Laryngoscopy In Patients Research Articles

Comparison of Routine Preoperative Ultrasound-Guided Airway Examination Versus Clinical Airway Examination in Predicting Difficult Laryngoscopy in Patients Coming for Elective Surgery: An Observational Study

Comparison of Routine Preoperative Ultrasound-Guided Airway Examination Versus Clinical Airway Examination in Predicting Difficult Laryngoscopy in Patients Coming for Elective Surgery: An Observational Study

47 GlideScope™ video laryngoscopy in patients with severely restricted mouth opening – a pilot study

47 GlideScope™ video laryngoscopy in patients with severely restricted mouth opening – a pilot study

Use of Video Laryngoscope during Intubation in Patients with Non Difficult Airway

Endotracheal intubation using laryngoscope which is an important skill required for all anesthesiologist in day to day practice is considered as gold standard for airway management. Various methods can be used for endotracheal intubation of which direct laryngoscopy is most commonly used and video laryngoscopy is an alternative. The success rate of tracheal intubation in cases of difficult airways has increased dramatically with the use of video laryngoscopes and improvements in the degree of glottic exposure. Hence this study aims to evaluate the laryngoscopic view, ease of intubation and haemodynamic changes during intubation using video laryngoscope in patients with non difficult airway. This interventional study was conducted in fifty nine patients of ASA I or II, ≥18 yrs of age with Mallampati grade I or II, mouth opening >3 cms, thyromental distance >6.5 cms of either sex planned for elective surgery under general anesthesia. General anesthesia was induced with similar doses for all the patients and intubated using video laryngoscope. Cormack-Lehane grade, intubation time, number of attempts for intubation and haemodynamic parameters were recorded. In this study, all patients had grade I type of laryngeal view during laryngoscopy and the mean time required for intubation was 18.93±7.08 sec. Out of 59 patients, 58 (98.3%) were intubated in single attempt and there was no significant haemodynamic changes during laryngoscopy with video laryngoscope. Hence, the result of this study concluded that endotracheal intubation using video laryngoscope provides good laryngoscopic view, better intubating condition for the ease of intubation without significant haemodynamic changes, thus considering worth for intubation of non difficult airway.

Relation of catecholamines with oxidative stress in patients undergoing cardiac surgery before and after endotracheal intubation

Inroduction
 Endotracheal intubation is used to maintain the airway open so that oxygen, medicine, or anesthesia can be administered. Anesthesia and surgery boost the release of cross-regulating hormones through physiological responses and psychological stress. There is a strong link between psychological stress and oxidative stress, according to research.
 Objective: - The goal of this study was to determine the levels of catecholamines (adrenaline and noradrenaline) and oxidative stress before and after endotracheal intubation in patients undergoing cardiac surgery and to study association between them.
 Material & Methods: - Total 30 patients undergoing cardiac surgery were enrolled. Blood samples were collected before and after endotracheal intubation. Plasma adrenaline and noradrenaline levels were estimated by ELISA. MDA & SOD were estimated by spectrophotometric method.
 Results: - Mean levels of plasma adrenaline (p< 0.01), noradrenaline (p< 0.0001) and Serum MDA (p< 0.0001) were significantly decreased while Serum SOD were significantly increased (p< 0.0001) after endotracheal intubation as compared to before endotracheal intubation by laryngoscopy in patients undergoing cardiac surgery. We found significant positive correlation of MDA with adrenaline and nor-adrenaline before and after intubation. SOD activity was negatively correlated with MDA, adrenaline and noradrenaline before and after intubation
 Conclusion: Elevated levels of adrenaline, noradrenaline, MDA, and lower levels of SOD show that patients are stressed prior to endotracheal intubation, resulting in a stronger stress response and increased oxidative stress. After intubation, the levels of adrenaline and noradrenaline reduced, indicating a reduction of stress. Our study also shows a link between psychological and oxidative stress. For a better outcome and to avoid subsequent complications, it is preferable to evaluate stress levels and oxidative stress in patients undergoing cardiac surgery before and after endotracheal intubation.

Role of flexible fiberoptic nasopharyngolaryngoscopy and indirect laryngoscopy in the diagnosis of laryngopharyngeal pathologies

Background: Visualization of the larynx and pharynx is essential to diagnose and treat pathologies, and to prognosticate. This can be done by using indirect laryngoscopy, rigid and flexible endoscopy, and direct laryngoscopy. The main purpose of the article was to assess the profile of laryngopharyngeal pathologies diagnosed by flexible fiberoptic nasopharyngolaryngoscopy and indirect laryngoscopy in patients with laryngopharyngeal symptoms and to estimate the level of agreement between flexible fiberoptic nasopharyngolaryngoscopy and indirect laryngoscopy for selected laryngopharyngeal conditions like vocal nodule, vocal cord polyp, Reinke’s edema, hypopharyngeal growth, vocal cord palsy, vocal cord growth. An Independent t-test and chi-square test were used to analyze the results. Statistical package for the social sciences (SPSS) version 20 was used for statistical analysis. Methods: In this descriptive cross-sectional study, 101 patients with laryngopharyngeal symptoms were subjected to both indirect laryngoscopy and flexible fiberoptic nasopharyngolaryngoscopy. The structures visualized, pathologies detected, time taken and discomfort levels were statistically analyzed. Results: In our study, we found that laryngopharyngeal symptoms were more common among the 61 to 70 years age group. The majority of them were males. The majority of them were retired employees. The most common presenting complaint was difficulty in swallowing, followed by globus sensation and voice change. All structures were visualized by flexible fiberoptic nasopharyngolaryngoscopy. Whereas, in indirect laryngoscopy, some structures were visualized and some were not. Pyriform fossa apex and post-cricoid region were not visualized for all patients with indirect laryngoscopy. Laryngopharyngeal reflux was the most common pathology detected. There is no significant difference between IDL and FOL in site, subsite, and clinical appearance of the pathology detected. There is a significant difference between IDL and FOL in time taken (FOL has a higher mean) and discomfort levels (IDL has a higher mean). Conclusions: Though indirect laryngoscopy is cost-effective in terms of investment, the time taken for the procedure is also less, flexible fiberoptic laryngoscopy is considered superior because it can visualize all structures and can detect pathologies early in their stage so that the patient gets treatment early which can alter the prognosis.

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 Indirect and Direct Laryngoscopes in Pediatric Patients with a Difficult Airway: A Systematic Review and Meta-Analysis.

This meta-analysis was performed to determine whether an indirect laryngoscope is more advantageous than a direct laryngoscope for tracheal intubation in the setting of a difficult pediatric airway. Data on the intubation failure and intubation time during tracheal intubation were extracted from prospective and retrospective studies identified through a comprehensive literature search. Data from 10 individual articles (11 trials) were combined, and a DerSimonian and Laird random-effects model was used to calculate either the pooled relative risk (RR) or the weighted mean difference (WMD) and the corresponding 95% confidence interval (CI). Meta-analysis of the 10 articles indicated that the intubation failure of tracheal intubation with an indirect laryngoscope was not significantly different from that of a direct laryngoscope in patients with a difficult airway (RR 0.86, 95% CI 0.51-1.46; p = 0.59; Cochrane's Q = 50.5; I2 = 82%). Intubation time with an indirect laryngoscope was also similar to that with a direct laryngoscope (WMD 4.06 s; 95% CI -1.18-9.30; p = 0.13; Cochrane's Q 39.8; I2 = 85%). In conclusion, indirect laryngoscopes had the same intubation failure and intubation time as direct laryngoscopes in pediatric patients with a difficult airway. Currently, the benefits of indirect laryngoscopes have not been observed in the setting of a difficult pediatric airway.

Preoperative radiological indicators for prediction of difficult laryngoscopy in patients with atlantoaxial dislocation

BackgroundDifficult airway remains a great challenge in patients with atlantoaxial dislocation (AAD). Preoperative evaluation and reliable prediction are required to facilitate the airway management. We aimed to screen out reliable radiological indicators for prediction of difficult laryngoscopy in patients with AAD. MethodsA retrospective nested case-control study within a single center longitudinal AAD cohort was conducted to investigate the radiological indicators. All the patients with difficult laryngoscopy from 2010 to 2021 were enrolled as the difficult laryngoscopy group. Others in the cohort without difficult laryngoscopy were randomly selected as the non-difficult laryngoscopy group by individually matching with the same gender, same surgery year, and similar age (±5 years) at a ratio of 6:1. Radiological data on preoperative lateral X-ray images between the two groups were compared. Bivariate logistic regression model was applied to screen out the independent predictive indicators and calculate the odds ratios of indicators associated with difficult laryngoscopy. Receiver operating characteristic curve and area under the curve (AUC) were used to describe the discrimination ability of indicators. ResultsA total of 154 patients were finally analyzed in this study. Twenty-two patients with difficult laryngoscopy and matched with 132 controls. Four radiological parameters showed significant difference between the two groups. Among which, ΔC1C2D (the difference of the distance between atlas and axis in the neutral and extension position), owned the largest AUC. ConclusionsΔC1C2D could be a valuable radiologic predictor for difficult laryngoscopy in patients with AAD.

Comparison of Disposcope endoscope with Macintosh laryngoscope for laryngoscopy

PurposeDisposcope is a novel fibreoptic intubation device that allows visualization of the glottis without aligning the oral, pharyngeal, and tracheal axes. This device may offer advantages in improving glottis exposure, or reducing hemodynamic disturbance, and minimizing movement of the upper cervical spine (C-spine). In this study, we aimed to evaluate laryngoscopy using Disposcope compared to Macintosh laryngoscope.MethodsThis study enrolled 60 adult patients (American Society of Anesthesiologists physical status 1 and 2), both male and female, underwent lumbar spine surgery, scheduled for general anesthesia with endotracheal intubation. We compared the Cormack and Lehane grade, hemodynamic response, and the maximal change in the angle between adjacent cervical vertebrae and cumulative upper C-spine movement between Disposcope and Macintosh laryngoscope. A crossover trial design was employed, with half of the patients being exposed to the glottis using the Macintosh laryngoscope first, followed by the Disposcope, and vice versa for the other half.ResultsThe intubation time in the Disposcope group was significantly lower than that in the Macintosh laryngoscope group (P < 0.01). Using the Disposcope resulted in improved views of the glottis (Z = −4.82, P < 0.01). Cormack and Lehane grade I views were achieved with the Disposcope in more patients than the Macintosh laryngoscope (36.7% versus 13.3%, P < 0.01). Grade II views were obtained in 58.3% of patients with the Disposcope, whereas a lower percentage (43.3%) was observed with the Macintosh laryngoscope. The incidence of grade III views was significantly lower with the Disposcope than with the Macintosh laryngoscope (5% versus 33.3%, P < 0.01). Additionally, there was significantly less hemodynamic disturbance (mean arterial pressure and heart rate) with the Disposcope compared to the Macintosh laryngoscope (P < 0.01). Finally, the median cumulative upper C-spine movement was greater with the Macintosh laryngoscope than with the Disposcope (26.9° versus 9.4°, P < 0.01).ConclusionsIn comparison to the Macintosh laryngoscope, the Disposcope provided improved views of the glottis and resulted in less hemodynamic disturbance and movement of the upper C-spine during laryngoscopy in patients.

Feasibility study of intubation in lateral position using Viva-sight double-lumen tube combined with video laryngoscope in patients undergoing pulmonary lobectomy

BackgroundDouble-lumen tube (DLT) intubation in lateral decubitus position is rarely reported. We designed this study to evaluate the feasibility of VivaSight double-lumen tube (VDLT) intubation assisted by video laryngoscope in lateral decubitus patients. MethodsPatients undergoing elective video-assisted thoracoscopic surgery (VATS) for lung lobectomy were assessed for eligibility between January 2022 and December, 2022. Eligible patients were randomly allocated into supine intubation group (group S) and lateral intubation group (group L) by a computer-generated table of random numbers. The prime objective was to observe whether the success rate of VDLT intubation in lateral position with the aid of video laryngoscope was not inferior to that in supine position. ResultsA total of 116 patients were assessed, and 88 eligible patients were randomly divided into group L (n = 44) and group S (n = 44). The success rate of the first attempt intubation in the L group was 90.5%, lower than that of S group (97.7%), but there was no statistical difference (p > 0.05). Patients in both groups were intubated with VDLT for no more than 2 attempts. The mean intubation time was 91.98 ± 26.70 s in L group, and 81.39 ± 34.35 s in S group (p > 0.05). The incidence of the capsular malposition in the group L was 4.8%, less than 36.4% of group S (p < 0.001). After 24 h of follow-up, it showed a higher incidence of sore throat in group S, compared to that in group L (p = 0.009). ConclusionOur study shows the comprehensive success rate of intubation in lateral decubitus position with VDLT assisted by video laryngoscope is not inferior to that in supine position, with less risk of intraoperative tube malposition and postoperative sore throat. Trial registrationChinese Clinical Trail Register (ChiCTR2200062989).

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.

Glidescope Video Laryngoscopy in Patients with Severely Restricted Mouth Opening-A Pilot Study.

An inter-incisor gap <3 cm is considered critical for videolaryngoscopy. It is unknown if new generation GlideScope Spectrum™ videolaryngoscopes with low-profile hyperangulated blades might facilitate safe tracheal intubation in these patients. This prospective pilot study aims to evaluate feasibility and safety of GlideScopeTM videolaryngoscopes in severely restricted mouth opening. Feasibility study in 30 adults with inter-incisor gaps between 1.0 and 3.0 cm scheduled for ENT or maxillofacial surgery. Individuals at risk for aspiration or rapid desaturation were excluded. The mean mouth opening was 2.2 ± 0.5 cm (range 1.1-3.0 cm). First attempt success rate was 90% and overall success was 100%. A glottis view grade 1 or 2a was achieved in all patients. Nasotracheal intubation was particularly difficult if Magill forceps were required (n = 4). Intubation time differed between orotracheal (n = 9; 33 (25; 39) s) and nasotracheal (n = 21; 55 (38; 94) s); p = 0.049 intubations. The airway operator's subjective ratings on visual analogue scales (0-100) revealed that tube placement was more difficult in individuals with an inter-incisor gap <2.0 cm (n = 10; 35 (29; 54)) versus ≥2.0 cm (n = 20; 20 (10; 30)), p = 0.007, while quality of glottis exposure did not differ. GlidescopeTM videolaryngoscopy is feasible and safe in patients with severely restricted mouth opening if given limitations are respected.

Comparison of Airtraq™ video-laryngoscope and Macintosh laryngoscope for tracheal intubation in adults—a randomised study

BackgroundAirway management by intubation is considered a major responsibility and vital skill for anaesthesiologists. Direct laryngoscopy and endotracheal intubation under vision continues to be the gold standard for airway management. Though conventional laryngoscopy is done with Macintosh blade, it has its own drawbacks. The Airtraq™ is a tube/guide channelled video-laryngoscope and can be used in patients with normal as well as difficult airway. On literature review, studies comparing intubation time with Airtraq™ and Macintosh laryngoscopes have shown heterogeneous results. Therefore, the present study was designed to compare the Airtraq™ video-laryngoscope and Macintosh laryngoscope for tracheal intubation in adults.ResultsThe median time to intubation was significantly longer in group A [45 (27–77) s] than in group M [24 (21–26) s] (p < 0.001). In both groups, 96% patients had POGO score 75–100% and CL grade I. Intubation was noted to be easy in 88% cases in group A and 92% in group M (p > 0.05). Three cases in group A required a second attempt for successful intubation, whereas in group M, all cases were intubated in the first attempt (p > 0.05). Hemodynamic parameters and complications were comparable among the groups (p > 0.05).ConclusionsAirtraq™ video-laryngoscope took longer time for intubation than Macintosh laryngoscope. However, both the devices were similar in terms of glottic view, ease of intubation, number of intubation attempts, incidence of failed intubation, hemodynamic changes, and complications. The overall performance of Airtraq™ video-laryngoscope was similar to Macintosh laryngoscope in patients having normal airways.

Comparison of C-MACTM Videolaryngoscope with Macintosh Laryngoscope in Anticipated Difficult Airway

Background: Failure to intubate is one of the dreaded outcomes of airway management. Videolaryngoscopes have the potential to increase intubation success by overcoming the shortcomings of direct laryngoscopy. This study aimed to compare the first-attempt intubation success rate of the C-MACTM videolaryngoscope and Macintosh laryngoscope in patients with anticipated difficult airways. Methods: Eighty adult patients with multiple predictors of difficult airway scheduled for surgery under general anaesthesia were randomised either into Group C (first using the C-MACTM videolaryngoscope) or Group D (first using the Macintosh laryngoscope). Laryngoscopy was done sequentially with both laryngoscopes in a patient based on the randomisation. The primary outcome was the first-attempt intubation success rate. Intubation time, Cormack–Lehane view, use of airway adjuncts and the need for external laryngeal manipulations constituted the secondary outcomes. Results: The first-attempt intubation success rate was 100% in both groups with the P value 1.0 and the intubation time was 26 s in Group C and 24.4 s in Group D with P = 0.17. The C-MACTM videolaryngoscope provided better grades of laryngoscopic view than direct laryngoscopy (P = 0.02). Tracheal tube introducer-assisted intubation (P = 0.01) and requirement of laryngeal manipulation to aid intubation (P = 0.01) were higher with the Macintosh laryngoscope. Conclusion: The Macintosh laryngoscope was comparable to the C-MACTM videolaryngoscope in terms of intubation success, intubation time and complications. However, an increased requirement for external laryngeal manipulation, lifting force and the use of an introducer for intubation were noted in the Macintosh group.

Comparison of the Intubation Success Rate in Video Laryngoscopy versus Direct Laryngoscopy in Patients with Philadelphia Collar: A Randomized Clinical Trial

Background: Video laryngoscopy (VL) and direct laryngoscopy (DL) are two approaches to provide secure airway for patients with compromised airways. This study aims to compare the intubation success rate in video laryngoscopy versus direct laryngoscopy in patients with Philadelphia collars.&#x0D; Methods: 172 patients with cervical collars who have undergone general anesthesia were enrolled. After induction of anesthesia for all patients, an oral airway was used to facilitate the ventilation. A VL approach in Group A and DL approach in Group B were used. In order to evaluate the effectiveness of each method, we considered related parameters, including intubation time, the number of intubation attempts, Cormack-Lehane (CL) score, orodental injuries, heart rate, and blood pressure 3 minutes after intubation, oxygen saturation, neck circumference, and BMI.&#x0D; Results: The ratio of first-attempt intubations was not different among the two groups (P = 1.00). The mean [SD] time for intubation was shorter with DL vs VL (p&lt;0.0001). There were almost equal rates of CL grades 1 and 2 (67.5% and 29%) using the VL than with the. The mean [SD] mean arterial pressure in VL vs DL was 86.17 mmHg vs 90.88 mmHg (p = 0.086).&#x0D; Conclusion: According to our results, there was no significant difference in complications and hemodynamic changes after intubation in both groups, but the intubation duration was significant shorter in DL group.

Comparison of the McGRATHTM Video Laryngoscope and Macintosh Laryngoscope for Orotracheal Intubation in a Simulated Difficult Airway Scenario: An Open-Label, Randomized Clinical Trial

Background and Objectives: Difficult intubation, which may be encountered unexpectedly during anesthesia, can increase patients' morbidity and mortality. The McGRATH video laryngoscope is known to provide improved laryngeal visibility in patients with difficult or normal airways. The purpose of this study was to evaluate the efficacy of the McGRATH video laryngoscope for orotracheal intubation compared with that of conventional Macintosh laryngoscopes in simulated difficult airway scenarios. Materials and Methods: In this randomized controlled trial, patients who were scheduled for surgery under general anesthesia requiring orotracheal intubation were assigned to the Macintosh laryngoscope (n = 50) or McGRATH video laryngoscope (n = 45) groups. In this study, to create a simulated difficult airway condition, the subjects performed manual in-line stabilization and applied a soft cervical collar. The primary outcome was the rate of successful intubation within 30 s. The time required for an intubation, glottis grade, intubation difficulty scale (IDS score), the subjective ease of intubation, and optimal external laryngeal manipulation (OLEM) were evaluated. In addition, complications caused by each blade were investigated. Results: The intubation success rate within 30 s was not significantly different between the two groups (44 (88.0%) vs. 36 (80.0%), p = 0.286). The glottic grade was better in the McGRATH group than in the Macintosh group (p = 0.029), but neither the intubation time (26.3 ± 8.2 s vs. 24.2 ± 5.0 s, p = 0.134) nor the rates of oral bleeding (2 (4.0%) vs. 0 (0.0%)) and tooth injury (0 (0.0%) vs. 1 (2.2%)) were significantly different between the two groups. Conclusions: The use of the McGRATH video laryngoscope did not improve the intubation success rate or shorten the intubation time. However, the McGRATH video laryngoscope provided a better glottis view than the conventional Macintosh laryngoscope in patients with a simulated difficult airway.

The Use of McGrath MAC Video Laryngoscope Versus McCoy Laryngoscope in Adults with Anticipated Difficult Airway Undergoing Elective Surgery.

Difficult airway management remains one of the most challenging clinical situations encountered by anaesthetists. The study compared the effectiveness of the McGrath MAC video laryngoscope to the McCoy® laryngoscope in patients with difficult airway. Following the institution's ethical approval, the randomised controlled trial was conducted involving 74 adults with American Society of anaesthesiologists' physical status (ASA) grading of I-III scheduled for elective surgery. The Patients were randomised into either group MVL (McGrath MAC) or group MCC (McCoy) and intubated after preoxygenation with 100% oxygen and administration of IV propofol and suxamethonium. The Intubation Difficulty Score (IDS), success rate of intubation, time to intubation, number of optimising manoeuvres and complications was assessed. Statistical analysis was performed using the statistical Package for Social Sciences (SPSS) version 24.0 computer software (IBM SPSS Statistics, IBM Corp. NY, United States). Numerical and categorical data were compared using the student's t-test and Chi square (χ2) test respectively. A value of P < 0.05 was considered statistically significant. Lower IDS scores were noted in the McGrath group; 54.1% vs. 5.4% of patients had IDS score of 0 in the McGrath and McCoy groups respectively, (P < 0.001). Overall success rate was higher in the McGrath group (100% vs. 89.1%), P = 0.040. Lower IDS scores and improved intubation success rate was achieved with the McGrath compared with the McCoy laryngoscope in patients with predicted difficult airway. The McGrath has proved to be useful in managing patients with difficult airway.

Diagnostic Accuracy of Hyomental Distance Ratio (HMDR) for Prediction of Difficult Laryngoscopy in Patients Undergoing Surgery Under General Anesthesia Using Tracheal Intubation

Background: To keep the airway open, a flexible plastic tube (ETT) is inserted into the trachea during tracheal intubation. Even when done correctly, tracheal intubation requires much clinical experience, and catastrophic problems can occur. Mandibular space has been estimated using hyomental distance (HMD), although HMD has only been found to provide a limited amount of diagnostic accuracy on its own. In order to determine how well the Hyomental Distance Ratio (HMDR) predicts difficult laryngoscopy, we conducted this study. Objectives: Using the Cormack and Lehane classification as the gold standard, the objective is to assess the diagnostic validity of the Hyomental Distance Ratio (HMDR) for the prediction of challenging laryngoscopy in patients undergoing surgery under general anaesthesia. Materials &amp; Methods: The department of anesthesiology and the general surgery operating rooms at Sir Ganga Ram Hospital in Lahore conducted this cross-sectional study over the course of six months in 2015–2016. The approach of non-probability purposive sampling was applied. Informed consent was acquired, and patient demographics were recorded. The researcher herself then assessed patients for HDMR. In order to determine if a patient had a difficult or normal laryngoscopy, HDMR was determined. After that, the researcher performed a laryngoscopy on the patients. If the vocal cords were visible, the mouth was opened, and the case was assessed using the Cormack and Lehane classification (CL), with easy or difficult laryngoscopy being designated. SPSS version 20 was used to enter and analyse all of the data. Results: The patients in our study had a mean age of 43.23 11.63 years and a male to female ratio of 1.5:1. In this study, 43.91% of patients had an HDR difficult intubation. HDR's difficult intubation has a sensitivity of 95.05%, a specificity of 96.12%, and a diagnostic accuracy of 95.65% when using CL as the gold standard. Practical Implication: According to this study, this strategy can be applied accurately in other hospitals. Government should establish guidelines for using the most trustworthy techniques as the benchmark in healthcare settings. Conclusion: According to the findings of our study, the HMDR is a viable diagnostic tool for anticipating challenging laryngoscopy in patients having general anaesthesia with tracheal intubation. According to this study, this strategy can be applied accurately in other hospitals. Government should establish guidelines for using the most trustworthy techniques as the benchmark in healthcare settings. Keywords: Laryngoscopy, difficult intubation, Cormack Classification, difficult surgery

Effect of oral clonidine and tizanidine on the induction dose of propofol and intubation response in general anesthesia

Background: Laryngoscopy and tracheal intubation are associated with hemodynamic and cardiovascular responses consisting of increased heart rate, blood pressure and tachycardia and dysarrhythmias. The alpha2-adrenoreceptor agonists such as clonidine and tizanidine have several beneficial actions during the perioperative period. They improve hemodynamic stability in response to endotracheal intubation and surgical stress. Objective: To study the effect of oral clonidine and tizanidine on induction dose of propofol and hemodynamic responses after laryngoscopy in patients undergoing surgery under general anesthesia Methods: Hundred patients in age group of 18-70 years old of ASA 1/2 undergoing elective surgeries under general anesthesia with tracheal intubation was included in the study. Tizanidine 4 mg prescribed to group A, 0.1 mg clonidine to group B 60 min before the time of induction or laryngoscopy. systolic blood pressure, diastolic blood pressure, mean arterial blood pressure and heart rate recorded before induction, pre-intubation, after intubation at 0 min, and then at interval of 1,3,5 minute after laryngoscopy by an independent observer.

Comparison of video-stylet and conventional laryngoscope for endotracheal intubation in adults with cervical spine immobilization: A PRISMA-compliant meta-analysis.

Background:Although minimization of cervical spine motion by using a neck collar or manual in-line stabilization is recommended for urgent tracheal intubation (TI) in patients with known or suspected cervical spine injury (CSI), it may worsen glottic visualization. The overall performance of video-stylets during TI in patients with neck immobilization remains unclear. The current meta-analysis aimed at comparing the intubation outcomes of different video-stylets with those of conventional laryngoscopes in patients with cervical immobilization.Method:The databases of Embase, Medline, and the Cochrane Central Register of Controlled Trials were searched from inception to June 2021 to identify trials comparing intubation outcomes between video-stylets and conventional laryngoscopes. The primary outcome was first-pass success rate, while secondary outcomes included overall success rate, time to intubation, the risk of intubation-associated sore throat, or tissue damage.Results:Five randomized controlled trials published between 2007 and 2013 involving 487 participants, all in an operating room setting, were analyzed. The video-stylets investigated included Bonfils intubation fiberscope, Levitan FPS Scope, and Shikani optical stylet. There was no difference in first-pass success rate (risk ratio [RR] =1.08, 95% confidence interval [CI]: 0.89–1.31, P = .46], overall success rate (RR = 1.06, 95% CI: 0.93–1.22, P = .4), intubation time [mean difference = 4.53 seconds, 95% CI: –8.45 to 17.51, P = .49), and risk of tissue damage (RR = 0.46, 95% CI: 0.16–1.3, P = .14) between the 2 groups. The risk of sore throat was lower with video-stylets compared to that with laryngoscopes (RR = 0.45, 95% CI: 0.23–0.9, P = .02).Conclusion:Our results did not support the use of video-stylets as the first choice for patients with neck immobilization. Further studies are required to verify the efficacy of video-stylets in the nonoperating room setting.