Tracheal Intubation In Patients Research Articles

Comparison of C-MAC D-Blade with macintosh laryngoscope for endotracheal intubation in patients with cervical spine immobilization: A randomized controlled trial

BackgroundRecently, indirect laryngoscopes have emerged as an important tool in managing a difficult airway but the literature is insufficient on the comparison of C-MAC D-Blade with Macintosh for tracheal intubation during manual-in-line stabilization. We compared the efficacy of C-MAC D-blade with Macintosh laryngoscope for tracheal intubation in patients with manual-in-line stabilization. MethodsEighty adult patients undergoing elective surgery under general anesthesia were intubated after application of MILS using C-MAC D-Blade (n = 40) or Macintosh laryngoscope (n = 40) as per group allocation. Intubation Difficulty Scale was the primary outcome. We also recorded the duration of laryngoscopy, modified Cormack-Lehane grading, time taken for intubation, total intubation time, optimizing maneuvers required, number of attempts, and complications. ResultThe median intubation difficulty score (inter-quartile range) was significantly lower with C-MAC D-Blade[(0, 0–1) vs (3, 2–3)](P < 0.0001). C-MAC D-Blade provided significantly better glottic view in lesser time (10 s[7.5–13]vs9 [7–10]) (P = 0.02) without optimum external laryngeal manipulation(p = 0.0001). Time taken for tracheal intubation was longer in the C-MAC D-Blade, though, the total duration of tracheal intubation was comparable in both the groups (P = 0.069). ConclusionC-MAC D-Blade is superior to the Macintosh laryngoscope in terms of lower Intubation Difficulty Score in patients undergoing tracheal intubation with cervical spine immobilization.

Effect of intraoperative neuromuscular blockade on postoperative sore throat and hoarseness in patients undergoing spinal surgery: a prospective observational study

Intraoperative neuromuscular blockade affects the resting tension between the vocal cords. We assessed the effect of neuromuscular blockade on postoperative sore throat and hoarseness following tracheal intubation in patients undergoing lumbar spinal surgery in the prone position. Altogether, 99 patients were included; 50 patients did not receive neuromuscular blockade, and 49 patients received moderate neuromuscular blockade during the maintenance of anesthesia. Neuromuscular blockade was performed depending on the use of intraoperative neurophysiological monitoring. The number of intubation attempts, time to achieve tracheal intubation, and duration of intubation were recorded accordingly. The incidence and severity of postoperative sore throat and hoarseness was assessed at 1, 6, and 24 h after surgery. The overall cumulative incidence of postoperative sore throat (60% vs. 59%, respectively; P = 1.000) and postoperative hoarseness (68% vs. 61%, respectively; P = 0.532) did not differ between the no neuromuscular blockade and moderate neuromuscular blockade. The incidence and severity of postoperative sore throat and hoarseness was also not different between the moderate and no neuromuscular blockade at each time point after surgery. Nevertheless, the incidences of postoperative sore throat and hoarseness were quite high. Further studies investigating strategies to alleviate them are warranted accordingly.

Ultrasound-guided versus Shikani optical stylet-aided tracheal intubation: a prospective randomized study

BackgroundTo compare ultrasound-guided tracheal intubation (UGTI) versus Shikani optical stylet (SOS)-aided tracheal intubation in patients with anticipated normal airway.MethodsSixty patients aged 18–65 years old who presented for elective surgery under general anesthesia were recruited in this prospective randomized study. They were assigned into two equal groups, either an ultrasound-guided group (Group UG, n = 30) or an SOS-aided group (Group SOS, n = 30). After the induction of anesthesia, the tracheal intubation was performed by a specified skilled anesthesiologist. The number of tracheal intubation attempt and the duration of successful intubation on the first attempt were recorded. Complications relative to tracheal intubation including desaturation, hoarseness and sore throat were also recorded.ResultsThe first-attempt success rate is 93.3% (28/30) in Group UG and 90% (27/30) in Group SOS (P = 0.640). The second-attempt was all successful for the 2 and 3 patients left in the two groups, and the overall success rate of both groups was 100%. The duration of successful intubation on the first attempt of Group UG was not significantly different from that of Group SOS (34.0 ± 20.8 s vs 35.5 ± 23.2 s, P = 0.784). One patient in Group SOS had desaturation (P = 0.313), and there was none hoarseness in the two groups. Sore throat was detected in both group (4 in Group UG, 5 in Group SOS, P = 0.718).ConclusionUltrasound-guided tracheal intubation was as effective as Shikani optical stylet-aided tracheal intubation in adult patients with anticipated normal airway.Trial registrationChinese Clinical Trial Registry, ChiCTR-IIC-17010875. Date of Registration: 15 March 2017.

Randomized crossover trial comparing cervical spine motion during tracheal intubation with a Macintosh laryngoscope versus a C-MAC D-blade videolaryngoscope in a simulated immobilized cervical spine

BackgroundMaintaining cervical immobilization is essential during tracheal intubation in patients with unstable cervical spines. When using the Macintosh laryngoscope for intubation in patients with cervical immobilization, substantial neck extension is required for visualization of the glottis. However, the C-MAC D-Blade videolaryngoscope may require less neck extension due to its acute angulation. We hypothesized that C-MAC D-Blade videolaryngoscopic intubation would result in less cervical spine movement than Macintosh laryngoscopic intubation. We compared the effects of C-MAC D-Blade videolaryngoscopic intubation and Macintosh laryngoscopic intubation in terms of cervical spine motion during intubation in patients with simulated cervical immobilization.MethodsIn this randomized crossover study, the cervical spine angle was measured at the occiput–C1, C1–C2, and C2–C5 segments before and during tracheal intubation with either a C-MAC D-Blade videolaryngoscope or Macintosh laryngoscope in 20 patients, with application of a neck collar for simulated cervical immobilization. Cervical spine motion was defined as the change in angle measured before and during tracheal intubation.ResultsThe cervical spine motion at the occiput–C1 segment was measured at 12.1 ± 4.2° and 6.8 ± 5.0° during Macintosh laryngoscopic and C-MAC D-blade videolaryngoscopic intubation, respectively, corresponding to a 44% reduction in cervical spine motion when using the latter device (mean difference, − 5.3; 98.33% CI: − 8.8 to − 1.8; p = 0.001). However, there was no significant difference between the two intubation devices at the C1–C2 segment (− 0.6; 98.33% CI: − 3.4 to 2.2; p = 0.639) or C2–C5 segment (0.2; 98.33% CI: − 6.0 to 6.4; p = 0.929).ConclusionsThe C-MAC D-Blade videolaryngoscope causes less upper cervical spine motion than the Macintosh laryngoscope during tracheal intubation of patients with simulated cervical immobilization.Trial registrationThis study was registered at ClinicalTrials.gov on June 26, 2018 (NCT03567902).

The Effectiveness of High-Flow Nasal Oxygen During the Intraoperative Period: A Systematic Review and Meta-analysis.

High-flow nasal oxygen (HFNO) is increasingly being used in intensive care units for management of hypoxemia and respiratory failure. However, the effectiveness of HFNO for preventing hypoxemia in the intraoperative period is unclear. The purpose of this systematic review was to compare patient oxygenation and end-tidal CO2 (EtCO2), between HFNO and conventional oxygenation, during the intraoperative period in surgical patients. Standard databases were searched from inception to February 2020. Studies involving intraoperative use of HFNO with 1 of the 4 outcomes: (1) oxygen (O2) desaturation, (2) minimum O2 saturation, (3) safe apnea time, or (4) EtCO2 were included. Intraoperative period was divided into 2 phases: at induction with general anesthesia and during surgical procedure under sedation without tracheal intubation. Eight randomized controlled trials (RCTs; 4 induction, 4 procedure, 2314 patients) were included for systematic review and meta-analyses. We found the risk of intraoperative O2 desaturation was lower in HFNO versus conventional oxygenation control group; at induction with an odds ratio (OR; 95% confidence interval [CI]) of 0.06 (0.01-0.59, P = .02), and during procedure, OR (95% CI) of 0.09 (0.05-0.18; P < .001). The minimum O2 saturation was higher in HFNO versus conventional oxygenation; at induction by a mean difference (MD) (95% CI) of 5.1% (3.3-6.9; P < .001), and during procedure, by a MD (95% CI) of 4.0% (1.8-6.2; P < .001). Safe apnea time at induction was longer in HFNO versus conventional oxygenation by a MD (95% CI) of 33.4 seconds (16.8-50.1; P < .001). EtCO2 at induction was not significantly different between HFNO and conventional oxygenation groups. This systematic review and meta-analysis show that, in the intraoperative setting, HFNO compared to conventional oxygenation reduces the risk of O2 desaturation, increases minimum O2 saturation, and safe apnea time. HFNO should be considered for anesthesia induction and during surgical procedures under sedation without tracheal intubation in patients at higher risk of hypoxemia.

Risks to healthcare workers following tracheal intubation of patients with COVID-19: a prospective international multicentre cohort study.

SummaryHealthcare workers involved in aerosol‐generating procedures, such as tracheal intubation, may be at elevated risk of acquiring COVID‐19. However, the magnitude of this risk is unknown. We conducted a prospective international multicentre cohort study recruiting healthcare workers participating in tracheal intubation of patients with suspected or confirmed COVID‐19. Information on tracheal intubation episodes, personal protective equipment use and subsequent provider health status was collected via self‐reporting. The primary endpoint was the incidence of laboratory‐confirmed COVID‐19 diagnosis or new symptoms requiring self‐isolation or hospitalisation after a tracheal intubation episode. Cox regression analysis examined associations between the primary endpoint and healthcare worker characteristics, procedure‐related factors and personal protective equipment use. Between 23 March and 2 June 2020, 1718 healthcare workers from 503 hospitals in 17 countries reported 5148 tracheal intubation episodes. The overall incidence of the primary endpoint was 10.7% over a median (IQR [range]) follow‐up of 32 (18–48 [0–116]) days. The cumulative incidence within 7, 14 and 21 days of the first tracheal intubation episode was 3.6%, 6.1% and 8.5%, respectively. The risk of the primary endpoint varied by country and was higher in women, but was not associated with other factors. Around 1 in 10 healthcare workers involved in tracheal intubation of patients with suspected or confirmed COVID‐19 subsequently reported a COVID‐19 outcome. This has human resource implications for institutional capacity to deliver essential healthcare services, and wider societal implications for COVID‐19 transmission.

The clinical effect of dexmedetomidine combined with parecoxib sodium on sedation, antianxiety and prevention of intubation stress in patients undergoing functional endoscopic sinus surgery: a randomised controlled trial

BackgroundTo investigate the effect of intravenous injection of dexmedetomidine combined with parecoxib sodium on sedation and anxiety and stress response of tracheal intubation in patients undergoing functional endoscopic sinus surgery.MethodsOne hundred twenty patients undergoing endoscopic sinus surgery were randomly divided into four groups: group DP, group D, group P and group N. The blood pressure (BP), heart rate (HR), blood oxygen saturation (SPO2), EEG, bispectral index (BIS), Ramsay sedation score and state anxiety questionnaire (SAI) were recorded before administration (T0), 10 min (T1), 20 min (T2) and 30 min (T3) after administration. After 30 min, endotracheal intubation was performed after anesthesia induction. The BP, HR, SPO2 were recorded 1 min before intubation (T4), intubation (T5), 3 min (T6) after intubation, 5 min (T7) after intubation, and blood samples were collected from patients before administration and after intubation 2 min to detect serum cortisol (Cor), adrenalin (E) norepinephrine (NE) and blood glucose (BS).ResultsThere was no significant difference in Ramsay sedation score before anesthesia, but the Ramsay sedation score in group D、DP was significantly higher than that in group P and group N, the BIS, BP, HR and anxiety scores were significantly lower than those in the group P and group N (p < 0.05). There was no significant difference in Ramsay sedation score, BIS value, anxiety score and BP, HR between group D and group DP (p > 0.05). Compared with T4, there was no significant difference in BIS and BP, HR in group D, group DP and group P (p > 0.05), but the BIS, BP and HR in group N were significantly higher than T4, (p < 0.05). Three minutes after intubation there was no statistical difference in the changes of Cor, E, NE and BS values compared with before intubation in group P and group DP (p > 0.05), but the changes of Cor, E, NE and BS values were significantly lower than that in group N (p < 0.05). Compared with T0, the values of NE, E, Cor, BS decreased in group D, DP and P at T4, group DP decreased more significantly than group D (p < 0.05). while the NE, E, Cor, BS of T6 are at the same level as the base value. In group N, the NE, E, Cor, BS of T4 were at the same level of T0, but significantly higher at T6.And at T6, NE and E in group D, P and N were significantly different from those in group DP (p < 0.05).ConclusionPreoperative intravenous infusion of dexmedetomidine combined with parecoxib sodium by functional nasal endoscopy can not only calm and resist anxiety, but also better prevent stress response of endotracheal intubation, which is a safe and effective way of preoperative medication.Trial registrationChiCTR-OPN-17010444. Prospectively registered on 16 January 2017.

The Effect of Anaesthesia on Oral Fibreoptic Tracheal Intubation in A Patient of Ankylosing Spondylitis

Airway management in patients with ankylosing spondylitis (AS) is a challenging problem for anaesthesiologists. The fibreoptic intubation (FOI) is designed to assist tracheal intubation for patients with a difficult airway. If we chose to do FOI, our first step is to decide whether to do a fibreoptic intubation with the patient anesthetized or awake. Once we’ve decided on anesthetized or awake, chose either the oral or nasal route. The aim of the study was to report the successful intubation by anesthetized nasal fibreoptic tracheal intubation of an AS patient after the failed intubation by anesthetized oral fibreoptic tracheal intubation because of a difficult airway found, and to discuss the effect of anaesthesia on oral fibreoptic tracheal intubation in patients with AS.

Application of ultrasound-guided superior laryngeal nerve block combined with cricothyroid membrane puncture for awake tracheal intubation in patients with cervical spinal cord injury

Application of ultrasound-guided superior laryngeal nerve block combined with cricothyroid membrane puncture for awake tracheal intubation in patients with cervical spinal cord injury

Tracheal intubation in patients with COVID-19.

Limit the number of in-room team members depending on the patient’s condition and delegate an outside-room “runner” to provide additional outside-room equipment and medications. The airway manager should be experienced enough to achieve greater than 85% first-pass success for endotracheal

Tracheal intubation in patients with severe and critical COVID-19: analysis of 18 cases

To analyze the clinical characteristics of patients with severe or critical coronavirus disease 2019 (COVID-19) receiving tracheal intubation. We analyzed clinical characteristics of 18 severely or critically ill patients with COVID-19 undergoing tracheal intubation. The general demographic and clinical data of the patients including their age, gender, pre- intubation state of consciousness and the ventilation mode were recorded. The anesthesiologists performing the tracheal intubation procedure evaluated and recorded the tracheal intubation conditions of the patients. The changes in the vital signs of the patients before anesthesia induction and after intubation were recorded. The average ages of these patients were 70.39±8.02 years. Fifteen patients (83.33%) received non- invasive ventilation before tracheal intubation, and 13 patients (72.22%) were conscious before tracheal intubation. After induction of anesthesia, the blood pressure and heart rate of the patients decreased significantly (P < 0.05). Most of the patients (94.44%) were in excellent or good conditions for tracheal intubation, and the first-attempt success rate of tracheal intubation was 100%. Five patients died within 3 weeks following the intubation. Tracheotomy was performed in one patient. Twelve patients were still on endotracheal mechanical ventilation in the intensive care unit, and one of them received ECMO treatment due to poor oxygenation. A total of 16 experienced anesthesiologists participated in tracheal intubation, all with third-level protection during the operation, and no medical staff infection has been detected so far. For patients with severe and critical COVID-19 and indications of tracheal intubation, we recommend early intubation with invasive respiratory support to improve the treatment efficacy and reduce the mortality. Anesthetic agents should be used carefully during tracheal intubation to ensure patients' safety. The medical staff should have a high-level protection during the intubation to maximally ensure their safety.

Video Laryngoscopic Intubation Using the King VisionTM Laryngoscope in a Simulated Cervical Spine Trauma: A Comparison Between Non-Channeled and Channeled Disposable Blades.

Videolaryngoscopes may reduce cervical spine movement during tracheal intubation in patients with neck trauma. This manikin study aimed to compare the performance of disposable non-channeled and channeled blades of the King Vision™ videolaryngoscope in simulated cervical spine injury. Fifty-eight anesthesiologists in training intubated the TruMan manikin with the neck immobilized using each blade in a randomized order. The primary outcome was the time needed for tracheal intubation, secondary aims included total success rate, the time required for visualization of the larynx, number of attempts, view of the vocal cords, and subjective assessment of both methods. Intubation time with the channeled blade was shorter, with a median time of 13 s (IQR 9–19) vs. 23 s (14.5–37.5), p < 0.001, while times to visualization of the larynx were similar in both groups (p = 0.54). Success rates were similar in both groups, but intubation with the non-channeled blade required more attempts (1.52 vs. 1.05; p < 0.001). The participants scored the intubation features of the channeled blade significantly higher, while visualization features were scored similarly in both groups. Both blades of the King Vision™ videolaryngoscope are reliable intubation devices in a simulated cervical spine injury in a manikin model when inserted by non-experienced operators. The channeled blade allowed faster intubation of the trachea.

Tracheal intubation in patients at risk for cervical spinal cord injury: A systematic review.

Tracheal intubation in patients at risk for secondary spinal cord injury is potentially difficult and risky. To compare tracheal intubation techniques in adult patients at risk for secondary cervical spinal cord injury undergoing surgery. Primary outcome was first-attempt failure rate. Secondary outcomes were time to successful intubation and procedure complications. Systematic review and meta-analysis of randomized controlled trials (RCTs) with trial sequential analysis (TSA). Databases searched up to July 2019. Randomized controlled trials comparing different intubation techniques. We included 18 trials enrolling 1972 patients. Four studies used the "awake" approach, but no study compared awake versus non-awake techniques. In remaining 14 RCTs, intubation was performed under general anesthesia. First-attempt failure rate was similar when comparing direct laryngoscopy or fiberoptic bronchoscopy versus other techniques. A better first-attempt failure rate was found with videolaryngoscopy and when pooling all the fiberoptic techniques together. All these results appeared not significant at TSA, suggesting inconclusive evidence. Intubating lighted stylet allowed faster intubation. Postoperative neurological complications were 0.34% (no significant difference among techniques). No life-threatening adverse event was reported; mild local complications were common (19.5%). The certainty of evidence was low to very low mainly due to high imprecision and indirectness. Videolaryngoscopy and fiberoptic-assisted techniques might be associated with higher first-attempt failure rate over controls. However, low to very low certainty of evidence does not allow firm conclusions on the best tracheal intubation in patients at risk for cervical spinal cord injury.

The Comparison of Hemodynamic Responses Following Laryngeal Mask Airway Insertion Versus Tracheal Intubation in Hypertensive Patients Scheduled for Elective Ophthalmic Surgery Under General Anesthesia

We compared hemodynamic responses following laryngeal mask airway insertion versus tracheal intubation in hypertensive patients who were scheduled for elective ophthalmic surgery under general anesthesia. We studied 48 controlled hypertensive patients that were randomly divided into two groups (n=24) for insertion of laryngeal mask airway (LMA) and endotracheal intubation (EI). The mean arterial blood pressure (MAP), heart rate, rate pressure product (RPP), and ST-segment changes were recorded preoperatively, immediately preintubation and 1, 3, and 5 minutes after LMA insertion or tracheal intubation in all patients and compared between two groups. There was a reduction in MAP after induction and immediately preintubation in all of patients of both groups (P&lt;0.05). The MAP, heart rate and RPP increased immediately after both LMA insertion and tracheal intubation (P&lt;0.05). The elevation of MAP and RPP were maintained for longer time in intubation group versus LMA group (P&lt;0.05). There was no difference between the groups with respect to ST-segment variation. The incidence of airway injury was similar between two groups. The laryngeal mask airway insertion may be preferable to endotracheal intubation in hypertensive patients where attenuation of hemodynamic stress response is desired. © 2019 Tehran University of Medical Sciences. All rights reserved. Acta Med Iran 2019;57(5):289-294.

The use of dexmedetomidine in fibrooptic tracheal intubation in patients with predictable difficult respiratory tract during head and neck surgical interventions

The study included 31 oncological patients who underwent surgical treatment for head and neck tumors. Airway patency was assured by fibrooptic intubation of the trachea while preserving the patient's spontaneous breathing. 15-20 min before the fibrooptic tracheal intubation, dexmedetomidine was administered intravenously at the dose of 3 μ g/kg per 1 h until the loading dose of 1 μ g/kg was reached. Fibrooptic intubation of the trachea had been applied till the patient's sedation exceeded 3 scores on the Ramsay sedation scale. In all observations, patients maintained spontaneous breathing. Immediately prior to the introduction of the fibrobronchoscope, lidocaine in the dose of 1.5 mg/kg and ketamine (0.5 mg/kg) were administered intravenously. Further, fibrooptic tracheal intubation was carried out, the quality of which was evaluated by the anesthesiologist directly while it was performed and by the patient in the postoperative period.

Comparison of silicone double-lumen tube and polyvinyl chloride single-lumen tube in fibreoptic tracheal intubation in patients with semi-rigid neck collar: a randomized controlled non-inferiority trial

Introduction Direct insertion of a double-lumen tube over a fibreoptic bronchoscope is considered more difficult and traumatic than that of a single-lumen tube, especially in patients with difficult airway. We hypothesized that time to intubation over fibreoptic bronchoscope using a silicone double-lumen tube would be non-inferior to that using a polyvinyl chloride single lumen tube in patients with semi-rigid neck collar. Methods Fifty patients were randomly allocated to fibreoptic tracheal intubation with either a silicone double-lumen tube or polyvinyl chloride single lumen tube with bronchial blocker (DLT and SLT groups, respectively). Time to tracheal intubation (time to insertion of fibreoptic bronchoscope plus railroading [advancement over the fibreoptic bronchoscope] time); total time for correct tube and bronchial blocker positioning; difficulty of railroading; and the incidence of sore throat, swallowing difficulty, and hoarseness were compared between groups. Results The median time to intubation over the fibreoptic bronchoscope was 24 s in the DLT group and 23 s in the SLT group. The upper limit of the confidence interval of this difference was below the non-inferiority margin of 10 s (median difference: –1 s; 95% confidence interval: –5 to 4 s). Railroading over the fibreoptic bronchoscope (rated on a four-point scale) was regarded as less difficult in the DLT group than in the SLT group (p Discussion Tracheal intubation using fibreoptic bronchoscope can be achieved at least as fast using the silicone double-lumen tube as using the polyvinyl chloride single lumen tube in patients with semi-rigid neck collar. Railroading the silicone double-lumen tube was easier than that of the polyvinyl chloride single lumen tube.

Efficacy of WEI NASAL JET for supraglottic ventilation before tracheal intubation in patients with tooth loss

Objective To evaluate the efficacy of WEI NASAL JET for supraglottic ventilation before tracheal intubation in the patients with tooth loss. Methods Sixty patients of both sexes with tooth loss (more than 8 teeth missing), aged 67-83 yr, of American Society of Anesthesiologists physical statusⅠ-Ⅲ, with Mallampati classificationⅠ-Ⅲ, with body mass index of 18-25 kg/m2, undergoing surgery with general anesthesia, were divided into 2 groups (n=30 each) using a random number table method: WEI NASAL JET group (S group) and mask group (M group). After the end of anesthesia induction, WEI NASAL JET was inserted via the nasal cavity to perform supraglottic ventilation in group S, and two-hand buckle mask was performed in group M, and the patients were tracheally intubated after 5-min ventilation.At 5-min spontaneous breathing after nitrogen removal by oxygen supply, 1, 2, 3 and 4 min after no spontaneous breathing and immediately after intubation (T5), ultrasound was used to measure the amplitude of diaphragm motion induced by respiratory movement, and blood gas analysis was performed to record the development of pH value<7.30, SpO2<90% and fluctuation in mean arterial pressure and heart rate ≥30% of baseline before operation.The development of ventilation-related complications was also recorded. Results Compared with group M, the amplitude of diaphragm motion induced by respiratory movement was significantly increased at T1-5, PaO2was increased at T2-5, PaCO2 and PETCO2 were decreased at T3-5, the incidence of sore throat and nasal mucosal bleeding was increased, the incidence of gingiva injury and flatulence was decreased (P 0.05). The pH value<7.30 and SpO2<90% were not found in two groups. Conclusion WEI NASAL JET can provide satisfactory supraglottic ventilation efficacy before tracheal intubation with good safety in the patients with tooth loss. Key words: WEI NASAL JET; Teeth missing

Are we glorifying the use of video laryngoscopes? A randomized control study comparing C-MAC(R) laryngoscope and McCoy blade for tracheal intubation in patients undergoing general anaesthesia with simulated immobilization of cervical spine

Objective: Intubating patients with cervical spine injury is a challenge as the cervical spine is immobilized to prevent neurological damage. Although Fibre optic intubation is gold standard, many anaesthetist’s use video laryngoscope or McCoy blade for intubation. The purpose of this study was to compare the efficacy of C-MAC(R) video laryngoscope and direct laryngoscope with McCoy blade in intubating patients with cervical spine immobilization simulating cervical spine injuries. Materials and Methods: A total of 60 patients undergoing general anaesthesia were randomized into two groups. Intubation was attempted using C-MAC(R) video laryngoscope and McCoy blade after cervical immobilization using hard collar. Time to intubate, hemodynamic parameters and Intubation difficulty score was used to compare the groups. Result: The laryngoscopic views and success of intubation was comparable in both video laryngoscope and Mc Coy group (30/30; 100% success in both the groups). The time to intubate was found to be less in McCoy group (29.83 ± 1.46 s and 25.67 ± 2.04 s) when compared to C-MAC (R) video laryngoscope. The intubation response was lesser in C-MAC compared to McCoy blade (82.97±7.23 s and 88.30±6 s). Time taken for the hemodynamic to return to baseline was the same in the groups (8.67±1.52 s and 9.13±1.25 s). Conclusion: Direct laryngoscopy and intubation with McCoy blade is faster when compared to C-MAC(R) video laryngoscope; but with exaggerated intubation response]. Keywords: Laryngoscopy, Intubation, Cervical spine immobilization, Hemodynamics.

Assessment of Airway in Patients with Acromegaly Undergoing Surgery: Predicting Successful Tracheal Intubation

AbstractBackground In the field of anesthesia, acromegaly is considered a cause of difficult tracheal intubation and airway management. There is a high probability of unanticipated difficult intubation in acromegalic patients despite a lower percentage of patients being identified preoperatively as having a difficult airway. In this study, we carried out various airway assessment tests preoperatively and during induction of anesthesia to find out the predictors of easy tracheal intubation in patients with acromegaly.Methods All patients of either sex, diagnosed as a case of acromegaly and scheduled to undergo pituitary surgery were enrolled over a period of 3 years. Various airway assessment tests were performed prior to surgery, which included modified Mallampati (MP) classification (sitting and supine), mouth opening (MO), upper lip bite test (ULBT), neck movement (NM), thyromental (TM) distance, thyrohyoid (TH) distance, sternomental (SM) distance, hyomental (HM) distance, length of upper incisors (IL), receding mandible (RM), any history of obstructive sleep apnea (OSA), mask ventilation (MV), Cormack-Lehane (CL) III and IV, and external laryngeal manipulation (ELM). Results were reported as odds ratios (95% confidence interval [CI]). The p-value &lt; 0.05 was considered statistically significant.Results A total of 42 patients were enrolled over a period of 3 years. The male-to-female ratio was 19:23 with a mean age of 37.95 years and mean weight of 72.7 kg. Out of 15 airway assessment parameters, only ULBT and CL grade showed significant results.Conclusion We conclude that ULBT and CL grading are reliable predictors of easy intubation in patients with acromegaly undergoing surgery.

Requirement for urgent tracheal intubation after traumatic injury: a retrospective analysis of 11,010 patients in the Trauma Audit Research Network database

Advanced airway management is a treatment priority in trauma care. It is likely that a proportion of patients who receive urgent airway management on arrival in the emergency department represent an unmet demand for airway intervention in the pre-hospital phase. This study aimed to investigate emergency airway practice in major trauma patients and establish any unmet demand in this patient group. A retrospective review of the Trauma Audit and Research Network database was performed to identify airway intervention(s) performed for patients admitted to major trauma centres in England from 01 April 2012 to 27 June 2016. In total, 11,010 patients had airway interventions: 4375 patients (43%) had their tracheas intubated in the pre-hospital setting compared with 5889 patients (57%) in the emergency department. Of the patients whose tracheas were intubated in the emergency department, this was done within 30 min of hospital arrival in 3264 patients (75%). Excluding tracheal intubation, 1593 patients had a pre-hospital airway intervention of which 881 (55%) subsequently had their trachea intubated in the emergency department; tracheal intubation was done within 30 min of arrival in the majority of these cases (805 patients (91%)). Over 70% of emergency department tracheal intubations in patients with traumatic injuries were performed within 30 min of hospital arrival; this suggests there may be an unmet demand in pre-hospital advanced airway management for trauma patients in England.