Laryngoscope Blade Research Articles

A Rare Case of Uvulitis Following Endotracheal Intubation Using C- Mac Videolaryngoscope and How To Avoid It

Uvular injuries are uncommon after general anesthesia and can result from direct trauma to the posterior part of the soft palate or compression and restriction of blood flow to the uvula caused by the inadvertent placement of the airway or suction devices in the oral cavity. There have been cases of inflammation and ulceration occurring in the midline oropharyngeal structures such as the uvula after general anesthesia with a tube or laryngeal mask airway, even in the absence of direct trauma or infection, presumably due to compression ischemia. While sore throat following general anesthesia is a common symptom, it is important to evaluate any severe or persistent pain to exclude uvulitis. Here we present a case of uvulitis that developed after the insertion of a flexometallic endotracheal tube using the midline technique during C-Mac video laryngoscopy. We also emphasize the measures that can be implemented to prevent such a complication. The entrapment of the uvula during intubation often goes unnoticed due to limited oral space after insertion of the video laryngoscope blade, with the intubating anesthetist staying focused on the monitor. This complication following the use of a C-Mac video laryngoscope has not been previously documented.

Comparing Air Medical Personnel Intubation Success Rates Using Direct, Channeled Video-Assisted, and Unchanneled Video-Assisted Laryngoscopy

ObjectiveThe aim of this study was to determine the first-pass intubation success rates of air medical providers using direct laryngoscopy, channeled blade video laryngoscopy, and nonchanneled blade video laryngoscopy. MethodsThis was a retrospective cohort study of the Orlando Health Air Care Team (ACT) airway quality registry over a 5-year period. The ACT had 3 approved approaches for endotracheal intubation: direct laryngoscopy, the King Vision (Ambu, Ballerup Denmark) channeled blade laryngoscope, or the C-MAC (Karl-Storz, Tuttlingen Germany) (nonchanneled) laryngoscope. The main outcome was the first-pass success rate. The secondary outcomes included the number of attempts, the overall success rate, and complications. ResultsOf 517 intubations, 312 were performed with direct laryngoscopy, 126 with a channeled video laryngoscope, and 79 with a nonchanneled laryngoscope. The mean number of attempts was 1.26, and the overall success rate was 93%. Use of the nonchanneled video laryngoscope had a higher first-pass success rate than direct or channeled laryngoscopy (92% vs. 76% and 78%, P = .006), required fewer attempts (1.09 [95% confidence interval (CI), 1.01-1.17] vs. 1.29 [95% CI, 1.23-1.35] and 1.28 [95% CI, 1.18-1.38], P < .001), and a higher overall success rate for intubation (99% vs. 90% and 95%, P = .018). ConclusionThe use of a nonchanneled video laryngoscope provided higher first-pass success rates, fewer total attempts, and higher overall success rates.

Comparative study of two different intubating doses of cisatracurium for hemodynamic changes during coronary artery bypass grafting under general anaesthesia

: The aim of the study was to compare hemodynamic response, assessment of intubating condition, time to achieve TOF 0 and any adverse effects associated with two different doses of cisatracurium i.e., 0.15mg/kg (3x ED95) and 0.3mg/kg (6x ED95) for endotracheal intubation during Coronary artery bypass grafting (CABG). : It was a prospective single blinded randomized controlled clinical trial, conducted by two investigators in 296 patients aged between 50-70 years of both sexes of ASA III grades. Patients having ejection fraction &amp;#62;45% and undergoing CABG were included in the study. Patients with neuromuscular diseases, anticipated difficult airway, morbid obesity and any associated valvular heart diseases were excluded from the study. Patients were randomly allocated into 2 groups depending on the doses of cisatracurium. Group R (n=148) → received 0.15 mg/kg, Group D (n=148) → received of 0.3 mg/kg. After 60 seconds of injecting cisatracurium, TOF was recorded every 30 seconds until it reaches 0, then laryngoscopy and endotracheal intubation was carried out using Macintosh laryngoscope blade no. 4 by one of the senior investigators who was blinded. The vital parameters such as heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), Mean arterial pressure (MAP) were monitored for 10 minutes after the administration of cisatracurium. Patients were monitored clinically for any adverse effects of histamine release. : The mean time required to achieve TOF 0 in Group D (0.3mg/kg) was shorter compared to Group R (0.15mg/kg) which was statistically significant. During intubation Group D showed statistically significant stable heart rate variation than Group R. Mean SBP, DBP and MAP did not differ between groups. No incidence of histamine release was observed in any of the group. : Patients who received 0.3mg/kg of cisatracurium showed stable heart rate fluctuation during laryngoscopy and intubation and lesser time to achieve TOF 0 compared to patients who received 0.15mg/kg of cisatracurium.

Dislodgement and aspiration of a tooth during endotracheal intubation in a cat

AbstractA 25‐week‐old Oriental shorthair cat was anaesthetised to perform computed tomography and bronchoscopy. During endotracheal intubation, a deciduous premolar was contacted with the laryngoscope blade, dislodged, and subsequently aspirated into the trachea. The tooth was removed via bronchoscopy, and the cat was recovered in the intensive care unit due to the development of laryngeal oedema. The risk factors for tooth dislodgement in the cat and proposed improvements in the immediate period after dislodgement are discussed in this report.

Association between video laryngoscopy characteristics and successful neonatal tracheal intubation: a prospective study

ObjectiveTo identify associations between procedural characteristics and success of neonatal tracheal intubation (NTI) using video laryngoscopy (VL).DesignProspective single-centre observational study.SettingQuaternary neonatal intensive care unit.PatientsInfants requiring NTI at the Children’s Hospital...

Association between video laryngoscopy characteristics and successful neonatal tracheal intubation: a prospective study

ObjectiveTo identify associations between procedural characteristics and success of neonatal tracheal intubation (NTI) using video laryngoscopy (VL).DesignProspective single-centre observational study.SettingQuaternary neonatal intensive care unit.PatientsInfants requiring NTI at the Children’s Hospital...

Perceived Versus Actual Time of Prehospital Intubation by Paramedics.

Situational awareness is essential during emergent procedures such as endotracheal intubation. Previous studies suggest that time distortion can occur during intubation. However, only in-hospital intubations performed by physicians have been studied. We aimed to determine whether time distortion affected paramedics performing intubation by examining the perceived vs actual total laryngoscopy time, defined as time elapsed from the laryngoscope blade entering the mouth until the endotracheal tube balloon passes the vocal cords. For this retrospective study we collected prehospital intubation data from a suburban, fire department-based emergency medical services (EMS) system from January 5, 2021-May 21, 2022. The perceived total laryngoscopy time was queried as a part of the electronic health record. Video laryngoscopy recordings were reviewed by a panel of experts to determine the actual time. Patients >18 years old who underwent intubation by paramedics with video laryngoscopy were included for analysis. The primary outcome was the difference between actual and perceived total laryngoscopy time. Secondary analysis examined the relationship between high time distortion, defined as the highest quartile of the primary outcome, and patient age, paramedic years of experience, perceived presence of difficult anatomy, excess secretions, use of rapid sequence intubation, and multiple intubation attempts. We conducted descriptive analysis followed by logistic regression analysis, chi-square tests, and Fisher exact tests when appropriate. A total of 122 intubations were collected for analysis, and 10 were excluded due to lack of video recording. Final analysis included 112 intubations. Mean actual laryngoscopy time was 50.0 seconds (s) (95% confidence interval [CI] 43.7-56.3). Mean perceived laryngoscopy time was 27.8 s (95% CI 24.7-31.0). The median difference between actual and perceived time was 18 s (interquartile range 6-30). We calculated high time distortion as having a difference greater than 30 s between actual and perceived laryngoscopy time. None of the secondary variables had statistically significant associations with high time distortion. Overall, we show that the paramedic's perception of total laryngoscopy time is significantly underestimated even when accounting for paramedic experience and perceived airway difficulty. This study suggests that time distortion may lead to an unrecognized prolonged procedure time. Limitations include use of a convenience sample, small sample size, and potential uncollected confounding variables.

Comparison of Paraglossal Technique of Miller Blade Insertion with McCoy and Macintosh Adult Laryngoscopes on the Cormack–Lehane Grade in Patients with Simulated Restricted Neck Mobility—A Randomized Control Trial

Abstract Background The paucity in round-the-clock availability of advanced tools like flexible bronchoscopes and video laryngoscopes makes it preferable to have alternative easily available gadgets for securing the airway in patients with cervical spine injuries where head and neck movements must be strictly avoided. This study compared the paraglossal technique of Miller blade insertion with the McCoy and Macintosh laryngoscope blades on the Cormack and Lehane grading (CLG) in patients with simulated restricted neck mobility. Methods We randomized 90 patients undergoing general anesthesia to be intubated either using Miller blade (Group-Mill), McCoy blade (Group-McCoy), or Macintosh blade (Group-Mac) following neck restriction using a soft cervical collar. CLG grade, the number of intubation attempts, use of bougie, intubation time, and hemodynamic parameters were noted. Nonparametric data were compared using the chi-squared test and parametric data using one-way analysis of variance. Results Group-MILL had significantly higher patients with Grade-1 CLG compared to Group-Mac (p = 0.02). The number of attempts, use of bougie, and intubation time were, however, comparable among the three groups. The hemodynamic parameters at intubation were not significantly different among the groups. Conclusion In adult patients with simulated restricted neck, the Miller laryngoscope blade, despite providing a better laryngeal view, showed no benefit in decreasing the intubation time when compared to the McCoy or Macintosh blades.

Unexpected Laryngoscope Blade Fracture at the Base during Laryngoscopy

Unexpected Laryngoscope Blade Fracture at the Base during Laryngoscopy

Comparison of Force Distribution during Laryngoscopy with the C-MAC D-BLADE and Macintosh-Style Blades: A Randomised Controlled Clinical Trial.

Background: The geometry of a laryngoscope's blade determines the forces acting on the pharyngeal structures to a relevant degree. Knowledge about the force distribution along the blade may prospectively allow for the development of less traumatic blades. Therefore, we examined the forces along the blades experienced during laryngoscopy with the C-MAC D-BLADE and blades of the Macintosh style. We hypothesised that lower peak forces are applied to the patient's pharyngeal tissue during videolaryngoscopy with a C-MAC D-BLADE compared to videolaryngoscopy with a C-MAC Macintosh-style blade and direct laryngoscopy with a Macintosh-style blade. Beyond that, we assumed that the distribution of forces along the blade differs depending on the respective blade's geometry. Methods: After ethical approval, videolaryngoscopy with the D-BLADE or the Macintosh blade, or direct laryngoscopy with the Macintosh blade (all KARL STORZ, Tuttlingen, Germany), was performed on 164 randomly assigned patients. Forces were measured at six positions along each blade and compared with regard to mean force, peak force and spatial distribution. Furthermore, the duration of the laryngoscopy was measured. Results: Mean forces (all p < 0.011) and peak forces at each sensor position (all p < 0.019) were the lowest with the D-BLADE, whereas there were no differences between videolaryngoscopy and direct laryngoscopy with the Macintosh blades (all p > 0.128). With the D-BLADE, the forces were highest at the blade's tip. In contrast, the forces were more evenly distributed along the Macintosh blades. Videolaryngoscopy took the longest with the D-BLADE (p = 0.007). Conclusions: Laryngoscopy with the D-BLADE resulted in significantly lower forces acting on pharyngeal and laryngeal tissue compared to Macintosh-style blades. Interestingly, with the Macintosh blades, we found no advantage for videolaryngoscopy in terms of force application.

Comparison of grooved and conventional Macintosh laryngoscope blades for throat pack insertion: A randomized control trial.

Throat pack insertion is required for many otolaryngological surgeries under general anesthesia. To facilitate surgery, an oral Ring, Adair, and Elwyn (RAE) endotracheal tube is used. When the Macintosh blade is used to insert the pack, the tube often moves to the left as per its design. We designed a groove in the Macintosh laryngoscope blade to hold the endotracheal tube in place during pack placement. This study was done to compare the grooved and conventional Macintosh laryngoscope blades for throat pack insertion with respect to the intraoral movement of the tube, ease of packing, time taken, and associated hemodynamic changes in patients who have been intubated with a preformed oral endotracheal tube. This randomized control trial included 80 patients after approval from the institutional ethics committee and CTRI. Informed written consent was taken from all patients. Packing of cases was done with either grooved (group G) or conventional Macintosh laryngoscope blade (group C). Student's t-test, Chi-square test, and Mann-Whitney U test were used to analyze data. The tube remained in the center in 35/40 patients in group G as compared to 10/40 patients in group C (P < 0.0001). Packing the throat was significantly easier (P = 0.005), and time taken to pack the throat was shorter in group G as compared to group C (P = 0.0008). The endotracheal tube remains in the center more often during throat pack insertion using a grooved laryngoscope blade as compared to the conventional Macintosh laryngoscope blade. The grooved blade is easier to use and takes less time to insert the throat pack.

A Comparison of Miller Straight Blade and Macintosh Blade Laryngoscopes for Intubation in Morbidly Obese Patients

The primary objective of this study was to demonstrate whether the Miller blade laryngoscope could provide better visualization of the vocal cords in morbidly obese patients than the Macintosh blade laryngoscope. The secondary objective was to identify the patient-measured factors associated with better visualization of the vocal cords when using the Miller vs. Macintosh blade, as well as whether the application of external pressure might improve the visibility of the glottis during intubation. A prospective, observational study encompassing 110 patients with a BMI &gt; 40 undergoing elective bariatric surgery and intubation procedure was performed. The evaluation of the vocal cords was performed according to the Cormack–Lehane scale and POGO scale in the same patient during intubation, performed with a Miller and a Macintosh blade laryngoscope, in a random matter. The following parameters were assessed: body weight, height, BMI, neck circumference, thyromental distance, sternomental distance, mouth opening, and Mallampati scale and their impact on visualization of the vocal cords using the Miller blade without the application of external pressure. The Miller blade provides an improved view of the glottis compared to the Macintosh blade measured with both the Cormac–Lehane scale (45 (40.91%) without external pressure application on the larynx, and 18 (16.36%) with external pressure application on the larynx) and the POGO scale (45 (40.91%) without external pressure application on the larynx, and 19 (17.27%) with external pressure application on the larynx). The application of laryngeal pressure improved the view of the glottis. Among the measured features, a significant improvement in the visibility of the glottis could be found in patients with a BMI over 44.244 kg/m2 and a neck circumference over 46 cm. To conclude, the usage of the Miller blade improves the visibility of the glottis compared to the Macintosh blade in morbidly obese patients. The recommendation to use the Miller blade in this group of patients requires further investigation, taking into account the effectiveness of the intubation. Trial Registration: NCT05494463.

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.

Comparison of Laryngoscopic Glottic Views Obtained via Macintosh vs Miller Blade in Adults Undergoing General Anesthesia with Endotracheal Intubation

Objective: To compare the glottic views obtained through Miller and Macintosh blade laryngoscopy in adults undergoing general anesthesia with endotracheal intubation. Methodology: This quasi-experimental study was conducted at Holy Family Hospital, Rawalpindi, from June 2022 to September 2022. Sixty patients scheduled for elective surgery under general anesthesia with endotracheal intubation were enrolled. Patients were randomly assigned to two groups: Miller blade group (n=30) and Macintosh blade group (n=30). The anesthesiologist conducting the intubation recorded the Cormack Lehane grade obtained. Data analysis utilized SPSS version 27.0, employing independent-sample t-tests, Mann-Whitney U tests, chi-square, or Fisher's exact tests as appropriate. A p-value &lt;0.05 was considered statistically significant. Results: In the Miller blade group, comprising 30 patients, the mean age was 44.60+13.310 years, and 53.3% were male. Cormack-Lehane grades were distributed as follows: 76.7% grade I, 20.0% grade II, and 3.3% grade III. In the Macintosh blade group, with 30 patients, the mean age was 40.93+12.798 years, and 46.7% were male. Cormack-Lehane grades were distributed as follows: 30.0% grade I, 50.0% grade II, 13.3% grade III, and 6.7% grade IV. Conclusion: The study concluded that Miller blade laryngoscopy provides superior glottic views compared to Macintosh blade laryngoscopy. However, the ease of intubation and the time taken for intubation were not investigated, suggesting areas for exploration in future studies.

Prevention of contamination after endotracheal intubation using a dedicated sleeve.

Contamination of work surfaces by used laryngoscopes after endotracheal intubation is a serious infection control concern but no strategies are available to address it. We assessed if contamination of the surfaces after endotracheal intubation would be reduced when providers used a dedicated, self-erected, disposable plastic sleeve (BladePouch) to store the used laryngoscope as compared to using single gloves or double gloves and sheathing the laryngoscope with the outer gloves. Twenty participants were recruited including attending physicians, trainees and allied health care professionals. They performed endotracheal intubation on a mannequin with oral cavity coated with a dye and stored the used laryngoscope blade using single gloves, double gloves or BladePouch. Each participant used both direct and video laryngoscopes. Following intubation, dye contamination of gloves, gown and work surface was evaluated. There was no difference in the contamination of gloves or gowns between the single gloves, double gloves or BladePouch groups. However, work surface contamination was significantly reduced when using BladePouch compared to single or double gloves (13% vs. 100% vs. 80% respectively, P<0.001). The odds of work surface contamination were significantly lower with BladePouch vs. single or double gloves, even when adjusted for intubation device, role and experience of participants with an adjusted odds ratio of 0.0054 (95% confidence interval: 0.0009-0.0314), P<0.001. In conjunction with standard precautions, the use of a dedicated plastic sleeve to store contaminated laryngoscope blade after endotracheal intubation may reduce the work surface contamination, independent of intubation device, role and experience of providers.

Comparison of Tracheal Intubation Using King Vision (Non-channeled Blade) and Tuoren Video Laryngoscopes in Patients With Cervical Spine Immobilization by Manual In-Line Stabilization: A Randomized Clinical Trial.

Glottic visualization on cervical immobilization with manual in-line stabilization (MILS) might be challenging in individuals with cervical spine injuries. We compared non-channeled King Vision video laryngoscope (VL) (Ambu GmbH, Bad Nauheim, Germany) with Tuoren video laryngoscope (Henan Tuoren Medical Device, Zhengzhou, China) for endotracheal intubation in patients with cervical spine immobilization. A total of 124 patients undergoing elective surgery under general anesthesia were included in this study. After induction of general anesthesia, patients were randomized into two groups (62 each): group K (non-channeled blade of King Vision video laryngoscope) and group T (Tuoren video laryngoscope). Cervical spine immobilization was achieved with manual in-line stabilization. The success of the first pass intubation, the time required to intubate, glottic visualization, and intubation difficulty score (IDS) were recorded. The first-attempt success rate of intubation was 95.2% (59 out of 62 patients) in group K and 90.3% (56 out of 62 patients) in group T, which were comparable. The mean glottic visualization time was significantly less with group T (12.74 ± 6.32 seconds) compared to group K (17.92 ± 4.24 seconds). Intubation time was significantly faster with group K (18.79 ± 5.857 seconds) compared to group T (27.21 ± 8.514 seconds). Both video laryngoscopes provided good grades of glottic visualization. We conclude that the performance of the Tuoren video laryngoscope is similar to the King Vision video laryngoscope in terms of first-attempt intubation success rate and glottic visualization score in patients with cervical spine immobilization by manual in-line stabilization. Although glottic visualization time was shorter with Tuoren VL, we could achieve faster intubationwith King Vision VL.

The efficacy of apneic oxygenation during intubation using a prototype of an oxygenation laryngoscope - a technical simulation

BackgroundRecently, a non-commercial oxygenation laryngoscope was able to maintain apneic oxygenation during simulated intubation efforts. Since that prototype was 3 mm wider than a standard Macintosh laryngoscope blade, the intubation performance of this device may differ from standard blades. A new prototype of an oxygenation laryngoscope was developed, consisting of a standard-size Macintosh blade and a fixed oxygen supply line to the side. Actually, it is unclear at which point of this blade the oxygen supply line should end to facilitate the best possible oxygen supply for apneic oxygenation.MethodsIn this simulation study using a standardized human airway manikin, the efficacy of apneic oxygenation by oxygen insufflation using standard and modified Macintosh blades was compared: a standard Macintosh blade without oxygen supply line as control, one with an additional oxygen supply line ending proximal near the handle, one with the line ending at the middle of the blade, and one with the line ending near the tip. A preoxygenated test lung was connected to an oximeter with a flow rate of 200ml/min, simulating oxygen consumption of a male adult, and to the trachea of an anatomically correctly shaped airway manikin. Apneic oxygenation was performed and oxygen content was measured over a 20-minutes observation period. Experiments were repeated five times for each laryngoscope blade.ResultsOxygen percentage in the test lung dropped from 100 ± 0% at the start of the experiment to 53 ± 1.5% in the room air control group (p < 0.001 compared to all other groups), and to 74 ± 2.5% in the proximal oxygen line group, whereas oxygen percentage remained at 100% in both the medium and distal oxygen line groups (p = 1 between these groups; p < 0.001 between all other groups).ConclusionsIn this simulation study with a preoxygenated airway manikin, the use of a modified Macintosh laryngoscope blade with oxygen line attached at the tip or at the middle were able to maintain apneic oxygenation without measurable drop of oxygen content over 20 min. Proximal placement of the oxygen supply line still showed an advantage against room air, however it did not completely prevent room air from entering the airway.Trial registrationNot applicable.

The size, number, and distribution of nerve endings around and within the human epiglottis, focusing on tracheal intubation maneuvers.

The aim of this study was to examine the distribution of nerve endings in the mucosa, submucosa, and cartilage of the epiglottis and the vallecula area and to quantify them. The findings could inform the choice of laryngoscope blades for intubation procedures. Fourteen neck slices from seven unembalmed, cryopreserved human cadavers were analyzed. The slices were stained, and cross and longitudinal sections were obtained from each. The nerve endings and cartilage were identified. The primary metrics recorded were the number, area, and circumference of nerve endings located in the mucosa and submucosa of the pharyngeal and laryngeal sides of the epiglottis, epiglottis cartilage, and epiglottic vallecula zone. The length and thickness of the epiglottis and cartilage were also measured. The elastic cartilage of the epiglottis was primarily continuous; however, it contained several fragments. It was covered with dense collagen fibers and surrounded by adipose cells from the pharyngeal and laryngeal submucosa. Nerve endings were found within the submucosa of pharyngeal and laryngeal epiglottis and epiglottic vallecula. There were significantly more nerve endings on the posterior surface of the epiglottis than on the anterior surface. The epiglottic cartilage was twice the length of the epiglottis. The study demonstrated that the distribution of nerve endings in the epiglottis differed significantly between the posterior and anterior sides; there were considerably more in the former. The findings have implications for tracheal intubation and laryngoscope blade selection and design.

Reusable laryngoscope blades: a more eco-responsible and cost-effective alternative

IntroductionConsumption of single-use medical devices has increased considerably, contributing to the excessive wastage produced during surgical procedures. The present study aimed to describe a methodology to assess the transition from single-use blades (SUB) to reusable laryngoscope blades (RUB) and to assess the ecological and economic impact of the switch. MethodsThe ecological analysis was based on the life cycle assessment method. Based on 30 operating rooms in a single tertiary university hospital, the economic analysis compared the usual SUB supplier with four RUB suppliers considering different costs: blade purchasing and depreciation, reprocessing, logistics and waste management. ResultsIn 2021, 17,200 intubations were performed requiring about 147 RUBs. Switching from SUB to RUB led to an annual saving of 26.5 tons of CO2eq (global warming impact), equivalent to 120 000 km by car. It avoids the extraction of 6.6 tons Oileq (petroleum) and 579 kg of copper (mineral resources) per year. This action also leads to a land occupation reduction of 626 m2 per year and water savings of 221.6 m3 per year. The average cost per intubation varies from 3.16 [3.15–3.16] for SUB to 2.81 [2.77–2.85] for RUB, representing an average saving of 0.35 per intubation leading to 5783.50 annual gain [5074.00–6192.00]. RUB are preferable from 3 and 86 uses from an ecological and economic viewpoint, respectively. ConclusionIn a model of 17,200 intubations /year, switching SUD to RUB would save 26.5 tons of CO2eq and 6.6 tons of Oileq with 5783.50 annual gain. RUBs are ecologically and cost-effective after 3 and 86 uses, respectively.

Evaluation of the Hemodynamic Response during Laryngoscopy and Intubation using McCOY and Macintosh Laryngoscope Blades

Basic elements of general anesthesia includeunconsciousness, amnesia, analgesia, muscle relaxation,diminished motor response to noxious stimuli, and reversibility.Muscle relaxation necessitates securing ventilation withendotracheal intubation. Laryngoscopy forms an importantpart of general anaesthesia and endotracheal intubation.Laryngoscopes are used to view the larynx and adjacentstructures for inserting an endotracheal tube into the trachea.Laryngoscopy aims to obtain good visualization of the vocalcords to facilitate smooth endotracheal intubation. The directlaryngoscopic view is best seen in sniffing in the morning airposition, improving the glottis view. Laryngoscopy triggers majorstress responses, one due to sympathetic stimulation releasingcatecholamines that leads to tachycardia and hypertension,which increases the myocardial oxygen demand, and the otherdue to vagal stimulation leading to parasympathetic activationthat manifests as bradycardia and hypotension. Both may becatastrophic in patients with a known history of ischemic heartdisease.Materials and Methods: This hospital-based prospective,observational study was carried out in the Department ofAnaesthesiology, Shri Ram Murti Smarak Institute of MedicalSciences, Bareilly over 112 patients of ASA physical status Iand II, undergoing elective surgery under general anaesthesiaduring a period of 18 months (February 2021 to June 2022).Results: In our study, a total of 112 patients were included,50.0% of cases were managed by Macintosh blade thoseconsisting of group I, and 50.0% of cases were managed byMcCoy blade, those consisting of group II. Pre-op Heart rate(HR) was 80.56 ± 11.48 and 76.79 ± 10.90 in group I and II,respectively and it was reduced pre-intubation in both groupsand it increased significantly during laryngoscopy (p &lt;0.05).Pre-op systolic blood pressure (SBP) was 116.56 ± 11.55 and119.48 ± 11.41 in group I and II, respectively and it was reducedat pre-intubation in both groups and it increased significantlyduring laryngoscopy (p &lt;0.05). Pre-op diastolic blood pressure(DBP) was 73.17 ± 8.54 and 73.61 ± 10.29 in group I and II,respectively and it decreased at pre-intubation and again, it wasincreased during laryngoscopy (p &lt;0.05). Pre-op mean arterialpressure (MAP) was 87.79 ± 8.64 and 89.28 ± 9.0 in group Iand II, respectively and it was decreased at pre-intubationand again, it was increased during laryngoscopy (p&lt;0.05).ECG was found normal in both groups at all time duration withtachycardia, but no change in the ST segment was noticed inany group.Conclusion: Our study concludes that the McCoy bladeproduces significantly lesser marked hemodynamic changes.The vitals like heart rate, systolic blood pressure, diastolicblood pressure and mean arterial pressure all rise in bothgroups following the laryngoscopy and intubation but increaseswith McCoy were less and insignificant than Macintoshlaryngoscopes.