracheal tube was railroaded over the bougie. STATISTICAL ANALYSIS USED: Chi-square test and independent sample t-test were used as applicable. RESULTS: The ease of intubation was significantly more in patients of Group S as compared to Group B (88.6% vs. 25.7%, respectively, P < 0.001) with significantly shorter intubation time (16.97 ± 7.91 vs. 77.43 ± 35.55 s, respectively, P < 0.001). The requirement of more than one attempt at intubation was significantly higher in Group B [57.1% vs. 5.7% P < 0.001, respectively]. Group B showed a significantly high mean arterial pressure at 1 and 3 min following intubation with no significant change in heart rate. CONCLUSION: Use of 60° angled styletted endotracheal tube resulted in easier and faster intubation as compared to intubation over a bougie when used with C-MAC videolaryngoscope.