Tracheal Tube Insertion Research Articles

Perioperative airway management for aortic valve replacement in an adult with mucopolysaccharidosis type II (Hunter syndrome)

We herein report anesthetic management during aortic valve replacement for aortic valve regurgitation in a patient with adult mucopolysaccharidosis type II (MPS type 2) (Hunter syndrome). This disorder is rare and related to the accumulation of a mucopolysaccharide in lysosomes. It affects various organs, including the airways, heart, and central nerves. In children with MPS type 2, the risk of airway obstruction during anesthesia/sedation is high, and the degree of difficulty increases with aging. The patient described herein was a 33-year-old male without mental retardation. Before surgery, trismus, megaloglossia, and the disturbance of cervical vertebral excursion were noted, suggesting difficulties with ventilation/intubation. Anesthesia was induced under sedation/spontaneous respiration. A laryngeal deployment was conducted using a video laryngoscope; however, the Cormack grade was III. Nasotracheal fiber intubation was performed, and airway obstruction occurred. A muscle relaxant was administered, facilitating ventilation. However, subglottic stenosis, which was not detected before the surgery, made the tracheal tube insertion difficult. Aortic valve replacement was performed without complications. A detailed postoperative examination of the airways revealed oropharyngeal soft tissue outgrowth, narrowing of the upper airway, subglottic stenosis, and displacement/circumflex of the airway axis. Either awake intubation or rapid induction can be selected for this patient; however, either way have risks of airway obstruction. It is important that strategies under light anesthesia or incomplete neuromuscular blockade should be avoided for such our patient as suggested in the JSA airway management guidelines. A preoperative multidisciplinary airway assessment and simulation are important.

Comparison of the streamlined pharynx airway liner and tracheal intubation in pediatric laparoscopic hernia surgery

Objective To observe the feasibility and safety of the SLIPATM in pediatric laparoscopic hernia surgery. Methods Eighty pediatric patients, who were scheduled to undergo laparoscopic hernia surgery(aged 3-12 y, ASA Ⅰ or Ⅱ), were randomly divided into two groups: SLIPATM group(S group) and tracheal intubation group(T group). Each group had forty patients. HR, SBP and DBP were recorded on time points of before anesthesia induction(T0), before insertion of SLIPATM or tracheal tube(T1), 1 min after the insertion of SLIPATM or tracheal tube(T2), and 1 min after extraction of SLIPATM or tracheal tube(T3). In addition, complications such as cough, hoarseness, pharyngalgia, dysphagia, bleeding and aryngospasm were also recorded after the extraction of SLIPATM or tracheal tube. Results There were totally seventy nine patients enrolled, including thirty nine patients in S group and forty in T group. At T2-T3, the HR, SBP, DBP of S group were significantly lower than T group(P 0.05). After extraction of SLIPATM or tracheal tube, five of the thirty nine patients coughed and four of the thirty nine patients had hoarse throats in S group while fifteen of the forty patients coughed and twelve of the forty patients had hoarse throats in T group. The incidences of cough and hoarseness in S group were significantly lower than the incidences happened in T group(P<0.05). However, there was no statistically difference at the incidence of complications such as pharyngalgia, dysphagia, bleeding and laryngospasm between the two groups. Conclusions SLIPATM has fewer effects on pediatric hemodynamics and lower complication incidence than the incidence of tracheal intubation. Therefore, it can be safely applied in pediatric laparoscopic hernia surgery. Key words: Laryneal mask; Tracheal intubation; Therapeutic laparoscopy; Herniorrhaphy

Clinical Comparison of I-Gel Supraglottic Airway Device and Cuffed Endotracheal Tube for Pressure-Controlled Ventilation During Routine Surgical Procedures.

Recently, there has been a trend favouring the use of supraglottic airway devices over endotracheal tubes (ETT) during short surgical procedures. In this study, we are going to assess the suitability of one such supraglottic airway device, i-gel, for pressure-controlled ventilation (PCV) during routine surgical procedures. The airway management for 60 patients was done with either i-gel (Group I) or cuffed tracheal tube (Group E) for this prospective, randomised, double-blinded study. Insertion time, number of attempts, ease of insertion and haemodynamic monitoring were recorded before, during and after insertion of these devices. Airway leak tests, leak volume and leak fraction were measured at 15, 20 and 25 cm H2O PCV, and pharyngolaryngeal morbidity was evaluated postoperatively. I-gel is easier to insert than a tracheal tube (p=0.0056). The increase in heart rate and MAP was higher following insertion of tracheal tube in the first few minutes (p<0.001) and subsequently became comparable between the two groups. The leak volume and leak fraction between the two groups were comparable at 15 cm H2O PCV, but significant difference was seen at 20 and 25 H2O PCV between the two groups (p=0.232, p<0.001, p<0.001). Thirty minutes later, the leak volume and leak fraction between groups were comparable at 15 cm H2O PCV (p=0.495, p=0.104) but not at 20 and 25 H2O PCV (p<0.001, p<0.001). Pharyngolaryngeal morbidity was significantly lesser in the i-gel group. I-gel provides a reasonable alternative to cuffed ETT for pressure-controlled ventilation provided the pressures can be limited to 15 to 20 cm H2O.

ENDOTRACHEAL INTUBATION WITH SEVOFLURANE IN SURGICAL PEDIATRIC PATIENTS: INCREMENTAL VERSUS HIGH CONCENTRATION INHALATION INDUCTION

Background&#x0D; Sevoflurane is a preferred anesthetic agent for induction and maintenance of pediatric anesthesia. Many studies have been undertaken to show the optimal technique of induction with sevoflurane. In this study we compare the optimal time needed for successful tracheal intubation with immediate high concentration sevoflurane and incremental sevoflurane induction in surgical pediatric patients.&#x0D; Patients and Methods&#x0D; With the approval of the Research Scientific and Ethic Committee of the School of Medicine at Sulaimani University at 18th of May 2011, and the informed written consent from the parents, we studied 100 patients of ASA (American Society of Anesthesiologists) physical status І and II elective pediatric surgical patients aged 2-7 years, patients admitted to Sulaimani Teaching Hospital at the Otorhinolaryngology, Head and Neck Surgical Department, from the first of June 2011 to the first of September 2011. Sevoflurane has been used for induction in children who were scheduled for elective adenotonsillectomy operations. Patients were randomly divided into two equal groups, group 1 (G1) 50 patients, using incremental induction with sevoflurane (1-8 %) in 100% O2, the vapor concentration is increased by 1% every few breaths, and group 2 (G2) 50 patients, using high concentration of sevoflurane for induction, (8%) in 100% O2 from the beginning of induction. Intubation is done when the pupils are miotic and centered, after establishing a good muscle relaxation with no movements in response to laryngoscopy and tracheal intubation. The time from induction to successful tracheal intubation is recorded.&#x0D; Results&#x0D; We have found that the mean time for tracheal tube insertion was shorter in (G2) 208.4 seconds ± 44.5 (SD), than (G1) 265.8 seconds ± 44.4 (SD), and this was statistically significant with a P value of less than 0.001, Vital signs were stable in both groups.&#x0D; Conclusion&#x0D; In healthy pediatric patients undergoing mask induction of general anesthesia with sevoflurane, the induction time can be significantly shortened using a high concentration compared with a conventional, incremental induction method.

Evaluation of the McGrath® MAC Videolaryngoscope in a tertiary teaching hospital

Background:Videolaryngoscopes have become increasingly popular in recent years for use in both normal and difficult airways. Despite this trend, their benefit remains controversial. The McGrath® MAC videolaryngoscope (Aircraft Medical Ltd, Edinburgh, UK) is used for first line or rescue intubation, and for training in videolaryngoscopy intubation. We conducted a prospective observational study to assess the performance of the McGrath® MAC.Methods:We evaluated the use of the McGrath® MAC videolaryngoscope from January 2016 to April 2016. We recruited 500 adult patients undergoing elective surgery requiring endotracheal intubation. Data was collected via an online survey. The primary outcome was the success of intubation with the McGrath® MAC. Secondary outcomes included the ease of the McGrath® MAC insertion, best glottic view, ease of tracheal tube insertion, number of intubation attempts, evidence of airway trauma, quality of view, adjunct used, airway manoeuvres used, quality of image on monitor screen ...

Three-Dimensional Imaging-Based Web Application for Predicting Tracheal Tube Depth in Preterm Neonates

Background: Positioning a tracheal tube (TT) to the correct depth in preterm infants is challenging. Currently, there is no reliable single-predictor model for neonates applicable to the whole range of size or age. Objective: In this study, we used post-mortem magnetic resonance imaging (PMMRI) of preterm infants to measure tracheal dimensions and to develop a clinical guide for TT positioning. Methods: We measured tracheal length (TL) and tracheal diameter (TD) in a cohort of normal neonates and foetuses that underwent PMMRI (cause of death unexplained). The distance between the lips and the mid-tracheal point, i.e., the mid-tracheal length (mid-TL), and the TD measurement were obtained. We produced univariate prediction models of mid-TL and TD, using gestational age (GA), foot length (FL), crown-rump length (CRL) and body weight (BW) as potential predictors, as well as multiple prediction models for mid-TL. Results: Tracheal measurements were performed in 117 cases, with a mean GA of 28.8 weeks (range 14-42 weeks). The best linear association was between mid-TL and FL (mid-TL = FL × 0.914 + 1.859; R² = 0.94), but was improved by multivariate regression models. We developed a prediction tool using only GA and BW (R² = 0.92), and all four predictors (GA, BW, FL and CRL; R² = 0.94) which is now available as a web-based application via the Internet. Conclusion: Post-mortem imaging data provide estimates of TT insertion depth. Our prediction tool based on age and BW can be used at the bedside and is ready to be tested in clinical practice.

Induction to inhalation anaesthesia in agamid lizards with alfaxalone

The aim of this study was to evaluate intravenous anaesthesia with alfaxalone for tracheal tube insertion in three species of agamid lizards. Alfaxalone, at a dose rate of 5 mg/kg, was administered intravenously to 80 inland bearded dragons (Pogona vitticeps), 10 Rankin’s dragons (Pogona henrylawsoni) and 10 Chinese water dragons (Physignathus cocincinus) following 24 h of fasting. The righting reflex in inland bearded dragons, Rankin’s dragons and Chinese water dragons was lost within 12–45 s (17.52 ± 8.80 s), 15–40 s (24.60 ± 9.61 s) and 12–40 s (21.70 ± 9.53 s), respectively. The mean tracheal tube insertion time for inland bearded dragons, Rankin’s dragons and Chinese water dragons was 23.61 ± 10.91 s, 35.30 ± 14.71 s and 32.00 ± 14.32 s, respectively. Intravenous use of alfaxalone proved to be a suitable method for safe tracheal tube insertion and induction to inhalation anaesthesia in agamid lizards.

Effect of Multiple Doses of Dexmedetomidine for Moderate Sedation Facilitating Intubation during Nasotracheal Fiberoptic Laryngoscope in Awake Patients-A Randomized Prospective Study

Background: Nasal fiberoptic intubation in fully conscious patients is the gold standard technique of choice in known difficult airway as cervical instability, limited mouth opening and any facial defects. The usage of an ideal sedation agent with a perfect dose or regimen securing stability of hemodynamic conditions and optimizing the intubating condition at the same time is an indispensable demand for awake fiberoptic intubation. Aim: To detect variant efficiency of different doses of dexmedetomidine used for conscious sedation facilitating intubation by using nasotracheal fiberoptic laryngoscope in awake patients. Methods: The study was performed in a prospective, blinded, randomized manner to compare the effect of different loading and maintenance doses of dexmedetomidine during awake fiberoptic intubation on 40 patients of both sexes aged between 20 and 60 years with ASA grade I or II enrolled for elective surgery. Patients randomly divided into two groups; 20 for each. All patients received 50 mcg Fentanyl and 2 mg Midazolam at premedication room, before transfer to operating room. Group I patients received I.V. Dexmedetomidine 1 mcg/kg as a bolus dose slowly over ten minutes then 0.7 mcg/kg/h as maintenance dose throughout the fiberoptic manipulation. Group II patients received I.V. Dexmedetomidine 0.7 mcg/kg as a bolus dose slowly over ten minutes then 0.2 mcg/kg/h as a maintenance dose throughout the technique. Primary outcomes were assessment of sedation level of each patient by Alertness and Sedation Scale (AA/S). Patient's reaction to insertion of tracheal tube that could be also assessed during Pre-oxygenation, both fiberscope placement and endotracheal placement (at 1, 2, 3, 4, 5 min interval) and if the patients were feeling comfort or distressing .This comfort scale for each patient was estimated by addition of seven comfort items at each time point, the total score was 35. Patient tolerance also was assessed on the basis of 5 point fiber optic index (FOI) score. Secondary outcomes were hemodynamic categories as heart rate, systolic blood pressure, diastolic blood pressure, mean blood pressure, oxygen saturation and end tidal capnography during Pre-oxygenation, both fiberoptic placement and endotracheal insertion ( at 1, 2, 3, 4, 5 min interval) and any side effects were also explored. Results: All patients in both groups underwent fiberoptic intubation with no differences statistically among two groups demographically, heart rate, systolic, diastolic and mean blood pressure. There were statistically differences among two groups as regard to SPO2, PACO2 and OAA/S scale only at 3, 4 and 5 min during endotracheal tube placement. No side effects were observed. Conclusion: We concluded that dexmedetomidine especially with loading 1 μg/kg and higher maintenance dose 0.7 μg/kg/h were more suitable for fiberoptic intubation with better patient tolerance, patient comfort, patient satisfaction, good sedation and preserved upper airway with spontaneous breathing.

Evaluation of the McGrath® MAC videolaryngoscope in a tertiary teaching hospital

Background: Videolaryngoscopes have become increasingly popular in recent years for use in both normal and difficult airways. Despite this trend, their benefit remains controversial. The McGrath® MAC videolaryngoscope (Aircraft Medical Ltd, Edinburgh, UK) is used for first line or rescue intubation, and for training in videolaryngoscopy intubation. We conducted a prospective observational study to assess the performance of the McGrath® MAC. Methods: We evaluated the use of the McGrath® MAC videolaryngoscope from January 2016 to April 2016. We recruited 500 adult patients undergoing elective surgery requiring endotracheal intubation. Data was collected via an online survey. The primary outcome was the success of intubation with the McGrath® MAC. Secondary outcomes included the ease of the McGrath® MAC insertion, best glottic view, ease of tracheal tube insertion, number of intubation attempts, evidence of airway trauma, quality of view, adjunct used, airway manoeuvres used, quality of image on monitor screen and overall impression of the device. Results: A total of 428 responses were analysed. The overall success rate was 97.9% (95% confidence interval 96.0–99.0%). The success rate for those with predictors of difficult airway was 95.5% (95% confidence interval 87.6–99.5%). Easy scope insertion was reported by 97.2% of anaesthetists and 89.7% reported easy tube insertion. Some of our cases (1.9%) were complicated by airway trauma involving superficial oropharyngeal or lip injury. Conclusion: The McGrath® MAC videolaryngoscope is a good choice for a videolaryngoscope, conferring advantages of a high intubation success rate, ease of laryngoscope insertion and ease of intubation. It is suitable for use in predicted difficult airways.

The practical use of computed tomography in evaluation of shell lesions in six loggerhead turtles (Caretta caretta)

Six adult loggerhead turtles were found stranded and were rescued near Sicily within a period of 12 months. Macroscopically apparent lesions of the shell were present. After thorough physical examination, ketamine-dexmedetomidine-atipamezole induction and tracheal tube insertion all six patients underwent computed tomographic examination under inhalant anaesthesia with isoflurane. A vertebral lesion at the level of the 3&lt;sup&gt;rd&lt;/sup&gt; thoracic-lumbar vertebra with vertebral lamina and the vertebral body being involved without compression of the spinal cord, a vertebral lesion at the level of the 7&lt;sup&gt;th&lt;/sup&gt; thoracic-lumbar vertebra and a vertebral lesion at the level of the 8&lt;sup&gt;th&lt;/sup&gt; thoracic-lumbar vertebra were recorded in the first female. Loss of the shell near the left carapace-plastron bridge, with massive haemorrhage and compression of organs were present in the second female. The remaining four turtles had only superficial lesions with no involvement of bones and organs of the coelom. Computed tomography was proved to be a valuable non-invasive method for clinical examination of stranded sea turtles.

Pitfalls and peculiarities in chlorhexidine allergy

Chlorhexidine (CHX) is a synthetic biguanide available in different forms (diacetate, dihydrochloride, and digluconate) and used as an antiseptic. In the past few years, there has been a substantial increase in the number of CHX-containing products used in health care. Hypersensitivity reactions to CHX are increasingly reported and include allergic contact dermatitis, photosensitivity, fixed drug eruptions, asthma, and lifethreatening anaphylaxis. Here, we report 3 cases of anaphylaxis due to CHX with a particular course, highlighting possible pitfalls and peculiarities in CHX allergy.

Difficult tracheal tube insertion

Difficult direct laryngoscopy refers to inability on the part of the laryngoscopist to visualise the larynx because of anatomical abnormality or distortion of the larynx or trachea. There is, however, no mention in the literature of airways that appear to be simple during laryngoscopy and Cormach-Lehane grading , but turn out to be exceedingly difficult when actual insertion is being attempted. We consider that for such cases a new phrase, difficult tracheal tube insertion (DTTI), should be employed. Fortunately cases of DTTI can be managed successfully if smaller-size tubes are used or a malleable guide is introduced into the endotracheal tube prior to its insertion through the glottic opening.

A prospective, randomized comparative study for use of proseal laryngeal mask airway as an alternative to endotracheal intubation for airway management in children under general anesthesia

Introduction: Proseal laryngeal mask airway (PLMA) which is an upgraded modification of classic LMA, incorporating a gastric drainage tube lateral to the main airway tube which permits the regurgitated liquid gastric contents to bypass the glottis and prevents pulmonary aspiration. A prospective randomized interventional comparative study was performed to compare the efficiency of PLMA with a tracheal tube (TT) in pediatric patients with respect to number of attempts to placement of devices, hemodynamic responses and perioperative complications. Material and Methods: Sixty children, ASA physical status I and II weighing 10-20 kg between 2 and 8 years of age group of either sex undergoing elective infraumblical surgeries of 30-60 minutes duration, randomly divided into two group of 30 patients each. All patients were premedicated with IV midazolam and glycopyrrolate. General anesthesia with caudal epidural analgesia was given in all cases. IV propofal and sevoflurane was used for inducing general anesthesia. PLMA was inserted in group I and tracheal tube (TT) in patients of group II. In all cases after PLMA / TT insertion; caudal epidural analgesia was given and general anesthesia (GA) was maintained with O2, N2O and sevoflurane. Results: Ease of insertion was comparable in both the groups. There were no significant differences in mean oxygen saturation SpO2 (%) and end tidal carbon dioxide (ETCO2)) levels recorded at different time intervals between the two groups. However, highly significant changes in hemodynamic parameters were observed in the TT group. Complications such as nausea and vomiting (3.33%), sore throat (2%) and coughing (26.66%) were observed in the TT group. Conclusion: We concluded that PLMA could be used as an effective and safe airway device in children alternative to TT undergoing general anesthesia. Keywords: General anesthesia, Hemodynamic response, Paediatric, Proseal laryngeal mask airway, Tracheal tube

Cuff depth and continuous chest auscultation method for determination of tracheal tube insertion depth in nasal intubation: observational study.

Incorrect endobronchial placement of the tracheal tube can lead to serious complications. Hence, it is necessary to determine the accuracy of tracheal tube positioning. Markers are included on tracheal tubes, in the process of their manufacture, as indicators of approximate intubation depth. In addition, continuous chest auscultation has been used for determining the proper position of the tube. We examined insertion depth using the cuff depth and continuous chest auscultation method (CC method), compared with insertion depth determined by the marker method, to assess the accuracy of these methods. After induction of anesthesia, tracheal intubation was performed in each patient. In the CC method, the depth of tube insertion was measured when the cuff had passed through the glottis, and again when breath sounds changed in quality; the depth of tube insertion was determined from these values. In the marker method, the depth of tube insertion was measured and determined when the marker of the tube had reached the glottis, using insertion depth according to the marker as an index. Insertion depth by the marker method was 26.6 ± 1.2 cm and by the CC method was 28.0 ± 1.2 cm (P < 0.0001). The CC method indicated a significantly greater depth than the marker method. This study determined the safe range of tracheal tube placement. Tube positions determined by the CC method were about 1 cm deeper than those determined by the marker. This information is important to prevent accidental one-lung ventilation and accidental extubation. UMIN No. UMIN000011375.

The AirView Study: Comparison of Intubation Conditions and Ease between the Airtraq-AirView and the King Vision

We conducted a study assessing the quality and speed of intubation between the Airtraq with its new iPhone AirView app and the King Vision in a manikin. The primary endpoint was reduction of time needed for intubation. Secondary endpoints included times necessary for intubation. 30 anaesthetists randomly performed 3 intubations with each device on a difficult airway manikin. Participants had a professional experience of 12 years: 60.0% possessed the Airtraq in their hospital, 46.7% the King Vision, and 20.0% both. Median time difference [IQR] to identify glottis (1.1 [−1.3; 3.9] P = 0.019), for tube insertion (2.1 [−2.6; 9.4] P = 0.002) and lung ventilation (2.8 [−2.4; 11.5] P = 0.001), was shorter with the Airtraq-AirView. Median time for glottis visualization was significantly shorter with the Airtraq-AirView (5.3 [4.0; 8.4] versus 6.4 [4.6; 9.1]). Cormack Lehane before intubation was better with the King Vision (P = 0.03); no difference was noted during intubation, for subjective device insertion or quality of epiglottis visualisation. Assessment of tracheal tube insertion was better with the Airtraq-AirView. The Airtraq-AirView allows faster identification of the landmarks and intubation in a difficult airway manikin, while clinical relevance remains to be studied. Anaesthetists assessed the intubation better with the Airtraq-AirView.

Determination of tracheal tube insertion depth for dental procedure and oral and maxillofacial surgery

Determination of tracheal tube insertion depth for dental procedure and oral and maxillofacial surgery

Alfaxalone as an induction agent for anaesthesia in terrapins and tortoises

The aim of this study was to evaluate short-term intravenous anaesthesia with alfaxalone in chelonians. In the first part of the study, alfaxalone at a dose rate of 5 mg/kg...

Intubating laryngeal mask airway placement by non-physician healthcare providers in management out-of-hospital cardiac arrests: A case series

Aim of the studyThe role of supralaryngeal devices in airway management in out-of-hospital cardiac arrests (OHCA) remains controversial. The aim of this prospective observational trial was to evaluate the feasibility and effectiveness of intubating laryngeal mask airway (ILMA) when used by trained prehospital emergency nurses in the setting of OHCA. MethodsAfter approval from the Research Ethics Board, prehospital emergency nurses trained in placement of ILMA (Fastrach™, LMA Vitaid, Toronto, Ontario, Canada) followed a formal protocol for airway control during OHCA. The primary outcome was the success rate of ILMA placement, while secondary outcomes were success rate of tracheal intubation through the ILMA, and the incidence of regurgitation of gastric contents. ResultsDuring the study period, 302 ILMA placements were attempted by emergency nurses during OHCA resuscitation. After ILMA placement, but before attempt for intubation, ventilation was possible in 290 patients (96%). Obstruction or major leaks were observed in 12 patients (4%). Tracheal tube insertion through the ILMA was attempted in 265 patients, and was performed in 254 (95.8%). This allowed for proper lung ventilation through the tracheal tube in 242 cases whereas 12 tubes were esophageal or proved obstructed. Regurgitation of gastric contents occurred in 43 (14.2%) patients; in 23 cases before arrival of the first aid team, in 18 cases before ILMA placement, and in 2 cases after the ILMA placement. ConclusionThe use of ILMA for airway management by trained emergency nurses during OHCA resuscitation is feasible and allows for effective airway management. The success rate of tracheal tube placement through the ILMA was high. In addition, the incidence of regurgitation was lower when using the ILMA than that previous historical reports with face-mask ventilation.

To assess the efficacy of i-gel for ventilation, blind tracheal intubation and nasogastric tube insertion.

Background:The i-gel is a novel supraglottic airway device with a soft and non-inflatable cuff. In our study we attempted to evaluate the performance of i-gel as a ventilatory device, as a conduit to blind tracheal intubation using conventional polyvinyl chloride tracheal tube and gastric tube insertion through it.Materials and Methods:A total of 180 patients of American Society of Anesthesiologist (ASA) physical status I/II undergoing elective surgery under general anesthesia were included in this study. After induction of anesthesia, i-gel was inserted and the following parameters were recorded: Time taken for successful i-gel insertion, airway leak pressures, ease of gastric tube insertion and laryngeal view using fiberscope. Following this blind tracheal intubation was attempted. First attempt and overall success rate in blind tracheal intubation and gastric tube insertion were evaluated and tracheal intubation time was measured. Also presence of any side effects or complication following removal was recorded.Results:We achieved a 100% success rate in insertion of i-gel and in 171 out of 180 patients; i-gel was inserted in the 1st attempt itself. We also were able to achieve an overall success rate for blind endotracheal intubation via i-gel in 78.33% cases, and successful gastric tube placement was possible in 92.22%. In our study we also achieved a leak pressure of 25.52 (±2.33) cm of H2O.Conclusion:I-gel may be effectively used for ventilation, nasogastric tube insertion and as a conduit to blind endotracheal intubation with minimal complication and acceptable airway sealing pressures.

Alfaxalone anaesthesia in the green iguana (Iguana iguana)

The aim of this study was to evaluate short-term intravenous anaesthesia with alfaxalone in green iguanas (Iguana iguana). Alfaxalone at a dose rate of 5 mg/kg was administered to thirteen adult male green iguanas via the ventral caudal vein following 24 h fasting. The induction time, tracheal tube insertion time, surgical plane of anaesthesia interval, and full recovery time were recorded. Systolic, diastolic and mean arterial blood pressure (measured indirectly), pulse rate, respiratory rate, SpO2 and ETCO2 were recorded. The induction time and tracheal tube insertion time was 41.54 ± 27.69 s and 69.62 ± 37.03 s, respectively. The time from the alfaxalone administration to the loss of toe-pinch reflex was 2.20 ± 1.47 min. Full activity was restored 14.23 ± 4.15 min after the initial alfaxalone administration. The respiratory rate increased significantly (P &lt; 0.01) from 4.3. ± 3.2 to 6.8 ± 1.6 breaths per min and a gradual decrease of ETCO2 from 43.65 ± 10.54 to 26.58 ± 8.10 mmHg (P &lt; 0.01) was noted from the second to the 13th min after alfaxalone administration. The pulse rate, SpO2 and blood pressure did not change significantly. Intravenous use of alfaxalone proved to be a suitable and safe form for short term anaesthesia in green iguanas.