Murphy’s Eye: A Last Moment Saviour for Anaesthesiologist In Case of Surgery for Recurrent Vocal Cord Polyposis.

Securing the airway in Juvenile papillomas of the vocal cords and trachea is sometimes hazardous and potentially lethal. In our case, when such patient was planned under GA, her right sided chest developed decreased air entry with varying degree of severity, while her left side chest presented as silent chest gradually during surgery. On exploration, the possible reason for ventilation on the right side was found to be the presence of Murphy’s eye, which functioned as a vent, when the primary distal opening of an ETT became occluded.

A Comparative Study of Fentanyl and Dexmedetomidine in Attenuating Haemodynamic Response of Laryngoscopy and Intubation.

Background: Dexmedetomidine is a centrally acting alpha-2 adrenoceptor agonist. In this study, we compared dexmedetomidine to fentanyl in attenuating sympathetic response to laryngoscopy and tracheal intubation. Methods: Eighty ASA grade I-II patients requiring tracheal intubation were included in this prospective study and were randomly assigned to the dexmedetomidine (Group D) and fentanyl group (Group F) (40 patients in each group). Both the drugs were given at 1 μg/kg dose prior to laryngoscopy. We assessed heart rate, blood pressures and complications (bradycardia, hypotension and sedation). Results: The two groups were comparable in demographic parameters. The baseline mean heart rate (P=0.94) was not significantly different between Group F and Group D. Increase in heart rate after laryngoscopy and intubation was significantly lower in Group D compared to Group F (P=0.039). Mean heart rate remained lower at one minute after intubation in Group D but it was not statistically significant (94.64 s vs 86.28 sec). The difference in mean heart rate between two groups was comparable at three, five, ten and fifteen minutes after intubation. The baseline Mean arterial pressure was comparable between the groups (P=0.83) and remained similar throughout 15 minutes after intubation. Group D showed significant hypotension compared to Group F (P=0.03), whereas there was no significant bradycardia between these groups (P=0.19). Mean sedation score is higher in Group D compared to Group F. Conclusion: At 1 μg/kg dose, both dexmedetomidine and fentanyl cause partial attenuation of sympathetic response to laryngoscopy and intubation but dexmedetomidine blunts this response more effectively than fentanyl.