Comparative study of a standard Macintosh blade III and a modified Optic Viewmax blade II for endotracheal intubation

The availability of a laryngoscope blade that could improve visualization of glottic structures without requiring excess traction force during tracheal intubation would be helpful in reducing the perioperative complications related to laryngoscopy. The Viewmax laryngoscope blade II [Rusch] is a modified laryngoscope blade which incorporates an unmagnified optic side port to a standard Macintosh [MAC] blade III. This modification allows for an alternative view of the glottis from a position 1 cm behind the left tip of the blade while still allowing the standard direct view provided with MAC-3 blade during tracheal intubation. In this study, we compared the Viewmax to a standard MAC-3 blade using a randomized cross-over study design. Fifty six patients ASA physical status I and II requiring tracheal intubation were enrolled in this study. The preanesthesia airway evaluation included Mallimpoti score, thyromental distance, and maximal mouth opening. Anesthesia was induced with propofol 2 mg/kg and fentanyl 50-100 mg, followed by rocuronium 0.6 mg/kg IV for muscle relaxation. According to a randomization, either the standard MAC-3 blade [Mac Group] or Viewmax II blade [Viewmax Group] was first chosen for laryngoscopy. After viewing the laryngeal structures, the first blade was withdrawn and the second blade [MAC or Viewmax] was used to repeat the laryngoscopy. A strain gauge laryngoscope handle was used with both blades to measure the peak axial force applied at the handle by the anesthesiologist during the laryngoscopy. After viewing the laryngeal structures with the second blade, tracheal intubation was performed in all patients. The views of laryngeal structure during laryngoscopy were classified by the anesthesiologist as: Grade 1= most of the glottis is visible; Grade 2 = only the posterior portion of the glottis is visible; Grade 3 = only the epiglottis is visible; and grade 4 = only the soft palate is visible. Anesthesiologist's satisfaction with the Viewmax laryngoscope was evaluated using a verbal score from 0 to 100. Our results showed that there were no significant differences in the laryngoscopic views between the two blades. However, the use of Viewmax blade was associated with lower percentage of laryngoscopic views grade III and IV compared to MAC blade. The recorded force applied to the laryngoscope handle during laryngoscopy was significantly less in Viewmax group compared to MAC group. The view of the laryngeal structures with Viewmax 11 blade was comparable to the MAC-3 blade. However, the use of Viewmax blade required less axial force applied at-the handle during the laryngoscopy

Mycotic venous aneurysms in cases in autogenous arteriovenous fistulae for chronic haemodialysis

Mycotic venous aneurysms are presently met with due to the repeated needling of the autogenous arterio-venous fistulae established for chronic hemodialysis. Twenty-four cases were studied. The average age was 40.3 years. The male to female ratio was 5:1. The interval form the establishment of the fistula to the mycotic aneurysms was 4.6 months. The fistula was radio-cephalic in 75% of cases and brachio-cephalic in 25% of cases. In two thirds of cases the mycotic aneurysm was near the site of the fistula and distant in the rest. Diagnosis was easy due to the subcutaneous site and peripheral situation along with the repeated examination of this region during hemodialysis Staph. aureus was the responsible organisms in 83.3% of the cases. Patients were treated by dismanteling of the fistula, ligation of the vein together with excision and drainage of the aneurysm and the infected tissues

Mycotic arterial aneurysms

Fifteen patients with mycotic arterial aneurysms were studied. Fourteen were males with the age averaged 40 years. Pain, palpable swelling, fever and leucocytosis were the commonest clinical features. The source of infection was due to invasive procedure or bullet injury in 11 and unknown in 4. Staphylococcus aureus was the commonest organism [60%]. The common femoral artery was frequently affected, but no peripheral artery was immune. Resection and drainage was the main line of treatment. Reconstruction was attempted if the lesion was encapsulated and restoration of blood flow was essential to the vitality of the limb. A bypass procedure through noninfected area with autologous vein using monofilament sutures was the method recommended

Popliteal vein entrapment two cases report

The present study was conducted to evaluate clinically and pharmacologically a modified method for protamine sulfate administration during heparin reversal, so as to overcome the systemic hypotension, which commonly occurs as a side effect after protamine infusion. The modified method is as follows: One third of the calculated dose of protamine is given slowly i.v. over 3 minutes and after 3 minutes the remaining two thirds of protamine is given over another 3 minutes. The clinical and pharmacological results of this study showed that, this method of protamine administration has the advantage that it is devoid of any effect of the arterial blood pressure both in humans as well as in experimental animals. In a trail to detect the possible site of action of such vasodepressor effect, which followed protamine administration in heparinized, but not unheparinized animals. The experimental work showed that the hypotension is probably reflex in nature, as it disappeared completely in spinal animals, atropinized animals, animals in which both vagi are excised and in animals in which a ganglion blocker was given