Comparison between lignocaine nebulization and airway nerve block for awake fiberoptic bronchoscopy-guided nasotracheal intubation: a single-blind randomized prospective study / 대한마취과학회지

BACKGROUND: The preferred management strategy for difficult airways is awake fiberoptic bronchoscopy-guided intubation, which requires effective airway anesthesia to ensure patient comfort and acceptance. This randomized single-blind prospective study was conducted to compare lignocaine nebulization and airway nerve block for airway anesthesia prior to awake fiberoptic bronchoscopy-guided intubation. METHODS: Sixty adult patients scheduled for surgical procedures under general anesthesia were randomly allocated to two groups. Group N received jet nebulization (10 ml of 4% lignocaine) and Group B received bilateral superior laryngeal and transtracheal recurrent laryngeal nerve blocks (each with 2 ml of 2% lignocaine) followed by fiberoptic bronchoscopy-guided nasotracheal intubation. All patients received procedural sedation with dexmedetomidine. The intubation time, intubating conditions, vocal cord position, cough severity, and degree of patient satisfaction were recorded. Student’s t test was used to analyze parametric data, while the Mann-Whitney U test was applied to non-parametric data and Fisher’s test to categorical data. P values < 0.05 were considered statistically significant. RESULTS: The time taken for intubation was significantly shorter in Group B [115.2 (14.7) s compared with Group N [214.0 (22.2) s] (P = 0.029). The intubating conditions and degree of patient comfort were better in Group B compared with Group N. Although all patients were successfully intubated, patient satisfaction was higher in Group B. CONCLUSIONS: Airway nerve blocks are preferable to lignocaine nebulization as they provide superior-quality airway anesthesia. However, nebulization may be a suitable alternative when a nerve block is not feasible.

Comparison of predictors of difficult intubation

Context: Unanticipated difficult laryngoscopy and tracheal intubation always remain a primary concern for an anaesthesiologist as the failure to maintain a patent airway during induction of anaesthesia may lead to anaesthesia related morbidity and mortality. Aims: The aim of our study was to predict difficult intubation and to identify best predictor(s) among them and also to compare the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of various airway parameters.Airway parameters taken in our study were Modified Mallampati Classification (MMT), Thyromental Distance (TMD), Sternomental Distance (SMD), Interincisor Gap (IIG), Upper Lip Bite Test (ULBT), Degree of Neck Extension (DNE), Anterior Subluxation of Mandible (ASM) and Protruding Teeth (PT). Methods and Material: 350 patients of ASA Grade 1 and 2 scheduled for various elective surgeries under general anaesthesia were included in our study and were assessed preoperatively for different airway parameters. Intraoperatively all patients were classified as difficult and easy intubation group according to Cormack and Lehane laryngoscopic view. Clinical data of each test was collected, tabulated and analyzed to obtain the sensitivity, specificity, positive predictive value and negative predictive value. Results: The upper lip bite test had the highest sensitivity (80%); Anterior subluxation of mandible had highest specificity (99.06%) and both of above were most accurate tests. The overall incidence of difficult intubation was 8.57%. Conclusion: Upper lip bite test was the best predictor of difficult intubation and it should be included as a routine test along with Modified mallampati test in preanaesthetic evaluation.

Anesthetic management of a patient with atrial fibrillation posted for emergency exploratory laparotomy for perforation peritonitis: a review of literature

Atrial fibrillation is very common cardiac arrythmia which is encountered during the perioperative period.Atrial fibrillation in perioperative period may lead to haemodynamic impairment and thromboembolic events resulting into significant morbidity and mortality.So it is very crucial for an anesthesiologist to maintain the haemodynamic stability of the patient with atrial fibrillation and prevent furthur complications associated with it.Here we report a case of forty year old female patient posted for emergency exploratory laparotomy for perforation peritonitis with pre-existing atrial fibrillation

Comparison of intubating conditions and hemodynamics during rapid sequence induction and intubation using propofol and rocuronium with low dose ephedrine and without ephedrine

Background: Rocuronium, a non-depolarizing neuromuscular blocking agent, has been used for rapid sequence induction and intubation, as it has rapid onset and acceptable intubating conditions at higher doses. Propofol, when used as an induction agent reduces cardiac output, thereby may decrease delivery of neuromuscular blocking agent at neuromuscular junction and thereby time of onset of action of rocuronium can be increased. Ephedrine has been described to speed up the onset of action of rocuronium and provide better intubating conditions during induction of anesthesia. We conducted this study to quantify the effect of ephedrine on intubation conditions and hemodynamic profile during induction of general anesthesia with propofol and rocuronium

Methodology: Sixty adult patients of ASA Grade 1 and 2, aged between 18-55 years scheduled for various elective surgeries under general anesthesia, were randomly allocated into two groups with 30 patients in each group; Group A [n = 30] received inj ephedrine 70 microg/kg followed one minute later by propofol 2.5 mg/kg with rocuronium 0.6 mg/kg and Group B [n = 30] received normal saline followed one minute later by propofol 2.5 mg/ kg and rocuronium 0.6 mg/kg. Intubating conditions and hemodynamic parameters were assessed in both groups

Results: The demographic data and baseline hemodynamic parameters were comparable between the two groups, [P > 0.05]. However, there was a significant difference in hemodynamic parameters after induction in both groups, [P < 0.05] but clinically the difference was insignificant. The intubating conditions were significantly better in Group A as compared to Group B, [P < 0.05]

Conclusion: The use of low dose ephedrine before induction with propofol and rocuronium [0.6 mg/kg] provided better intubating conditions as compared to induction with propofol and rocuronium alone at 60 seconds. The variations in hemodynamic parameters were found to be statistically significant but clinically insignificant from their baseline values