Laryngeal View Research Articles

Unusual cause of airway obstruction after nasal intubation with a preformed endotracheal tube.

Unusual cause of airway obstruction after nasal intubation with a preformed endotracheal tube.

Risk factors affecting the difficulty of fiberoptic nasotracheal intubation.

BackgroundThe success rate of intubation under direct laryngoscopy is greatly influenced by laryngoscopic grade using the Cormack-Lehane classification. However, it is not known whether grade under direct laryngoscopy can also affects the success rate of nasotracheal intubation using a fiberoptic bronchoscpe, so this study investigated the same. In addition, we investigated other factors that influence the success rate of fiberoptic nasotracheal intubation (FNI).MethodsFNI was performed by 18 anesthesiology residents under general anesthesia in patients over 15 years of age who underwent elective oral and maxillofacial operations. In all patients, the Mallampati grade was measured. Laryngeal view grade under direct laryngoscopy, and the degree of secretion and bleeding in the oral cavity was measured and divided into 3 grades. The time required for successful FNI was measured. If the intubation time was > 5 minutes, it was evaluated as a failure and the airway was managed by another method. The failure rate was evaluated using appropriate statistical method. Receiver operating characteristic (ROC) curves and area under the curve (AUC) were also measured.ResultsA total of 650 patients were included in the study, and the failure rate of FNI was 4.5%. The patient's sex, age, height, weight, Mallampati, and laryngoscopic view grade did not affect the success rate of FNI (P > 0.05). BMI, the number of FNI performed by residents (P = 0.03), secretion (P < 0.001), and bleeding (P < 0.001) grades influenced the success rate. The AUCs of bleeding and secretion were 0.864 and 0.798, respectively, but the AUC of BMI, the number of FNI performed by residents, Mallampati, and laryngoscopic view grade were 0.527, 0.616, 0.614, and 0.544, respectively.ConclusionUnlike in intubation under direct laryngoscopy, in the case of FNI, oral secretion and nasal bleeding had a significant effect on FNI difficulty than Mallampati grade or Laryngeal view grade.

Supraglottic Airway Devices for Elective Pediatric Anesthesia: I-gel versus Air-Q, Which is the Best?

Objectives:The objectives of the study were to compare the insertion facility, the effect on hemodynamic parameters, and effective ventilation using I-gel versus Air-Q supraglottic airway devices (SADs) for pediatric patients undergoing short-duration surgical procedures.Patients and Methods:One hundred and fifty children aged 3–10 years were randomly divided into two equal groups: Group I received I-gel and Group Q received Air-Q SAD. All patients were anesthetized by sevoflurane inhalation using a face mask without neuromuscular blockade. Study outcomes included SAD insertion success rate (SR), insertion time, anatomic alignment of the SAD to the larynx as judged using fiberoptic bronchoscope (FOB) inserted through the SAD, and tidal volume leak, and incidence of postoperative complications.Results:Total and first attempt SRs were 97.3% and 85.3% for I-gel and 94.7% and 82.7% respectively, for Air-Q with nonsignificant differences. However, I-gel insertion time (12.3 ± 3.6 s.) was significantly (P = 0.034) shorter than Air-Q (13.7 ± 4.2 s). FOB grading of laryngeal view through SAD was better with I-gel but without significant difference for patients who had view Grades 1-2. Percentage of tidal volume loss was significantly decreased at 5 min after insertion than immediately after insertion, in all patients, with a nonsignificant difference in favor of I-gel. Intraoperative hemodynamic changes and postoperative complications showed a nonsignificant difference between both the groups.Conclusion:Both Air-Q and I-gel SAD provided advantages for pediatric anesthesia during short-duration surgical procedure with nonsignificant differences. However, I-gel SAD required a shorter insertion time and provided a high SR which is satisfactory for trainees and during an emergency. I-gel SAD allowed minimization of tidal volume leak and gastric inflation and is associated with infrequent complications.

A randomised preliminary study to compare the performance of fibreoptic bronchoscope and laryngeal mask airway CTrach (LMA CTrach) for visualisation of laryngeal structures at the end of thyroidectomy

Background and Aims:Various methods have been used to check vocal cord movements as a routine before awakening the patient at the end of thyroidectomy to rule out recurrent laryngeal nerve (RLN) palsy; out of which, fibreoptic-assisted visualisation via laryngeal mask airway (LMA) being the most desirable.Methods:Thirty patients of either sex, aged 18-65 years, American Society of Anaesthesiologists (ASA) grade I/II, scheduled for thyroidectomy under general anaesthesia (GA) were included and were randomised to receive either fibreoptic assisted (FB) or LMA CTrach-assisted (CT) visualisation of laryngeal structures at the end of thyroidectomy. The primary outcome was grade of view of laryngeal structures and secondary outcomes were time taken to achieve optimal view of laryngeal structures, ease of visualisation, hemodynamic parameters, and complications.Results:In the fibreoptic group, we obtained comparable optimal laryngeal view i.e., grade 1 and 2 in all (100%) patients in comparison to 14 (93.33%) in LMA CTrach group. The “time taken to achieve the optimal view” was significantly lower in the CTrach group when compared to Fibreoptic group (220.67 ± 95.98 vis-a-vis 136.67 ± 68.98). The ease of visualisation of laryngeal structures was comparable (P = 0.713) and the baseline haemodynamic parameters were comparable between the 2 groups and at various designated intervals. In total, 6.66% and 26.66% patients in group FB and CT group, respectively, required manoeuvres. However, difference was statistically significant (P < 0.05).Conclusion:Both Fibreoptic-assisted and LMA CTrach-assisted visualization of laryngeal structures in thyroidectomy are equally efficacious in terms of the optimal laryngeal view obtained and ease of visualisation. However, the time taken to achieve optimal laryngeal view was lesser with LMA CTrach.

Fiberoptic-Guided and Blind Tracheal Intubation Through iLTS-D, Ambu® Auragain™, and I-Gel® Supraglottic Airway Devices: A Randomized Crossover Manikin Trial.

The use of supraglottic airway devices (SADs) is becoming more widespread. However, there is little evidence to show which device is best in an emergent clinical scenario. We compared both fiberoptic-guided and blind tracheal intubation through the Intubating Laryngeal Tube Suction-Disposal (iLTS-D), the AuraGain™, and the i-gel® in an airway manikin. Thirty residents were included in a randomized trial to perform both fiberoptic-guided and blind tracheal intubation using the iLTS-D, the AuraGain, and the i-gel. The main endpoint was the total time taken to achieve successful fiberoptic intubation through the SAD. Additional endpoints included total time for blind intubation, SAD insertion time, tracheal tube insertion time, intubation success rate, fiberoptic view, and maneuvers performed to achieve tracheal intubation. All participants performed fiberoptic intubation using all three SADs on the first attempt. The total time to fiberoptic tracheal intubation using the i-gel, AuraGain, and iLTS-D was 42s, 56s, and 56s, respectively. The blind tracheal intubation success rate was 80% with the iLTS-D, 43% with the i-gel, and 0% with the AuraGain. The total time for blind tracheal intubation through the i-gel and the iLTS-D was 29s and 40s, respectively. Laryngeal view grades were significantly poorer with the iLTS-D compared to the other devices. The iLTS-D required significantly more maneuvers to achieve successful tracheal intubation. In an airway manikin, the iLTS-D, AuraGain, and i-gel appear to be reliable devices for airway rescue and fiberoptic-guided tracheal intubation. The iLTS-D is recommended for blind tracheal intubation.

Predicting difficult intubation: A comparison between upper lip bite test (ULBT) and Modified Mallampati test (MMT)

Introduction: No anaesthesiologist like to face scenario of unanticipated difficult intubation, as it may cost patients life. Many tests are there to predict difficult intubation, amongst those tests Modified Mallampati test [MMT] is a gold standard test. Upper lip bite test [ULBT] is an acceptable option for predicting difficult intubation. Our study aimed to compare both the tests to predict difficult intubation. Objectives: To analyse positive predictive value (PPV), negative predictive value (NPV), sensitivity, specificity and accuracy of ULBT and MMT. To compare the results of both the tests to predict difficult intubation. Aim: To ascertain whether ULBT can be incorporated in standard protocol of airway assessment along with other tests to increase predictive accuracy of difficult endotracheal intubation Materials and Methods: It was prospective randomised comparative observational study carried out at single centre. Three hundred patients of either sex, aged between 16-60 yrs scheduled for elective surgery under general anaesthesia with endotracheal intubation were enrolled in the study. Preoperative evaluation of airway was done with ULBT and MMT and findings were documented.MMT class III,IV and ULBT class III were considered as predictors of difficult intubation. On the day of the surgery after direct laryngoscopy laryngeal view was noted and was classified according to Cormack and Lehane classification. Patients with Cormack Lehane class III,IV considered as difficult to intubate. Cormack Lehane classification (C &L class) redings were compared with ULBT and MMT. Observations and Results: Demographic data and ASA grade was same for both the groups as participants were same. By comparing ULBT with Cormack and Lehane score we got 88.46% sensitivity, 92.74% specificity, 71.87% Positive predictive value (PPV), 97.45% ne gative predictive value (NPV) and 92% accuracy. For MMT we go t 19.23% sensitivity, 91.93% specificity, 33.33% PPV, 84.44% NPV a nd 79.33% acc

Influence of operating table height on laryngeal view during direct laryngoscopy: A randomized prospective crossover trial

BackgroundOperating table height/patient level in relation to anaesthesiologist influences mask ventilation, laryngoscopy, intubation and task performance in terms of physical and mental workload. The same was evaluated in this study. MethodsTwenty five specialist anaesthesiologists performed mask ventilation and laryngoscopy thrice and intubation once on six patients each, [n = 150] at three different operating table levels (Level X: patient at level of xiphisternum of anaesthesiologist, level A: 5 cms above; level B: 5 cms below xiphisternum). Primary variable was quality of laryngoscopic view obtained. Secondary variables were anaesthesiologist's comfort, ease of performing these tasks and movements at various joints in anaesthesiologist assessed in subjective and objective ways. ResultsLaryngoscopic view was best at levels X and A when compared to B (p = 0.0004). Mask ventilation was most comfortable at level B and least at level A (p < 0.01). At level B, there was maximum discomfort in 76.6% during laryngoscopy and 60% during intubation (p < 0.001). Level A had the fastest time (mean ± SD) for both laryngoscopy (8.30s) and intubation (18.3s) (p < 0.01). Total joint movements were maximal at level B (p < 0.001). ConclusionHigher operating table levels are ideal for laryngoscopy and intubation whereas lower levels favour mask ventilation.

The Effect of Obesity on Transnasal Flexible Laryngoscopy

Transnasal flexible laryngoscopy (TFL) is a practical and cost-effective procedure, allowing excellent evaluation of the upper airway with minimal risk of complications. The effect of obesity on endoscopic examination still remains unclear. The aim of this study was to determine if obesity has an effect on TFL. Demographic data including age and gender, and physical and endoscopic examinations including body mass index (BMI), neck circumference, and grade of the laryngeal view according to Tasli classification (TC), Mallampati classification (MC), Friedman classification, and Moore tongue base classification (MTC) scores of 200 patients were evaluated. The patients were divided into two categories as obese and nonobese, and the scores of patients were compared. Evaluation was made of 99 (50.5%) obese and 97 (49.5%) nonobese patients ranging in age from 18 to 65 years (mean age: 37.89 ± 13.55 years). Of the 196 patients in this study, 101 (51.5%) were male, and 95 (48.5%) were female. The mean BMI of the obese and nonobese patients was 33.18 ± 5.18 (min: 25, max: 45) and 22.48 ± 1.5 (min: 19, max: 24), respectively. According to cutoff points, 27 patients (27.3%) were classified as overweight, 30 (30.3%) as obese, and 42 (42.4%) as morbidly obese. According to TC, there was no statistically significant difference between the obese and nonobese groups (mean difference 0.12, P: 0.39). In Pearson correlation analysis, the scores for a correlation between TC, and MC and MTC were 0.206 (very weak) and 0.653 (strong), respectively, which were statistically significant (P < 0.05). There was no correlation between TC and BMI values (r = -0.051; P: 0.48). The results of this study demonstrated that obesity influences the scores of MC, Friedman classification, and MTC, but does not affect the laryngeal view on TFL.

Comparison of three airway conduits for fiberoptic-guided intubation: A randomized controlled trial

ABSTRACTBackground: Many oral airways are used for aiding fiberoptic bronchoscope (FOB)-guided endotracheal intubation. This study was done to evaluate modified William’s airway, modified Guedel’s airway, and LMA MADgic airway as conduits for FOB-guided endotracheal intubation.Methods: Sixty patients presented for elective surgery under general anesthesia were randomly allocated into three groups: Modified Guedel’s airway group (GG), modified Williams airway group (GW), and LMA MADgic airway group (GM). The three study groups were compared with regard to time of insertion of the airway, time of intubation, ease of airway insertion, number of intubation attempts, Laryngeal View Grade (LVG), and the incidence of complications.Results: Gw had shorter time of airway insertion, shorter time of intubation, lower number of intubation attempts, and better laryngeal view compared to GG and GM. The anesthesiologist was more comfortable in Gw compared to the other two groups.The incidence of complications (sore throat, and blood-stained airway) was comparable between the three groups.Conclusion: Modified Williams airway provided shorter time of endotracheal tube intubation, and lower number of intubation attempts in comparison to modified Guedel’s airway and LMA MADgic airway when used as conduit for FOB-guided endotracheal intubation. This randomized controlled study was conducted in Cairo University Hospital. Research Ethics Committee approved the study (N-40–2016).

Flexible video endoscope versus Macintosh laryngoscope for orotracheal tracheal intubation in the lateral position: a study protocol for a randomized controlled trial

BackgroundTracheal intubation with the patient in the lateral position is difficult because the laryngeal view is compromised during direct laryngoscopy. Flexible video endoscopes may facilitate intubation even when laryngeal views are poor on direct laryngoscopy because the patients are positioned laterally. Thus, this trial aims to compare the efficacy of flexible video endoscopes to Macintosh laryngoscopes for orotracheal intubation in the lateral position and to investigate their feasibility, i.e., whether the use of the two devices in combination can secure the airway when endotracheal intubation in the lateral position has failed using one device.MethodsThis will be a prospective, randomized, single-center, clinical trial. One hundred and seventy-four patients aged 18–65 years, who have been scheduled to undergo tracheal intubation under uniform general anesthetic techniques for elective kidney surgery in the lateral decubitus position will be randomly divided into the flexible video endoscope and the Macintosh laryngoscope groups. Primary outcomes include intubation time and intubation success rate. Secondary outcomes include overall user satisfaction (graded from 1 to 10 (1 = very poor, 10 = excellent)) and perioperative side effects and complications, such as frequency of esophageal intubation, lip or dental injury, sore throat, and hoarseness.DiscussionThe trial will clarify the efficacy of intubation with a Macintosh laryngoscope and a flexible video endoscope in the lateral position, and whether the two devices could be used in combination to secure the airway in cases where endotracheal intubation in the lateral position has failed with one device.Trial registrationChinese Clinical Trial Register, ChiCTR- IOR-15007175. Registered on 6 October 2015.

Comparison of lateral insertion technique of ClassicTM laryngeal mask airway along right versus left border of tongue in adults

Introduction Appropriate placement of laryngeal mask airway (LMA) is crucial for successful ventilation during conduct of anaesthesia as well as during cardiopulmonary resuscitation. As LMA insertion is generally performed blindly, clinicians are always in search of an ideal technique that will provide a higher incidence of correct placement. We aimed at comparing the lateral insertion technique of ClassicTM LMA along the right border of the tongue with that of the left border in adults. Methodology In this prospective randomised control study, we included 132 ASA I/II patients of either gender between 18 to 65 years and allocated into two groups. The operators were natural right-handed individuals. In Group R, LMA was inserted through the right border of the tongue and vice versa for Group L. We compared fibreoptic grading of laryngeal view, number of attempts, time taken for successful insertion, ease of insertion and complications. Results In our study the fibreoptic grading and the time taken in both the groups were similar. Ease of insertion and number of attempts was in favour of Group L. Even though the overall sore throat incidence was found to be less, it was significantly more in Group R than Group L. Conclusion The lateral technique of insertion of the ClassicTM LMA along either the right border or the left border of the tongue is comparable in terms of the fibreoptic grading and the time taken for successful insertion. However, left side technique is easier as per the operator, requires fewer number of attempts, has lesser incidence of sore throat after 2 hours.

Comparative evaluation of laryngeal view and intubating conditions in two laryngoscopy positions-attained by conventional 7 cm head raise and that attained by horizontal alignment of external auditory meatus - sternal notch line – using an inflatable pillow - A prospective randomised cross-over trial

Background and Aims:We compared the laryngoscopy position attained by a 7-cm-high pillow (Sniffing position-SP) with that attained by horizontal alignment of external auditory meatus-sternal notch (AM-S) line-using variable height inflatable pillow.Material and Methods:This prospective-randomised-cross-over study included 50 patients in each group. Group-AM-S: A 7 cm uncompressible pillow was used for attaining first laryngoscopy position, followed by horizontal alignment of external auditory meatus-sternal notch (AM-S) line-using an inflatable pillow for attaining second laryngoscopy position followed by intubation. Group-SP: Horizontal alignment of external auditory meatus-sternal notch (AM-S) line-was done using an inflatable pillow for attaining first laryngoscopy position, followed by using 7 cm uncompressible pillow for second laryngoscopy position followed by intubation. The CL-grade, Intubation Difficulty Score (IDS) and time to intubation were compared in both positions. The head raise (in cm) required for attaining AM-S alignment was noted.Results:CL-grade-I was obtained in significantly larger number of patients with AM-S alignment position than with 7 cm head raise (P = 0.004). CL-grade-III was obtained in significantly lesser number of patients with AM-S alignment (P = 0.002). Mean IDS with AM-S alignment (1.18 ± 1.69) was significantly less than with 7cm head raise (2 ± 1.59; P = 0.007) and time to intubation with AM-S alignment (17.33 ± 4.52 s) was significantly less than that with 7cm head raise (18.94 ± 4.64 s; P = 0.041). The mean head rise required to achieve AM-S line alignment was 4.920 ± 1.460 cm.Conclusion:External Auditory Meatus-Sternal notch (AM-S) line alignment provides better laryngeal view, better intubating conditions and requires lesser time to intubate as compared to a conventional 7-cm-head raise. The size of pillow used for head raise should be individualised.

Comparison between three supraglottic airway devices as conduits for fiber-optic tracheal intubation

Background Securing the airway is a major task for anesthesiologists. Supraglottic airway devices (SADs) are widely used nowadays. Fiber-optic endotracheal intubation (ETT) plays an important role in difficult-to-manage airways. The general purpose of a conduit is to provide a clear protected pathway for the expensive, sensitive, and fragile fiber-optic cable. Aimof the work To compare between three SADs as conduits for fiber-optic tracheal intubation. Patients and methods A prospective, randomized study involving 81 adult patients (American Society of Anesthesiologists I or II), of both sexes who were allocated into three groups (27 patients each): Air-Q group (group Q), intubating laryngeal mask airway (ILMA) group (group L) or I-Gel group (group G). Fiber-optic ETT through SADs was performed. The number of attempts and duration of insertion of SAD, laryngeal view grading, number of attempts, and duration of insertion of ETT were assessed. Complications were recorded. Results The ease and number of attempts to insert SADs showed no statistically significant differences. The duration of insertion of SADs was statistically favoring the Air-Q intubating laryngeal airway (13±3 s), compared with ILMA (19±4 s) and I-Gel (18±3 s). The fiber-optic grading of laryngeal view through SADs also favored group Q compared with other groups. Number of attempts to insert ETT through SADs showed no statistically significant differences between groups. The duration of insertion of the ETT via fiber-optic bronchoscopic through the SADs showed highly statistically significant difference (P Conclusion Air-Q, ILMA, and I-Gel were useful conduits for fiber-optic ETT. Air-Q intubating laryngeal airway provides better visualization of the glottis and shorter time for insertion of both the device and the ETT than ILMA and I-Gel.

Comparative evaluation of air-Q and classic laryngeal mask airway for surgeries under anesthesia: A randomized open-label trial

Objective: Classic laryngeal mask airway (cLMA) is a prototype supraglottic airway device, and Air-Q is a newly introduced device for use as a primary airway and as an aid for intubation. Due to paucity of literature comparing Air-Q with cLMA, this prospective, randomized, single-blinded study was performed, to evaluate their clinical performance as a primary airway conduit. Methods: Sixty patients of either sex with the American society of anesthesiology Grade I or II, weighing between 50 and 70 kg, were randomly allocated to either the cLMA (n = 30) or Air-Q (n = 30) group. After induction of anesthesia, the assigned airway device was introduced. The ease of insertion, vital parameters, oropharyngeal seal pressure (OSP), airway morbidity, and fiberoptic grades of laryngeal view was recorded. Results: There was no significant difference in ease of insertion, the time taken for successful device placement, number of attempts, or postoperative morbidities. Air-Q was found better with respect to hemodynamic stability during placement of the device. There was a significant difference in the OSP between the Air-Q (22.12 ± 1.740 cm H2O) and cLMA (16.28 ± 2.052 cm H2O), P Conclusion: Air-Q was found to be superior to cLMA for controlled ventilation in view of better OSP and a superior fiberoptic laryngeal view.

Comparative evaluation of Truview evo2 and Macintosh laryngoscope for ease of orotracheal intubation in children - A prospective randomized controlled trial.

Background and Aims:Truview evo2 has been found to improve the glottic view when compared with the Miller blade in pediatric population. However, there is limited literature comparing it with Macintosh laryngoscope in children. We thus aimed to assess and compare Truview evo2 with the Macintosh laryngoscope for orotracheal intubation in children with regards to time to intubate, laryngoscopic view, ease of intubation, and associated hemodynamic changes.Material and Methods:Fifty ASA I-II children aged 2–8 years for elective surgery requiring general anesthesia with orotracheal intubation participated in this prospective randomized-controlled study. They were randomly allocated to two groups. In group-M (N = 25), laryngoscopy and intubation were performed using Macintosh laryngoscope, and in group-T (N = 25), Truview evo2 laryngoscope was used. Modified Cormack–Lehane grade, time to intubation, intubation difficulty score (IDS), and hemodynamic changes were compared between the groups. Data were analyzed using SPSS statistical software version 17 and P value <0.05 was considered statistically significant.Results:CL grade 1 was found in a larger number of patients of group-T (P = 0.003) and CL grades2a and 2b were found in a larger number of patients of group-M (P = 0.023 and P = 0.037, respectively). The mean time to intubation was significantly longer in group-T (19.0 ± 3.4 seconds) than in group-M (13.1 ± 2.1 seconds), P = 0.00. The over all IDS was lower in group-T than group M [i.e. median (IQR): 0 (0-0) vs 1 (0-2), respectively]. Heart rate, systolic and diastolic blood pressure, and oxygen saturation were comparable between the groups at all times.Conclusion:Truview evo2 provides better laryngeal view and has a lesser IDS, but takes longer for intubation, when compared to the Macintosh laryngoscope in children.

Lessons learnt from a difficult intubation scenario: Videolaryngoscopes cannot replace the humble bougie

With the advent of videolaryngoscopes, the incidence of difficult intubation has decreased. Videolaryngoscopes are slowly replacing other airway gadgets such as the fibreoptic bronchoscope and intubating supraglottic devices, especially in institutions where they are freely available. These could not only be the first choice in anticipated difficult intubation but also the first rescue device in unanticipated difficult intubations. A failed intubation can occur despite obtaining a good view of the glottis with a videolaryngoscope. We were unable to intubate an anticipated difficult airway with C-MAC D-blade with a preformed hockey stick-shaped tube using a stylet despite using manoeuvres to optimise laryngeal view. The patient was finally intubated over a gum elastic bougie passed when retaining the videolaryngoscope in place. This case report highlights that a simple gum elastic bougie holds an equally important place on the difficult airway cart as a videolaryngoscope. The use of a gum elastic bougie should be considered as important as a videolaryngoscope in a difficult intubation scenario. It is reasonable to attempt the use of a bougie in the case of failed videolaryngoscope-assisted intubation before switching to another intubating device or a supraglottic airway. A dental consult for poor dentition should be taken prior to surgery whenever possible. Control of bleeding from a broken tooth needs to be done simultaneously and expeditiously even when we have visualised the glottis and are anticipating a successful intubation.

Comparison of channelled blade with non-channelled Blade of King Vision™ videolaryngoscope for orotracheal intubation: A randomised, controlled, multicentric study

Introduction: We conducted a randomised, controlled, prospective, multicentric comparison of channelled blade versus non-channelled blade of the King Vision™ videolaryngoscope for orotracheal intubation. Patients and Methods: A total of 66 patients included in the study were divided into two groups as follows: Group CH for intubation with channelled blade and Group NC for intubation with non-channelled blade. We compared the intubation time, ease of intubation and best laryngeal view obtained. Ease of intubation was categorised into ease of device insertion and ease of passage of endotracheal tube. Various impingements which occurred at the laryngeal inlet were observed and manoeuvres used to accomplish intubation were noted. Results: The grade of laryngeal exposure and time of laryngeal exposure were similar in both types of blade. We found a shorter intubation time of 15.24 ± 10.6 s in Group CH, whereas it was 28.57 ± 14.09 s in Group NC (P

GlideScope® cobalt video laryngoscope versus direct Miller laryngoscope for lateral position-tracheal intubation in neonates with myelodysplasia: A prospective randomized study.

Background and Objective:Anesthesiologists encounter difficulties during laryngoscopy and tracheal intubation of neonates with myelodysplasia. Tracheal intubation in lateral position in such cases deemed profitable but not easy because of the compromised laryngeal view. We compared GlideScope video laryngoscope (GVL) versus conventional Miller direct laryngoscope (DL) for tracheal intubation in laterally positioned neonates with myelodysplasia.Materials and Methods:Sixty neonates scheduled for elective surgical repair of meningeocele or meningeomyelocele under general anesthesia were allocated randomly for endotracheal intubation using GVL or DL. Percentage of glottis opening (POGO) scores, time to best glottis view (TBGV), endotracheal tube passage time (TPT), intubation time (IT), intubation attempts, and overall success rate of intubation were recorded.Results:TBGV was significantly shorter in GVL group (median = 6.8 s, range = 3.5–28.2 s) in comparison with DL group (median = 8.4 s, range = 4.8–32.7 s) (P = 0.01); however, TPT and IT were comparable. POGO scores were significantly higher with GVL group than DL group (median = 93.8, range = 45–100 and median = 82.4, range 10–100, respectively) (P = 0.001). Overall success of intubation was the same; however, three patients in GVL group required a second attempt for intubation in comparison with five patients in DL group. One patient in DL group required a third attempt.Conclusion:In laterally positioned neonates, GVL is easier than DL with a similar intubation time, comparable time required for tube passage, better views of the glottis, shorter times to obtain the best glottic view, and high success rate as compared with DL. GlideScope seems to be an effective approach for endotracheal intubation of laterally positioned neonates with myelodysplasia.

A randomised comparison of C-MAC™ and King Vision® videolaryngoscopes with direct laryngoscopy in 180 obstetric patients

BackgroundCurrent evidence suggests that there is uncertainty about which videolaryngoscope performs best in obstetric anaesthesia. The aim of this study was to compare C-MAC and King Vision® videolaryngoscopes and direct laryngoscopy for tracheal intubation of patients undergoing caesarean section. MethodsOne hundred and eighty women were randomly assigned. The primary outcome was the time to tracheal intubation. Secondary outcomes were the time to the best laryngeal view, grade of Cormack and Lehane view, overall and first-pass success, intubation difficulty, the number of intubation attempts and optimisation manoeuvres; and complications. ResultsThe time to successful intubation, first-pass and overall success rates did not differ between the devices. The difficulty of intubation was less for C-MAC than King Vision® (P <0.001). No difference was observed between King Vision® and direct laryngoscopy (P=0.06) or C-MAC and direct laryngoscopy (P=0.05). King Vision® required the longest time to best laryngeal view (9 ± 6 s, P=0.028), had the highest rate of grade 1 view (47 (80%) patients, P <0.001), and the highest need for optimisation manoeuvres (59 (100%) patients, P <0.0001). Five minor complications were recorded with King Vision® and one with direct laryngoscopy. ConclusionsCompared to direct laryngoscopy, C-MAC and King Vision® did not prolong the time to intubation, supporting these videolaryngoscopes as primary intubation devices in obstetric anaesthesia. The C-MAC was easier to use and needed fewer additional manoeuvres than the King Vision®. The C-MAC may be better suited for tracheal intubation of obstetric patients undergoing caesarean section.

Optimal Position for Transnasal Flexible Laryngoscopy

Transnasal flexible laryngoscopy (TFL) is a simple, safe, and cost-effective procedure. TFL is routinely performed to awake patients in a sitting position but there is no a definite data about ideal head and neck position to be applied. The aim of this study is to determine which position is most appropriate to obtain the best laryngeal view during the TFL. The TFL videos of 132 randomized patients were evaluated by three blind observers experienced with laryngology. Three basic head positions; simple head extension (SHE), sniffing position (SP), and neutral position (NP) were performed during the TFL-Interobserver agreements for the grading system scores were assessed by using the kappa (k) statistic. For the SHE and SP, the numbers of patients constituting grade 1 were 127 (96.2%) and 126 (95.5%), respectively, while grade 2a were 5 (3.8%) and 6 (4.5%), respectively. In NP, the number of patients constituting grade 1 was 5 (3.8%), while grade 2a was 83 (62.9%), grade 2b was 37 (28%), and grade 3 was 7 (5.3%). The k score of the SHE was 0.826 (P < 0.001) between the ratings of observer 1 and observer 2, 0.905 (P < 0.001) between observer 1 and observer 3, and 0.919 (P < 0.001) between observer 2 and observer 3. These values denote nearly perfect agreement. A complete agreement was seen in 130 of the 132 (98.48%) videos. SHE and SP both provide a better glottic view than the NP and demonstrate the same success.