Intubation Conditions Research Articles

Effect of total intravenous anesthesia versus sevoflurane anesthesia on intraoperative facial nerve monitoring: a randomized controlled trial.

Intraoperative facial nerve monitoring (IFNM) facilitates effective nerve preservation during ear and head and neck surgeries. Quantitative differences in the timely feasibility of IFNM during total intravenous anesthesia (TIVA) vs sevoflurane anesthesia have not been investigated. We conducted a randomized controlled trial in which 98 patients undergoing ear surgery were allocated to either the TIVA or sevoflurane group. We used quantitative neuromuscular monitoring of train-of-four (TOF) responses to assess achievements of IFNM-feasible conditions, and recorded the TOF count (TOFC) or TOF ratio of T4/T1 (TOFR). The primary outcome was the time interval between a TOFR of 0.25 and 0.75 (recovery index). The most important secondary outcome was the time to reach a TOFR of 0.25. We also recorded the quality of IFNM, intubation condition, patient-ventilator dyssynchrony, surgeon's satisfaction, and postoperative analgesic and antiemetic requirements. Ninety-two patients completed the study. The median [interquartile range] recovery index was significantly shorter in the TIVA group (9 [7-11]min) than in the sevoflurane group (34 [24-53]min), with a difference in medians of 25min (95% confidence interval, 20 to 31; P < 0.001). Before IFNM requests, the time to TOFR of 0.25 was achieved earlier in the TIVA group (34 [29-41]min) than in the sevoflurane group (51 [43-77]min) (P < 0.001). Both groups achieved neuromuscular recovery in time for IFNM without a need for reversal agents. Intraoperative facial nerve monitoring was feasible earlier and faster under TIVA than under sevoflurane anesthesia. We suggest that TIVA may be a preferable choice over sevoflurane to meet a surgeon's request for an earlier IFNM. CRIS.nih.go.kr ( KCT0006676 ); first submitted 7 October 2021.

Cervical spine motion during videolaryngoscopic intubation using a Macintosh-style blade with and without the anterior piece of a cervical collar: a randomized controlled trial.

Applying a cervical collar during videolaryngoscopic intubation can increase the lifting force required to achieve adequate glottic view, potentially increasing cervical spine motion. We aimed to compared cervical spine motion during videolaryngoscopic intubation between applying only the posterior piece (posterior-only group) and applying both the anterior and posterior pieces (anterior-posterior group) in patients wearing a cervical collar. We conducted a dingle-centre, parallel-group, randomized controlled trial in 102 patients (each group, N = 51). We used a videolaryngoscope (AceScope™, Ace Medical, Seoul, Republic of Korea) with a Macintosh-style blade (AceBlade™, Ace Medical, Seoul, Republic of Korea) for videolaryngoscopic intubation. In each group (posterior-only vs anterior-posterior), we measured cervical spine motion during intubation, defined as change in cervical spine angle (calculated as cervical spine angle at intubation minus that before intubation) at three cervical spine segments on lateral cervical spine radiographs. The differences in mean cervical spine motion during intubation between the posterior-only and anterior-posterior groups were 1.2° (98.3% confidence interval [CI], -0.7 to 3.0), 1.0° (98.3% CI, -0.6 to 2.6), and -0.3° (98.3% CI, -2.2 to 1.7) at the occiput-C1, C1-C2, and C2-C5 segments, respectively. Mean (standard deviation) cervical spine angles at the occiput-C1, C1-C2, and C2-C5 segments in the posterior-only vs anterior-posterior groups were 10.8° (4.2) vs 9.6° (3.3) (P = 0.13), 5.6° (3.0) vs 4.7° (3.5) (P = 0.14), and 1.2° (3.7) vs 1.5° (4.3) (P = 0.74), respectively. Intubation times were shorter in the posterior-only group (median [interquartile range], 23 [19-28] sec vs 33 [20-47] sec; P = 0.003). In patients wearing a cervical collar, the differences in mean cervical spine motions during intubation between applying only the posterior piece and applying both the anterior and posterior pieces were approximately 1°. Intubation times were significantly shorter without the anterior piece of a cervical collar. These findings can be referred to when removal of the anterior piece of a cervical collar is considered to address difficult videolaryngoscopic intubation conditions. CRIS.nih.go.kr ( KCT0008151 ); first submitted 17 January 2023.

Magnesium as an Adjuvant to Rocuronium to Improve Intubation Conditions and Shorten the Intubation Time: A Randomized Controlled Study.

The purpose of the study is to compare the effects of rocuronium priming with the combined technique of magnesium pretreatment and rocuronium priming and to investigate whether this pretreatment could further accelerate the onset of neuromuscular blockade during intubation. A double-blinded randomized controlled trial (RCT) clinical study was done on patients at a tertiary care center for six months after obtaining approval from the institutional ethical committee. A total of 150 patients were randomly allocated as Group MP (infusion of 50 mg/kg of MgSo4 over 10 min was given 10 mins prior to premedication and dose of rocuronium 0.06 mg/kg given three minutes), Group P (priming dose of rocuronium 0.06 mg/kg given three minutes before the intubating dose), and Group C (control group with the same volume of 0.9% saline and rocuronium bolus of 0.6 mg/kg on intubation). Parameters such as demographic and hemodynamical data, American Society of Anesthesiologists (ASA) score, Mallampati scoring, neuromuscular monitoring, intubation grading, and number of successful/failed attempts were recorded. Our results showed that Group MP had a rapid onset of action of rocuronium with 58.90 +/- 4.77 seconds and a longer duration of action of rocuronium with 54.92 +/- 10.39 minutes, which are statistically significant compared to Group P (onset of action of ROC 106.70 +/- 4.24 seconds and duration of action rocuronium 45.88 +/- 6.22 minutes) and Group C (onset of action of ROC 154.56 +/- 11.39 seconds and duration of ROC 40.56 +/- 3.96 minutes). The maximum number of patients in Group MP (33 patients) showed good intubation conditions compared to Group P (23 patients) and Group C (16 patients), which was statistically significant. We conclude that magnesium sulfate pretreatment in combination with rocuronium priming (Group MP) considerably accelerates the onset of rocuronium action, increases the duration of action of rocuronium, and enhances the intubation procedure without any adverse effect of rocuronium and magnesium sulfate.

Quality of Life Comparison between Front-Line Residents and Medical Students during COVID-19 Pandemic

Background: The Covid-19 disease was the most significant pandemic of the century. Health care providers showed great sacrifices in managing this disease and saving humanity, and they suffered many injuries. So, this study aimed to investigate the effect of Covid-19 on the resident’s quality of life and comparison with medical students. Methods: This cross-sectional study was performed on 223 Residents and 225 medical students. Using a random sampling method, WHOQOL-BREF 26 questionnaire was distributed among the participants. The collected data were analyzed with SPSS 21 software using T-test and ANCOVA. Results: The results showed that covid-19 had caused a decrease in the quality of life of residents compared to medical students (P value&lt;0.001). In addition, more advanced statistical analyzes showed that high work and study hours, irregular sleep, work history in COVID-19 wards, and the experience of CPR and intubation conditions of covid-19 patients have independent effects on the quality of life. Conclusion: Covid-19 hurt all aspects of the quality of life of residents. Considering the essential role of residents in educational and treatment hospitals, it is necessary to make plans to improve the quality of life and psychological support of these people to prevent the decline in the quality of healthcare services.

Intravenous magnesium sulfate improves orotracheal intubation conditions: A randomized clinical trial

BackgroundMuscle relaxation facilitates orotracheal intubation, but in some situations, neuromuscular blocking agents may be contraindicated. AimTo study the effect of intravenous magnesium sulfate perfusion before induction on orotracheal intubation conditions and the pressor response upon intubation. MethodsThis prospective, randomized, double-blind trial compared magnesium sulfate with saline solution as a placebo. The patients were randomized into two groups: the magnesium group (Group Mg+), which received 50 mg/kg of magnesium sulfate in 100 ml of saline 15 min before induction of anesthesia, and the saline group (Group Mg-), which received only 100 ml of saline 15 min before induction of anesthesia without magnesium sulfate. The induction in both groups was performed without neuromuscular blocking agents.Intubation conditions in both groups were compared using the Copenhagen consensus conference: ease of laryngoscopy, vocal cord position and/or movement, and response to intubation or cuff (cough or diaphragmatic movement). Intubation conditions were considered acceptable (excellent or good) or unacceptable (poor). Systolic, diastolic arterial pressures and heart rate were also recorded during the study. ResultsIn total, 76 patients (38 in each group) were included in this study. Clinically acceptable intubation conditions were significantly more observed in the magnesium group Mg + compared to the saline group Mg-: 36 patients (95 %) vs. 15 patients (39 %) (P < 0.001).Hemodynamic stability was more observed in the magnesium group, with a statistically significant lower heart rate throughout Mg + compared to the saline group. ConclusionAdministration of magnesium sulfate before induction of anesthesia significantly improved intubation conditions without the need for neuromuscular blocking agents.

RANDOMIZED TRIAL FOR COMPARISON OF BUPRENORPHINE AND FENTANYL FOR AWAKE FIBEROPTIC INTUBATION

Objectives: Awake fiberoptic intubation (AFOI) is a step-forward technique for successful intubation of patients with difficult airways. The popularity of its usage is increasing day by day in handling difficult airways. Our study aims to compare the efficacy and efficiency of Buprenorphine and Fentanyl as sedative agents for AFOI. The primary and secondary outcome measure was to assess hemodynamic response and on intubating condition of the patient after AFOI. Methods: This randomized, prospective study was conducted in tertiary Center hospital. Total of 100 patient were enrolled for study and divided into two groups, Group A patients received intravenous Buprenorphine injection (2.5 (microgram/kilogram [μg/kg] over 10 min) and Group B Fentanyl injection (2 μg/kg over10 min) was injected prior to AFOI. The degree of sedation was assessed using the Observer’s assessment of alertness/sedation score (OAA/S), and the score of coughing during awake bronchoscopy was used to assess intubation status. Tolerability of intubation was assessed using a 5-point intubation score and a 3-point post-intubation assessment score immediately after the placement of the endotracheal tube into the trachea. Results: Group A had more favorable OAA score than Group B, whereas other intubation conditions cough score, limb movement, 5-point intubation score, 3-point post intubation score was more favourable in Group B than in Group A. Conclusion: Intravenous Fentanyl is better than Buprenorphine agent in terms of intubation score for AFOI. Both groups are comparable in terms of hemodynamic changes and stability.

Comparative evaluation of nebulized versus intravenous dexmedetomidine on intubating conditions during awake fiberoptic nasotracheal intubation

BackgroundThere is a search for an ideal agent to facilitate awake fiberoptic intubation (AFOI). Dexmedetomidine is a selective α2 agonist which can be administered through intravenous, intramuscular, buccal, intranasal & inhalational routes. It provides good intubation conditions without oxygen desaturation but may cause hypotension and bradycardia when administered intravenously. Hence, alternative routes of administering dexmedetomidine which may improve its safety profile are worth exploring. MethodsIn this randomised, controlled, double-blind trial, 46 ASA I/II adult participants scheduled for elective ENT surgery were randomly allocated to Group ND (Nebulised Dexmedetomidine) (n = 23) to receive nebulisation with dexmedetomidine 1μg.kg−1 and Group ID (Intravenous Dexmedetomidine) (n = 23) to receive intravenous dexmedetomidine 1μg.kg−1 before AFOI. All the patients received injection midazolam 1 mg i.v. as premedication before anaesthesia was initiated. The primary outcome was the cough score. The secondary outcomes were the RSS, SAYGO boluses, post-intubation score, hemodynamic parameters, recall of the procedure, patient satisfaction score and any side effects. ResultsThe cough score was significantly lower in nebulized group (2.43 ± 0.992 vs 3.52 ± 1.082) with p = 0.001. RSS(3.30 ± 0.926 vs 4.22 ± 1.126; p = 0.004), number of SAYGO boluses required (2.74 ± 0.864 vs 3.57 ± 1.161; p = 0.009) & the post intubation score (1.48 ± 0.593 vs 2.17 ± 0.778; p = 0.001) were also significantly lower in nebulized group. ConclusionsNebulisation with dexmedetomidine results in desirable degree of sedation and better tolerance of the procedure with adequate attenuation of the haemodynamic responses to intubation.

Prehospital Cervical Spine (C-spine) Stabilization and Airway Management in a Trauma Patient: A Review.

Severe traumatic damage to the brain-to-body signaling bundle that results in bruising and a partial or total tear of the spinal cord is known as a spinal cord injury (SCI). SCI may develop at the time of an eventor after. It can also developwhile handling the patient andcan worsen during the transportation of the patient. So prehospital care is crucial to prevent or minimize SCI. Prehospital care involves examining the patient, immobilizing the cervical spine (C-spine), providing cardiovascular support (keeping the mean arterial blood pressure over 85 mmHg), and carefully managing the airway (possibly intubating the patient using manual in-line stabilization (MILS)).Methylprednisolone (MPS) and other pharmacological treatments have not been shown to offer clinically meaningful and essential benefits for people with SCI. The therapeutic use of MPS in patients with SCI in the prehospital context is no longer supported. Additionally, whether or not pharmaceutical drugs will be effective in therapeutic hypothermiais unknown. When performing endotracheal intubation on these patients, the potential for C-spine damage is always considered. During intubation, the MILSapproach significantly reduces C-spine movement. The MILS method, however, can potentially restrict mouth opening and result in subpar laryngoscopic vision. These issues can be handled using the recently developed video laryngoscope, such as Airtraq laryngoscope and AirWay Scope (AWS). Compared to a direct laryngoscope, the AWSand Airtraqlaryngoscope reduced the improvement of intubation conditions and the acceleration of tracheal intubation through the occiput-C1 and C2-C4 levels of the C-spineextension movement.

Dexmedetomidine and Fentanyl in Endotracheal Intubation: A Comparative Analysis of Hemodynamic and Intubation Responses

Aim: Endotracheal intubation, a critical procedure in anaesthesia, can induce significant hemodynamic fluctuations, posing risks, especially to patients with cardiovascular concerns. This study compares the effects of dexmedetomidine and fentanyl, two agents commonly used to mitigate these responses, on endotracheal intubation conditions and associated hemodynamic changes.&#x0D; Material and Method: Conducted at tertiary care training and research hospital, this study involved 60 patients aged 40-60, all classified American Society of Anesthesiologists (ASA) I-II, undergoing elective upper and lower extremity surgeries. Excluding patients with contraindicating conditions, the subjects were divided into two groups to receive either dexmedetomidine or fentanyl, along with propofol and vecuronium, for induction. Hemodynamic parameters were continuously monitored, and intubation conditions were assessed using the Cooper scoring system.&#x0D; Results: The study found that both dexmedetomidine and fentanyl effectively stabilised hemodynamic parameters during intubation. However, the fentanyl group displayed significantly higher total scores on the Cooper intubation conditions scale, indicating more favourable conditions for endotracheal intubation in terms of ease and patient comfort.&#x0D; Conclusion: While both dexmedetomidine and fentanyl are effective in maintaining hemodynamic stability during endotracheal intubation, fentanyl demonstrates a slight advantage in optimising intubation conditions. This distinction offers valuable insight for anesthesiologists in tailoring anaesthetic strategies and balancing patient safety with procedural efficiency in surgical settings.

Effect of Video laryngoscope on Tp-e Interval, Qtc and Tp-e/Qtc Ratio Compared with Direct Laryngoscope in Patients With Double-Lumen Tube Undergoing Thoracic Surgery

Aim: QT interval is generally related to the increased risk of polymorphic ventricular tachycardias and ventricular arrythmias. Intubation and laryngoscopy might change in cardiac repolarization and an increase in QT interval length. Video laryngoscopes provide better laryngeal view, higher intubation success, and better correct positioning on double-lumen tube (DLT) intubation. We aimed to compare McGRATH MAC 5 video laryngoscope to direct Macintosh laryngoscope and their effects on Tp-e interval, QTc and Tp-e/QTc ration in those patients requiring intubation having DLT. Materials and Methods: The randomly controlled prospective work is carried out on 94 patients, scheduled for thoracic surgery, aged between 18-65. After anaesthetic induction and before tracheal intubation, all patients airway were evaluated Cormack and Lehane in using a Macintosh laryngoscope and patients having Cormack and Lehane grade-1 or -2a views included in study. The patients who are intubated with video laryngoscope (McGRATH MAC) are allocated into Group V and intubated with direct Macintosh Laryngoscope was allocated into Group L. The primary aim was compared between the two devices on Tp-e interval, QTc and Tp-e/QTc ratio with ECG recordings. The secondary goal was assessment of hemodynamic status and intubation conditions. Results: In Group V, QTc interval, Tp-e intreval and Tp-e/QTc ratio was lower in a significant way than Group L. There has not been a significant difference in terms of hemodynamic assessment among those two groups at all measurement periods. Cormack-Lehane scores, intubation times, DLT types and sizes were similar between two groups. Conclusion: McGRATH MAC video laryngoscope decreased Tp-e interval, QTc and Tp-e/QTc ratio compared to direct Maintosh laryngoscope. Hemodynamic response and intubation parameters are seen as similar to each other in both of the present groups.

Comparison of the Effectiveness of the Miller Laryngoscope and the McGrath-MAC Video Laryngoscope in Direct Visualization of the Glottic Opening.

Background and Objective: Placing the laryngoscope blade directly under the epiglottis (known as the direct view (DV) method) during videolaryngoscopy offers a superior view of the glottis when compared to the indirect method of lifting the epiglottis by positioning the Macintosh blade tip over the vallecula. While there are few studies comparing glottic views using Miller and Macintosh blades in pediatric patients, we have not come across such a study in adults. In this study, we aimed to compare the effectiveness and hemodynamic responses of the Miller laryngoscope and the McGrath-MAC videolaryngoscope (VL) in visualizing the glottic opening using the DV method. Material and Methods: A prospective study was conducted between August and December 2022 at XXX Hospital on 85 patients scheduled for surgical procedures involving endotracheal intubation. Patients were divided into two groups: Miller laryngoscope (Group M) and McGrath-MAC videolaryngoscope (Group VL) and intubated using the direct lifting method of the epiglottis. Hemodynamic responses before and after induction, as well as during laryngoscopy, intubation time, number of attempts, Cormack and Lehane (C&L) score, percentage of glottic opening (POGO), duration of the view of the opening, and need for external laryngeal pressure during intubation were recorded. Results: Both laryngoscopes showed similar effectiveness in terms of POGO and C&L score when used with the direct lifting method of the epiglottis. The median POGO values according to the DV method were 80% in Group M and 70% in Group VL (p = 0.099). Hemodynamic responses, intubation time, number of attempts, duration of view of the glottis opening, and the need for external laryngeal pressure were similar between the groups. Conclusions: Due to its ability to provide effective intubation conditions, we believe that the McGrath-MAC VL, when used with the indirect view method, can also be utilized in anesthesia practices alongside the DV method.

The optimal induction dose of ciprofol combined with low-dose rocuronium in children undergoing daytime adenotonsillectomy

Adenotonsillectomy is the most common daytime surgery performed on children. Anesthesiologists must select the optimal combination of drugs to ensure effective anesthesia effect and prompt recovery in children. The optimal induction dose of ciprofol in children is unclear. In this study, we aim to investigate the effect of different doses of ciprofol on anesthesia induction in children undergoing daytime adenotonsillectomy and provide a reference for clinical use. 144 children aged 3–12 years, ASA I-II, undergoing daytime adenotonsillectomy, were included in this clinical trial. The children were randomly divided into three groups and given 0.4 mg/kg (C4), 0.6 mg/kg (C6), or 0.8 mg/kg (C8) of ciprofol for anesthesia induction. The primary outcome was intubation conditions. Vital signs and injection pain were also recorded. The rates of unacceptable intubation conditions were 30.6%, 8.7%, and 8.2% in the C4, C6, and C8 groups (P value < 0.0167). The overall incidence of reported injection pain was 3.5%. The heart rate and mean arterial pressure did not differ between the groups at the same time points. We found that combining 0.6 mg/kg of ciprofol with low-dose rocuronium could provide optimal intubation conditions in pediatric daytime adenotonsillectomy patients. This combination resulted in stable circulation and BIS values. This study is registered at the Chinese Clinical Trial Registry (Registration number: ChiCTR2200063144, Date of Registration: 31/08/2022)

Evaluation of a rapid sequence induction technique in dogs with or without rocuronium

ObjectiveTo determine, using a rapid sequence induction (RSI) technique, whether rocuronium improves the quality and speed of endotracheal intubation in healthy dogs. Study designRandomized, crossover, experimental study. AnimalsSix adult intact male Beagles (12.3 ± 0.4 kg). MethodsDogs were premedicated with intravenous acepromazine (0.03 mg kg–1) and hydromorphone (0.1 mg kg–1). Ten minutes later, anesthesia was induced with intravenous propofol (2 mg kg–1 over 5 seconds), followed by saline (0.06 mL kg–1, CT group) or rocuronium (0.6 mg kg–1, RT group), with orotracheal intubation attempted after 45 seconds. Intubation time (IT) and conditions (IC) were assessed. PaO2, PaCO2, arterial blood pH and serum cortisol were obtained before and after RSI. After endotracheal intubation, saline (0.04 mL kg–1) or sugammadex (4 mg kg–1) were administered intravenously in CT or RT groups, respectively. Spontaneous ventilation restoration was noted. ResultsThe IT was 54.3 ± 6.9 (mean ± SD) and 57.8 ± 5.2 seconds for CT and RT, respectively (p = 0.385). All laryngoscopies indicated good IC in both treatment groups. Heart rate was lower in CT group than in RT group (66 ± 16 versus 103 ± 39 beats minute–1, p = 0.016). PaCO2, pH, PaO2 and cortisol did not differ between treatments. Compared with baseline, PaCO2 increased from 47.7 ± 6.2 to 58.8 ± 5.8 (p < 0.001) and pH decreased from 7.35 ± 0.04 to 7.28 ± 0.04 (p = 0.003), independent of treatment. Dogs in both treatment groups returned to spontaneous ventilation within 30 seconds of RSI. Conclusions and clinical relevanceRSI resulted in respiratory acidosis without hypoxemia or increased cortisol. Rocuronium did not improve IT or IC. Spontaneous ventilation was observed immediately after administering saline or sugammadex. The co-administration of rocuronium showed no clinical benefits over propofol alone in RSI in healthy dogs.

A randomized double blind study to evaluate the effect of nebulized dexmedetomidine on the haemodynamic response to laryngoscopy – Intubation and intubation conditions

: A cardiovascular stress response is frequently brought on by direct laryngoscopy and intubation. It is widely known that the sympathetic adrenal stimulation elicited by mechanical stimulation to the upper respiratory tract is what causes the haemodynamic response during laryngoscopy and intubation. The study's goal was to assess the impact of preoperative dexmedetomidine nebulization on the patient's hemodynamic response to laryngoscopy- intubation and the intubation conditions.: The American Society of Anaesthesiologists (ASA) I &amp; II adult patients, of either gender, undergoing elective surgeries requiring tracheal intubation were randomized to receive nebulized dexmedetomidine (Group D) or 0.9% saline (Group P), 30 minutes prior to the induction of anesthesia. This study was conducted in the department of anesthesia and critical care at the Christian Medical College in Ludhiana. Following laryngoscopy, the patient's heart rate and non-invasive systolic and diastolic blood pressure will be monitored for 10 minutes. The intubation conditions were noted during laryngoscopy.Total 100 patients with 50 in each group were included. At the time of laryngoscopy and after the intubation 1 min, 3 min,5 min, 7min and 10 min there were significantly lower trend in increasing HR, SBP, DBP and RPP in dexmedetomidine group versus saline. The intubation score representing conditions for intubation was significantly better in the dexmedetomidine group (P=0.013) than the saline group. There was no significant side effect noted (p=1.000). There was significant reduction in intraoperative analgesic and sedative requirement observed in dexmedetomidine groupOur study concluded that the nebulized dexmedetomidine attenuated haemodynamic response to laryngoscopy- intubation and provided better intubation conditions without significant side effects. We advise using nebulized dexmedetomidine pre-operatively for a surgical procedure requiring general anesthesia in order to reduce the haemodynamic response to intubation and to facilitate intubation conditions without experiencing any severe adverse effects.

Success rates of endotracheal intubation using the standard method versus the modified-ramped position.

The sniffing position used in intubation has disadvantages, including suboptimal glottic view, respiratory problems, increased risk of aspiration, and pain. In this regard, we have proposed new conditions to facilitate intubation and tube placement in patients with a Mallampati score higher than 2, by introducing a new position called the modified rapid airway management positioner (RAMP) position. The authors compared various parameters to improve intubation conditions between these two positions. This intervention is a randomized clinical trial study, with a random sampling method that divides the patients into two groups: a control group placed in the standard position (S) and an intervention group placed in the modified (M) RAMP position. An anesthesiologist performed intubation. In group (S), patients were placed in the supine position as usual, and a pillow with a height of 10cm was placed under their heads. In group (M), the patients were placed in the supine position on a modified RAMP with a triangular shape, 15cm in height, and 80cm in length, at a 30° angle. The pillow had lengths of 20 and 80cm. In the present study, 112 patients were investigated, consisting of 58 women (51.8%) and 54 men (48.2%). The intubation time in the intervention group using the modified RAMP roll technique was significantly shorter (51.25s) compared to the control group using the standard method (88.39s) (P=0.019). The results of the study showed that the modified RAMP roll improved the general conditions of intubation and led to a better view of the glottis in direct laryngoscopy. This is a very important aspect of intubation, and with a better view of the pharynx and glottis, the intubation procedure can be performed with higher quality, reducing the number of intubation attempts and the duration of the procedure.

Conventional videolaryngoscope versus 3D printed videolaryngoscope

&lt;b&gt;Background and objectives:&lt;/b&gt; In patients with Covid-19, using a video laryngoscope as an alternative to direct laryngoscopy is recommended to protect the intubator from infection and reduce intubation failures due to personal protective equipment. The cost of video laryngoscopes limits their availability in all healthcare institutions. The present study aimed to compare the efficacy and safety of 3D printed video laryngoscope and conventional video laryngoscope on intubation.&lt;br /&gt; &lt;b&gt;Material and methods:&lt;/b&gt; 30 ASA I-II patients who were not considered to have a difficult airway were included in the study after obtaining the ethics committee approval from Adnan Menderes University Clinical Research Ethics Committee. Patients were randomly divided into two groups, group 1 and group 2. After the induction of anesthesia under standard monitoring, the Cormack Lehane score was recorded by direct laryngoscopy in all patients. Patients in group 1 were intubated with a 3D-printed video laryngoscope. In contrast, patients in group 2 were intubated with a conventional video laryngoscope (STORZ C-mac videolaryngoscope). Intubation time, number of attempts, and hemodynamic values of patients with early postoperative complications were recorded. The data were recorded and statistically evaluated.&lt;br /&gt; &lt;b&gt;Results:&lt;/b&gt; There were no significant differences between the groups regarding demographic data, BMI, and hemodynamic data. The Cormack Lehane score was calculated as 1.6±0.51 in group 1 and 1.4±0.51 in group 2 (p=0.38). Intubation times of the groups were 32.6±18 s and 27.06±11.37 s, respectively (p=0.4). The number of intubation attempts was 1.2±0.63 in group 1 and 1±0.01 in group 2 (p=0.31). The image quality of the camera by the intubator, intubation conditions, and intubation satisfaction was similar in the two groups.&lt;br /&gt; &lt;b&gt;Conclusion:&lt;/b&gt;&lt;b&gt; &lt;/b&gt;Comparing a 3D-printed videolaryngoscope with a conventional videolaryngoscope, no differences were observed in intubation times, number of intubation attempts, hemodynamic changes, and early postoperative complications. Intubation satisfaction values by the practitioner were found to be similar. It was concluded that the 3D-printed videolaryngoscope, which is cost-effective and easy to access, can be used instead of conventional videolaryngoscope in patients with a normal airway.

Propofol TCI or sevoflurane anesthesia without muscle relaxant for thoracoscopic thymectomy in myasthenia gravis patients: a prospective, observational study

BackgroundMyasthenia gravis (MG) patients interact unpredictably with anesthetic agents, including neuromuscular blocking agents. Here, we investigate the effectiveness of general anesthesia without muscle relaxants using either propofol via target-controlled infusion systems (TCI) or sevoflurane in MG patients undergoing thoracoscopic thymectomy.MethodsThis prospective, open-label, observational study was conducted in a university hospital. We included 90 myasthenic patients undergoing thoracoscopic thymectomy with general anesthesia. Patients received induction and maintenance anesthesia with propofol TCI (group P, n = 45) or induction with propofol 2–3 mg.kg−1 and maintenance anesthesia with sevoflurane (group S, n = 45). In both groups, the procedure was performed under the guidance of entropy with sufentanil but not a muscle relaxant. Intubation conditions, hemodynamic changes, respiratory function, neuromuscular transmission, arterial blood gas, and complications were evaluated.ResultsAll patients achieved good intubation conditions. Hemodynamic instability was more frequent in group S than in group P, mostly in the induction stage, and was controllable. The reduction in the intraoperative train-of-four ratio from baseline at 30 min, 60 min, and 90 min in group S was 10.3%, 14.2%, and 14.3%, respectively, significantly higher than that in group P (6.8%, 7.2%, and 8.4%, respectively), which completely recovered at the end of the surgery. All patients were extubated in the operating room without complications. No other significant differences between the groups were observed.ConclusionsAnesthesia with propofol TCI or sevoflurane without muscle relaxants in MG patients offered safe and effective conditions for thoracoscopic thymectomy. Sevoflurane achieved higher levels of intraoperative muscular relaxation than propofol TCI. Postoperative neuromuscular function was not affected by these anesthetics.

Modified anterior approach versus traditional posterior approach for ultrasound-guided superior laryngeal nerve block in awake endotracheal intubation: a randomized non-inferiority clinical trial

Study objective This study was undertaken to compare the effect of the modified ultrasound-guided anterior superior laryngeal nerve block (SLNB) with the traditional ultrasound-guided posterior SLNB in providing intubation conditions during awake tracheal intubation (ATI) in patients without difficult airway. Design Randomized, assessor-blind. Registration number: ChiCTR2200058086. Setting West China Hospital of Sichuan University, Chengdu, China. Patients 104 patients aged 18–65 years, of American Society of Anesthesiologists status I-III, posted for elective general surgery with general endotracheal anesthesia. Interventions The patients were randomized into two groups (modified group, n = 52; traditional group, n = 52). Modified anterior SLNB or traditional posterior SLNB was performed under ultrasound guidance. Measurements The primary outcome was the proportion of acceptable intubation condition (AIC), which was analyzed in both per-protocol (PP) and intention-to-treat (ITT) populations. The prespecified non-inferiority margin was −4.8%. Secondary outcomes included intubation success rate on the first attempt, hemodynamic parameters during ATI, time taken for airway anesthesia and intubation, recall of intubation, patient perception of comfort, and incidence and severity of postoperative complications. Main results In the PP population, the proportion of AIC in the modified group was 49/49 (100%) and that in the traditional group was 49/49 (100%), absolute difference 0, lower limit of 1-sided 95% CI, −0.3%. In the ITT population, the primary outcomes in the modified and traditional group were 52/52 (100%) and 51/52 (98.1%), respectively, with an absolute difference of 1.9% and a lower limit of 1-sided 95% CI of −1.2%. The non-inferiority of modified ultrasound-guided anterior SLNB was confirmed in both populations. Conclusions Among adults without difficult airways during videolaryngoscope-assisted ATI, the modified ultrasound-guided anterior SLNB, compared to the traditional posterior approach, showed a statistically non-inferior effect in terms of providing AIC.

A COMPARATIVE STUDY BETWEEN LIGHT WAND AND AIRTRAQ AIDED TRACHEAL INTUBATION FOR ADULT PATIENTS WITH DIFFICULT AIRWAY UNDERGOING ELECTIVE SURGERY UNDER GENERAL ANESTHESIA

Objective: The objective of the study was to compare airtraq (AT) intubations and lightwand (LW) intubations in terms of safety, efficacy, ease of intubation, hemodynamic variabilities, and post-operative outcomes. Methods: A cross-sectional and randomized comparative study was conducted on sixty adult patients with a predicted difficult airway, scheduled to undergo elective surgery under general anesthesia using AT and LW intubation. Results: All the cases in both the AT group and LW group were successfully intubated, with an overall success rate of 100% in both groups. The success at the first attempt in AT group was 96.66% and that of LW group was 73.33%. Conclusion: AT had superior successful intubation conditions than LW. However, both LW and AT were proved to be safe and successful techniques of intubation in difficult airway patients.

Comparison of different ratios of propofol-ketamine admixture in rapid-sequence induction of anesthesia for emergency laparotomy: a randomized controlled trial

BackgroundWe aimed to compare the hemodynamic effect of two ratios of propofol and ketamine (ketofol), namely 1:1 and 1:3 ratios, in rapid-sequence induction of anesthesia for emergency laparotomy.MethodsThis randomized controlled study included adult patients undergoing emergency laparotomy under general anesthesia. The patients were randomized to receive either ketofol ratio of 1:1 (n = 37) or ketofol ratio of 1:3 (n = 37). Hypotension (mean arterial pressure < 70 mmHg) was managed by 5-mcg norepinephrine. The primary outcome was total norepinephrine requirements during the postinduction period. Secondary outcomes included the incidence of postinduction hypotension, and the intubation condition (excellent, good, or poor).ResultsThirty-seven patients in the ketofol-1:1 and 35 patients in the ketofol 1:3 group were analyzed. The total norepinephrine requirement was less in the ketofol-1:1 group than in the ketofol-1:3 group, P-values: 0.043. The incidence of postinduction hypotension was less in the ketofol-1:1 group (4 [12%]) than in ketofol-1:3 group (12 [35%]), P-value 0.022. All the included patients had excellent intubation condition.ConclusionIn patients undergoing emergency laparotomy, the use of ketofol in 1:1 ratio for rapid-sequence induction of anesthesia was associated with less incidence of postinduction hypotension and vasopressor consumption in comparison to the 1:3 ratio with comparable intubation conditions.Clinical trial registrationNCT05166330. URL: https://clinicaltrials.gov/ct2/show/NCT05166330.