Improving acute peritoneal dialysis outcome with use of soft peritoneal dialysis catheter (Cook Mac-Loc Multipurpose Drainage catheter®) among infants < 1500 g in a low resource setting.

BACKGROUND: Despite its utility, uncertainty exists on the feasibility of acute peritoneal dialysis (PD) and optimal PD catheter type for very low birth weight (VLBW < 1500 g) and extremely low birth weight (ELBW < 1000 g) infants. We hereby report our experience of acute PD among these high-risk infants and compare the outcome between stylet-based rigid catheter (SRC) and Cook Mac-Loc Multipurpose Drainage catheters® (CMMDC). METHODS: Case notes of infants < 1500 g undergoing PD between 2012 and 2021 in a network of five participating neonatal units supported by a tertiary paediatric nephrology centre in Kolkata, India, were retrospectively reviewed. PD was conducted either with SRC or after 2018 with CMMDC. Outcome parameters included complications, survival during PD, and survival to discharge. RESULTS: 24 infants (VLBW: n = 13 and ELBW: n = 11) underwent PD at median age 4.5 days (IQR 3-6) with either CMMDC (n = 14) or SRC (n = 10). Significant improvement in biochemical parameters and fluid removal was seen in both ELBW and VLBW infants. CMMDC was associated with significantly fewer PD-related complications 7/14 (50%) vs. 9/10 (90%) (p = 0.04) and higher survival during PD 13/14 (93%) vs. 5/10 (50%) (p = 0.02), without significant difference in survival to hospital discharge 8/14 (57%) vs. 3/10 (30%) (p = 0.25). CMMDC also enabled longer duration of PD, higher ultrafiltration, and better control of acidosis. Consumable cost was higher for CMMDC (USD$60) than SRC (USD$14). CONCLUSIONS: In a low resource setting, CMMDC had lower PD complications and superior short-term survival among ELBW/VLBW infants. A higher resolution version of the Graphical abstract is available as Supplementary information.

Primary Iliopsoas Abscess in an Infant: A Case Report.

Primary iliopsoas abscess (IPA) is rare in the infantile period. However, if treatment is not initiated soon, aggressive, and adequate, there is high risk for mortality or permanent damage to the hip joints. We present the case of a preterm neonate who presented at 2 months of age with swelling and restricted movements of the left leg for the past 1 week. A diagnosis of idiopathic left IPA was made due to Staphylococcus aureus which was drained surgically and treated with systemic antibiotics. Currently, the baby is 6 months old with no evidence of any sequelae.

Nasotracheal intubation with MacGrath videolaryngoscope using Schroeder directional stylet: Case series.

BACKGROUND AND AIMS: MacGrath videolaryngoscope is one of the recent videolaryngoscopes, which can be used to facilitate nasotracheal intubations using Scroeder directional stylet. MATERIAL AND METHODS: 15 patients, American Society of Anesthesiologists Grades I-II, undergoing tonsillectomy, requiring nasotracheal intubation were included. All patients were intubated with MacGrath videolaryngoscope and Schroeder stylet. Primary outcome measures were duration and ease of intubation. Overall success rate, number of attempts, modified Cormack-Lehane (C-L) grading, and complications were also recorded. RESULTS: All 15 intubations were successful during first laryngoscopy attempt. C-L Grade I views were obtained in 14 patients (93%) and Grade II view in one patient (7%). The time required to obtain the best C-L view was 9.4 ± 1.5 s. The time taken to complete tracheal intubation was 34.27 ± 3.38 s. Average numerical rating scale for tracheal intubation was 8.7 ± 0.9. Minor complications occurred in four patients (26.7%). CONCLUSIONS: MacGrath videolaryngoscope produces excellent laryngoscopic views in patients with normal airways. Impaction of tracheal tube on posterior nasopharyngeal wall can be overcome by Schroeder stylet.

Placental transfusion in preterm neonates of 30-33 weeks' gestation: a randomized controlled trial.

OBJECTIVES: To compare effect of placental transfusion by delayed cord clamping (DCC) or cord milking (CM) with early cord clamping (ECC) on a composite of mortality or abnormal neurological status at 40 weeks' post-menstrual age (PMA) and 24-30 months' chronological age in neonates of 30-33 weeks' gestation. STUDY DESIGN: Randomized, controlled trial. OUTCOMES: A composite of mortality or abnormal neurological status at 40 weeks PMA and survival free of neurodevelopmental abnormalities at 24-30 months' chronological age. RESULTS: A total of 461 neonates were randomized to placental transfusion (n = 233) or to ECC (n = 228). Among those assigned to placental transfusion group, 173 underwent DCC while in the remaining 60, CM was done. Incidence of mortality or abnormal neurological status at 40 weeks PMA (43 (18%) vs 35 (15%), RR (95% CI) 1.2 (0.8, 1.8), p = 0.4) and survival free of neurodevelopmental impairment at 24-30 months of chronological age (99 (47%) vs. 100 (50%); RR (95% CI): 0.9 (0.8, 1.2); P = 0.9) was similar between the study groups. The placental transfusion group showed a trend towards lower incidence of necrotizing enterocolitis. CONCLUSION: In 30-33 weeks' gestation preterm neonates, placental transfusion as compared to early cord clamping resulted in similar mortality or abnormal neurological status at 40 weeks PMA and at 24-30 months of chronological age.

Effect of Placental Transfusion on Iron Stores in Moderately Preterm Neonates of 30-33 weeks Gestation.

OBJECTIVE: To assess the effect of placental transfusion by delayed cord clamping (DCC) of 60 s or cord milking (CM) on serum ferritin levels at hospital discharge and 3 mo of postmenstrual age (PMA) in preterm neonates of 30 to 33 wk gestation in comparison to early cord clamping (ECC) within 10 s. METHODS: This mixed longitudinal study was conducted in moderately preterm neonates of 30 to 33 wk gestation born in a level III unit in Northern India with the study sample nested within a randomized controlled trial on placental transfusion. Intervention was delayed cord clamping for 60 s or cord milking compared with early cord clamping (within 10 s). Primary outcome measure was serum ferritin levels at discharge. Secondary outcome measures were serum ferritin levels at 3 mo PMA, incidence of anemia, need for blood transfusion and incidence of iron deficiency by 3 mo PMA. RESULTS: Out of the 215 randomly chosen infants, serum ferritin levels were estimated at least at one time point (at discharge or at 3 mo PMA) in 197 neonates [placental transfusion - 107; early cord clamping - 90]. Amongst them, ferritin level was estimated at discharge in 141 neonates, at 3 mo PMA in 76 neonates and at both time points in 20 neonates. Median (IQR) serum ferritin (µg/L) at discharge was significantly higher in placental transfusion group in comparison to the ECC group [399 (309,600) (n = 79) vs. 254 (190,311) (n = 62); p < 0.001]. Median (IQR) ferritin level at 3 mo PMA was not different between the study groups [20 (14,57) (n = 39) vs. 24 (8,52) (n = 37); p = 0.2]. The incidence of anemia by 3 mo PMA was significantly lesser in the placental transfusion group. No difference was observed in anemia requiring blood transfusion and iron deficiency by 3 mo PMA between the groups. CONCLUSIONS: In 30 to 33 wk preterm neonates, placental transfusion resulted in significantly higher serum ferritin at discharge in comparison to early cord clamping. However, this benefit did not persist till 3 mo PMA.

A randomised controlled trial comparing ProSeal laryngeal mask airway, i-gel and Laryngeal Tube Suction-D under general anaesthesia for elective surgical patients requiring controlled ventilation.

BACKGROUND AND AIMS: The ProSeal™ laryngeal mask airway (PLMA), i-gel™ and Laryngeal Tube Suction-D (LTS-D™) have previously been evaluated alone or in pair-wise comparisons but differing study designs make it difficult to compare the results. The aim of this study was to compare the clinical performance of these three devices in terms of efficacy and safety in patients receiving mechanical ventilation during elective surgical procedures. METHODS: This prospective, randomised, double-blind study was conducted on 150 American Society of Anesthesiologists physical status I-II patients, randomly allocated into 3 groups, undergoing elective surgical procedures under general anaesthesia. PLMA, i-gel™ or LTS-D™ appropriate for weight or/and height was inserted. Primary outcome measured was airway sealing pressure. Insertion time, ease of insertion, number of attempts, overall success rate and the incidence of airway trauma and complications were also recorded. Intergroup differences were compared using one-way analysis of variance with post hoc correction for continuous data and Chi-square test for categorical variables. RESULTS: Overall success rate was comparable between the three devices (i-gel™ 100%, LTS-D™ 94%, PLMA 96%). Airway sealing pressure was lower with i-gel™ (23.38 ± 2.06 cm H2O) compared to LTS-D™ (26.06 ± 2.11 cm H2O) and PLMA (28.5 ± 2.8 cm H2O; P < 0.0005). The mean insertion time was significantly more in PLMA (38.77 ± 3.2 s) compared to i-gel™ (27.9 ± 2.53 s) and LTS-D™ (21.66 ± 2.31 s; P < 0.0005). CONCLUSION: Airway sealing pressure and insertion time were significantly higher in PLMA compared to i-gel™ and LTS-D™.

Comparative evaluation of Airtraq™ optical Laryngoscope and Miller's blade in paediatric patients undergoing elective surgery requiring tracheal intubation: A randomized, controlled trial.

BACKGROUND AND AIMS: The Airtraq™ optical laryngoscope is the only marketed videolaryngoscope for paediatric patients besides the fibre-optic bronchoscope. We hypothesized that intubation would be easier with Airtraq™ compared to Miller blade. Hence, we compared Airtraq™ with the Miller laryngoscope as intubation devices in paediatric patients. METHODS: This prospective, randomized study was conducted in a tertiary care teaching hospital. Sixty children belonging to American Society of Anesthesiologists' Grade I-II, aged 2-10 years, posted for routine surgery requiring tracheal intubation were randomly allocated to undergo intubation using a Miller (n = 30) or Airtraq™ (n = 30) laryngoscope. The primary outcome measure was time of intubation. We also measured ease of intubation, number of attempts, percentage of glottic opening score (POGO), haemodynamic changes and airway trauma. Student t test was used to analyse parametric data. RESULTS: Intubation time was comparable between Miller's laryngoscope (15.13 ± 1.33s) compared to Airtraq™ (11.53 ± 0.49 s) (P = 0.29) The number of first and second attempts at intubation were 25 and 5 for the Miller laryngoscope and 29 and 1 for the Airtraq™. Median visual analogue score (VAS) for ease of intubation was 5 in Miller group compared to 3 in Airtraq™ group. The median POGO score was 75 in the Miller group and 100 in the Airtraq™ group (P = 0.01). Haemodynamic changes were maximum and most significant immediately and 1 min after intubation. Airway trauma occurred in three patients (9.09%) in Miller group and one patient (3.33%) in Airtraq™ group. CONCLUSION: The Airtraq™ reduced the difficulty of tracheal intubation and degree of haemodynamic stimulation compared to the Miller laryngoscope in paediatric patients.

A randomised comparative study of the effect of Airtraq optical laryngoscope vs. Macintosh laryngoscope on intraocular pressure in non-ophthalmic surgery.

BACKGROUND: We compared intraocular pressure changes following laryngoscopy and intubation with conventional Macintosh blade and Airtraq optical laryngoscope. METHODS: Ninety adult patients were randomly assigned to study group or control group. Study group (n=45) - Airtraq laryngoscope was used for laryngoscopy. Control group (n=45) - conventional Macintosh laryngoscope was used for laryngoscopy. Preoperative baseline intraocular pressure was measured with Schiotz tonometer. Laryngoscopy was done as per group protocol. Intraocular pressure and haemodynamic parameters were recorded just before insertion of the device and subsequently three times at an interval of one minute after insertion of the device. RESULTS: Patient characteristics, baseline haemodynamic parameters and baseline intraocular pressure were comparable in the two groups. Following insertion of the endotracheal tube with Macintosh laryngoscope, there was statistically significant rise in heart rate and intraocular pressure compared to Airtraq group. There was no significant change in MAP. Eight patients in Macintosh group had tongue-lip-dental trauma during intubation, while only 2 patients received upper airway trauma in Airtraq group. CONCLUSION: We conclude that Airtraq laryngoscope in comparison to Macintosh laryngoscope results in significantly fewer rises in intraocular pressure and clinically less marked increase in haemodynamic response to laryngoscopy and intubation.

[A randomised comparative study of the effect of Airtraq optical laryngoscope vs. Macintosh laryngoscope on intraocular pressure in non-ophthalmic surgery]. / Estudo comparativo randomizado do efeito do laringoscópio óptico Airtraq vs. laringoscópio Macintosh sobre a pressão intraocular em cirurgia não oftálmica.

BACKGROUND: We compared intraocular pressure changes following laryngoscopy and intubation with conventional Macintosh blade and Airtraq optical laryngoscope. METHODS: Ninety adult patients were randomly assigned to study group or control group. Study group (n=45) - Airtraq laryngoscope was used for laryngoscopy. Control group (n=45) - conventional Macintosh laryngoscope was used for laryngoscopy. Preoperative baseline intraocular pressure was measured with Schiotz tonometer. Laryngoscopy was done as per group protocol. Intraocular pressure and haemodynamic parameters were recorded just before insertion of the device and subsequently three times at an interval of one minute after insertion of the device. RESULTS: Patient characteristics, baseline haemodynamic parameters and baseline intraocular pressure were comparable in the two groups. Following insertion of the endotracheal tube with Macintosh laryngoscope, there was statistically significant rise in heart rate and intraocular pressure compared to Airtraq group. There was no significant change in MAP. Eight patients in Macintosh group had tongue-lip-dental trauma during intubation, while only 2 patients received upper airway trauma in Airtraq group. CONCLUSION: We conclude that Airtraq laryngoscope in comparison to Macintosh laryngoscope results in significantly fewer rises in intraocular pressure and clinically less marked increase in haemodynamic response to laryngoscopy and intubation.

A comparative study of three methods of ProSeal laryngeal mask airway insertion in children with simulated difficult laryngoscopy using a rigid neck collar.

BACKGROUND: Combined introducer tool and stylet technique of ProSeal laryngeal mask airway (PLMA) insertion was compared with the conventional digital manipulation and introducer tool technique in children with a rigid neck collar. METHODS: This was a randomized, single blinded, prospective study. Ninety ASA Grade I-II children weighing 10-20 kg were randomly allocated for PLMA insertion using the digital, introducer tool (IT) or combined IT and stylet techniques. Each group contained 30 patients. Difficult laryngoscopy was simulated using a rigid neck collar. The laryngoscopic view was graded prior to PLMA insertion. The digital and IT techniques were performed according to the manufacturer's instructions. The combined technique involved attaching the IT to the PLMA and inserting a flexible stylet through the drain tube. RESULTS: The median Cormack and Lehane grade was 2 in all three groups. Insertion was more frequently successful with the combined technique at the first attempt (combined 100%, digital 65.38%, IT 66.67%; p < 0.05), but success after three attempts was similar (combined 100%, digital 86.67%, IT 90%; p > 0.05). The time taken for successful placement was similar among groups at the first attempt, but was shorter for the combined technique for overall attempts (combined 18.33 ± 1.27 seconds, digital 27.85 ± 9.05 seconds, IT 26.89 ± 7.17 seconds; p < 0.05). There was no difference in postoperative airway morbidity. CONCLUSION: PLMA insertion with combined IT and stylet technique was more frequently successful than the digital or IT technique in pediatric patients without cervical spine motion.

Survival pattern in patients with acute organophosphate poisoning on mechanical ventilation: A retrospective intensive care unit-based study in a tertiary care teaching hospital.

BACKGROUND AND AIMS: Organophosphorus (OP) compound poisoning is one of the most common poisonings in India. The aim of the study was to study the outcomes and predictors of mortality in patients with acute OP poisoning requiring mechanical ventilation. METHODS: A retrospective study was conducted in the intensive care unit and 117 patients were included. Diagnosis was performed from the history taken either from the patient or from the patient's relatives. Demographic data, month of the year, mode of poisoning, common age group, duration of mechanical ventilation, time of starting pralidoxime (PAM), and mortality were recorded. Chi square test, Pearson correlation test, and multivariate binary logistic regression analysis was used. Data are presented as mean ± SD. RESULTS: 91.86% (79/86) of cases were suicidal and remaining cases were accidental. Duration of mechanical ventilation varied from less than 48 hours to more than 7 days. Mortality rate was 33.3%, 7.2%, and 100% in those who required mechanical ventilation for more than 7 days, 5 to 7 days, and 2 to 4 days, respectively. Lag time was less than 6 hrs in 13 patients and all of them survived. 17.1% and 28.1% patients died in whom PAM was started 6 to 12 hrs and 13 to 24 hrs after poisoning, respectively. There was statistically significant positive correlation between lag time of starting of PAM with duration of mechanical ventilation and total dose of PAM (P < 0.0001). None of the predictors age, lag time, severity of poisoning, and duration of ventilation were independent predictors of death. Overall mortality rate was 18.6%. CONCLUSION: Mortality from OP compound poisoning is directly proportionate to the severity of poisoning, delay in starting PAM, and duration of mechanical ventilation. Death is not dependent on a single factor, rather contributory to these factors working simultaneously.

Comparison of the Airtraq and McCoy laryngoscopes using a rigid neck collar in patients with simulated difficult laryngoscopy.

STUDY OBJECTIVE: To determine the efficacy of the Airtraq versus the McCoy laryngoscope as intubation devices with the neck stabilized by a rigid cervical collar. DESIGN: Prospective, randomized, double-blinded study. SETTING: Jawaharlal Nehru Medical College. PATIENTS: 60 ASA physical status 1, 2, and 3 patients, aged 18-70 years, scheduled for various surgical procedures requiring tracheal intubation for surgical anesthesia. INTERVENTIONS: Patients were randomly allocated to undergo intubation with the McCoy (n = 30) or Airtraq (n = 30) laryngoscope. MEASUREMENTS AND MAIN RESULTS: Differences in intubation times between the Airtraq and the McCoy laryngoscope, modified Cormack-Lehane score, percentage of glottic opening (POGO) score, and airway trauma were compared. Overall intubation success rates were 100% with both devices and a similar number of intubation attempts were required. However, the mean (SD) time required for successful intubation was shorter with the Airtraq (28.73 ± 6.39 sec) than the McCoy laryngoscope (39.11 ± 14.01 sec; P < 0.0001). The frequencies of intubation complications were similar. Esophageal intubation occurred in 4 cases but only with the McCoy laryngoscope. CONCLUSION: Intubation time was shorter with the Airtraq than the McCoy laryngoscope, even though the overall success rates between the two devices were similar.

Role of tranexamic acid in reducing postoperative blood loss and transfusion requirement in patients undergoing hip and femoral surgeries.

CONTEXT: Pharmacological agents are used to reduce postoperative blood loss. AIMS: To assess the effects of tranexamic acid on prevention of bleeding and requirement of blood transfusion after major hip and femoral surgeries. SETTINGS AND DESIGN: A prospective, randomized, double blinded study was conducted in the tertiary care teaching hospital. METHODS: Ninety ASA grade I-II patients undergoing hip fracture surgery were included in this prospective study. Forty-five patients received tranexamic acid (TA) given in a bolus dose of 500 mg 15 min before surgical incision followed by continuous infusion. The remaining, 45 patients were allocated as a control group. Postoperative bleeding (volume of blood in the drain), percentage fall of hemoglobin, transfusions and complications were recorded. RESULTS: Mean volume of blood in the drain was 39.33±10.09 ml (mean±SD) as compared to 91.11±17.61 ml in placebo group showing a P<0.001. Mean percentage fall in Hb at day 0 was 2.99±3.45 in the study group as compared to 7.70±6.05 in the placebo group (P<0.001), and fall at day 2 in the study group was 0.35±0.74, compared to 2.72±2.70 in the placebo group (P<0.001). The number of patients required blood transfusions were lower in the study group than in the placebo group (P=0.01). CONCLUSIONS: We conclude that tranexamic acid significantly reduces postoperative blood loss and transfusion requirements during major hip and femoral surgeries.

Comparison of Size 2.5 i-gel™ with Proseal LMA™ in Anaesthetised, Paralyzed Children Undergoing Elective Surgery.

BACKGROUND: The newest variation of i-gel is its pediatric version. This novel supraglottic airway device has the added advantage of a drain tube. In this study, we compared the effectiveness of size 2.5 i-gel with size 2.5 ProSeal LMA. AIMS: This study was designed to investigate the usefulness of the size 2.5 i-gel compared with the ProSeal laryngeal mask airway (PLMA) of the same size in anesthetized, paralyzed children. MATERIALS AND METHODS: Sixty ASA grade I - II patients undergoing elective surgery were included in this prospective study and were randomly assigned to the i-gel and PLMA groups (30 patients in each group). A size 2.5 supraglottic airway was inserted according to the assigned group. We assessed the ease of insertion, hemodynamic data, oropharyngeal sealing pressure, and postoperative complications. RESULTS: There were no differences in the demographic and hemodynamic data, success rates for the first attempt of insertion, or postoperative airway morbidity among the two groups. The airway leak pressure of the i-gel group (27.12 ± 1.69 cm H(2)O) was significantly higher than that of the PLMA group (22.75 ± 1.46 cm H(2)O). CONCLUSION: Hemodynamic parameters, ease of insertion and postoperative complications were comparable between the i-gel and PLMA, but the nairway sealing pressure was significantly higher in the i-gel group.

Comparison of three supraglottic devices in anesthetised paralyzed children undergoing elective surgery.

CONTEXT: The newest variation of the i-gel supraglottic airway is a pediatric version. AIMS: This study was designed to investigate the usefulness of the size 2 i-gel compared with the ProSeal laryngeal mask airway (PLMA) and classic laryngeal mask airway (cLMA) of the same size in anesthetized, paralyzed children. SETTINGS AND DESIGN: A prospective, randomized, single-blinded study was conducted in a tertiary care teaching hospital. METHODS: Ninety ASA grade I-II patients undergoing lower abdominal, inguinal and orthopedic surgery were included in this prospective study. The patients were randomly assigned to the i-gel, PLMA and cLMA groups (30 patients in each group). Size 2 supraglottic airway was inserted according to the assigned group. We assessed ease of insertion, hemodynamic data, oropharyngeal sealing pressure and postoperative complications. RESULTS: There were no differences in the demographic and hemodynamic data among the three groups. The airway leak pressure of the i-gel group (27.1±2.6 cmH(2)O) was significantly higher than that of the PLMA group (22.73±1.2 cmH(2)O) and the cLMA group (23.63±2.3 cmH(2)O). The success rates for first attempt of insertion were similar among the three devices. There were no differences in the incidence of postoperative airway trauma, sore throat or hoarse cry in the three groups. CONCLUSIONS: Hemodynamic parameters, ease of insertion and postoperative complications were comparable among the i-gel, PLMA and cLMA groups, but airway sealing pressure was significantly higher in the i-gel group.

Comparison of i-gel™ supraglottic device with classic laryngeal mask airway in anesthetized paralyzed children undergoing elective surgery.

CONTEXT: The newest variation of the i-gel supraglottic airway is a pediatric version. AIMS: This study was designed to investigate the usefulness of the size 2 i-gel compared with the classic laryngeal mask airway (cLMA) of the same size in anesthetized, paralyzed children. SETTINGS AND DESIGN: A prospective, randomized, single-blinded study was conducted in tertiary care teaching hospital. SUBJECT AND METHODS: Sixty ASA grade I-II patients undergoing lower abdominal, inguinal, and orthopedic surgery were included in this prospective study. The patients were randomly assigned to i-gel and cLMA groups (30 patients in each group). Size 2 supraglottic airway was inserted according to the assigned group. We assessed ease of insertion, hemodynamic data, oropharyngeal sealing pressure, and postoperative complications. STATISTICAL ANALYSIS USED: Parametric data were analyzed with the unpaired t-test and non-parametric data were analyzed with the Chi-square test. Unless otherwise stated, data are presented as mean (SD). Significance was taken as P < 0.05. RESULTS: There were no differences in the demographic and hemodynamic data among the two groups. The airway leak pressure of the i-gel group (26.1 ± 2.4 cm H2O) was significantly higher than that of the cLMA group (22.64 ± 2.2 cm H2O). The success rates for first attempt of insertion were similar among the two devices. There were no differences in the incidence of postoperative airway morbidity among the two groups. CONCLUSIONS: Hemodynamic parameters, ease of insertion, and postoperative complications were comparable between the i-gel and cLMA groups, but airway sealing pressure was significantly higher in i-gel group.

A prospective, randomized, Single-blinded, comparative study of Classic Laryngeal Mask Airway and ProSeal Laryngeal Mask Airway in pediatric patients.

CONTEXT: ProSeal Laryngeal Mask Airway (PLMA) is extensively being used in pediatric anesthesia. AIMS: To evaluate the efficacy of PLMA as compared to Classic Laryngeal Mask Airway (CLMA) for airway maintenance in pediatric patients. SETTINGS AND DESIGN: A prospective, randomized, Single-blinded study was conducted in a tertiary care teaching hospital. MATERIALS AND METHODS: Sixty ASA I and II children were included. Patients were randomized to either size 2 PLMA or size 2 CLMA groups. Parameters noted were time for insertion, number of attempts, airway sealing pressure, blood pressures (systolic, diastolic, and mean), pulse rate, end-tidal carbon dioxide (EtCO(2)), peripheral oxygen saturation (SpO(2)), and postoperative change in abdominal circumference, and airway trauma. STATISTICAL ANALYSIS USED: Parametric data were analyzed with the unpaired t-test and non-parametric data were analyzed with the chi-square (χ(2)) test. Unless otherwise stated, data are presented as mean (SD). Significance was taken as P < 0.05. RESULTS: There was no statistical difference between the two groups for the success rates at the first attempt of insertion, airway sealing pressure, hemodynamic responses, SpO(2), EtCO(2) and postoperative changes in abdominal circumference. Patients in the PLMA group had longer time of insertion and higher incidence of airway trauma. CONCLUSIONS: The PLMA and the CLMA were comparable for hemodynamic and ventilatory parameters and change in abdominal circumference; however, the time taken for insertion and airway trauma was more with PLMA.

A randomised comparative study of the effect of Airtraq optical laryngoscope vs. Macintosh laryngoscope on intraocular pressure in non-ophthalmic surgery / Estudo comparativo randomizado do efeito do laringoscópio óptico Airtraq vs. laringoscópio Macintosh sobre a pressão intraocular em cirurgia não oftálmica

BACKGROUND: We compared intraocular pressure changes following laryngoscopy and intubation with conventional Macintosh blade and Airtraq optical laryngoscope. METHODS: Ninety adult patients were randomly assigned to study group or control group. Study group (n = 45) - Airtraq laryngoscope was used for laryngoscopy. Control group (n = 45) - conventional Macintosh laryngoscope was used for laryngoscopy. Preoperative baseline intraocular pressure was measured with Schiotz tonometer. Laryngoscopy was done as per group protocol. Intraocular pressure and haemodynamic parameters were recorded just before insertion of the device and subsequently three times at an interval of one minute after insertion of the device. RESULTS: Patient characteristics, baseline haemodynamic parameters and baseline intraocular pressure were comparable in the two groups. Following insertion of the endotracheal tube with Macintosh laryngoscope, there was statistically significant rise in heart rate and intraocular pressure compared to Airtraq group. There was no significant change in MAP. Eight patients in Macintosh group had tongue-lip-dental trauma during intubation, while only 2 patients received upper airway trauma in Airtraq group. CONCLUSION: We conclude that Airtraq laryngoscope in comparison to Macintosh laryngoscope results in significantly fewer rises in intraocular pressure and clinically less marked increase in haemodynamic response to laryngoscopy and intubation.

JUSTIFICATIVA: Comparar as alterações de pressão intraocular após laringoscopia e intubação com lâmina Macintosh convencional e laringoscópio óptico Airtraq. MÉTODOS: Noventa pacientes adultos foram randomicamente designados para os grupos estudo ou controle. No grupo estudo (n = 45) o laringoscópio Airtraq foi usado para laringoscopia e no grupo controle (n = 45) o laringoscópio Macintosh convencional foi usado para laringoscopia. A pressão intraocular foi mensurada no pré-operatório com tonômetro Schiotz. A laringoscopia foi feita de acordo com o protocolo de cada grupo. Pressão intraocular e parâmetros hemodinâmicos foram registrados logo antes da inserção do dispositivo e três vezes após a inserção do dispositivo, com intervalo de um minuto. RESULTADOS: As características dos pacientes, os parâmetros hemodinâmicos basais e a PIO basal foram comparáveis nos dois grupos. Após a inserção do tubo endotraqueal com o laringoscópio Macintosh, houve um aumento estatisticamente significativo da frequência cardíaca e da pressão intraocular em comparação com o grupo Airtraq. Não houve alteração significativa da PAM. Oito pacientes do grupo Macintosh sofreram trauma de língua-lábio-dental durante a intubação, enquanto apenas dois pacientes sofreram trauma das vias aéreas superiores no grupo Airtraq. CONCLUSÃO: Concluímos que o laringoscópio Airtraq, em comparação com o laringoscópio Macintosh, resultou em elevações significativamente menores da PIO e em aumentos clinicamente menos acentuados da resposta hemodinâmica à laringoscopia e intubação.