review of hemodynamic response to the use of different types of laryngoscopes

Endotracheal intubation is the gold standard in airway management either as a means to administer general anesthesia or for mechanical ventilation in critically ill patients for protecting the airway when the airway reflexes are dysfunctional. Macintosh laryngoscope is the standard laryngoscope used for intubation though advances in science have resulted in development of laryngoscopes of different designs. The process of laryngoscopy and intubation [L and I] can result in significant hemodynamic response and this is a topic of debate and research in anesthesia. A comprehensive review of hemodynamic responses to various laryngoscope designs has been undertaken here. Tracheal intubation contributes to more hemodynamic response compared to laryngoscopy alone. The hemodynamic responses to L and I are exaggerated in the elderly and those with uncontrolled hypertension. Orotracheal intubation causes less hemodynamic response as compared to nasotracheal intubation. Laryngoscope design, duration of L and I and the forces applied on the laryngoscope all contribute to hemodynamic fluctuations. McCoy blade and videolaryngoscopes where L and I can be performed without the aid of stylets provide better attenuation of hemodynamic response compared to intubation using the Macintosh laryngoscope. Fibreoptic orotracheal intubation with the aid of combined lingual traction and jaw thrust maneuver provides superior attenuation of hemodynamic response compared to use of laryngoscope

Comparison of intrathecal fentanyl and midazolam for prevention of nausea-vomiting during cesarean section under spinal anesthesia

Nausea and vomiting remain as [the big little problem] in cesarean section underspinal anesthesia. Incidence of nausea-vomiting during and immediately after surgery in spinal anesthesia is high. It is physically as well as mentally distressing to the patient and disturbing to the surgeon and the anesthesiologist. Purpose of this study was to compare the clinical efficacy of intrathecal fentanyl and midazolam for prevention of nausea-vomiting in parturients undergoing cesarean section under spinal anesthesia. This prospective randomized double blind study was conducted in 90 women aged between 18-31 years [ASA physical status I] scheduled to undergo elective cesarean section under spinal anesthesia. Subjects were randomly divided into three equal groups. Group A received 0.5 ml normal saline, Group B received 2 mg midazolam and Group C received 12.5 micro/g fentanyl with 2 ml of hyperbaric bupivacaine 0.5% intrathecally. Nausea-vomiting was assessed according to Belville's score. The statistical analysis of data was done by using statistical package for social science [SPSS] evaluation version 20. Results were expressed as mean, standard deviation, and range values. Frequencies expressed as number and percentage. ANOVA was used for multiple group comparisons, and categorical data were analyzed by Chi-square test. 24 subjects out of 30 in the placebo group developed intraoperative and early postoperative nausea-vomiting compared to 11 in midazolam group and 8 in fentanyl group. Incidence of intraoperative and early postoperative nausea-vomiting was 79.5% with placebo, 36.6% with midazolam and 26.6% with fentanyl. Intrathecal fentanyl 12.5 microg or midazolam 2 mg, both reduce the incidence and severity of nausea-vomiting when administered with bupivacaine for cesarean section

Dexmedetomidine as an adjuvant to hyperbaric spinal bupivacaineforinfra-umbilical procedures: a dose related study

Various adjuncts have been used with local anesthetics in spinal anesthesia to provide good quality of intra-operative and better post-operative analgesia. Dexmedetomidine is a new

Perioperative anesthetic management for cesarean section in patients with cardiac disease

The perioperative anaesthetic management of a pregnant patient with pre-existing cardiac disease undergoing caesarean section poses a challenge for an anaesthesiologist. The anaesthesiologist must have the knowledge of its pathophysiology, clinical features, diagnostic evaluations and anaesthetic modalities and various drug interactions during anaesthesia. This review summarises the current management of a parturient with cardiac disease requiring surgical delivery

Awake rigid bronchoscopy for post intubation tracheal stenosis

Prolonged tracheal intubation is a common cause of tracheal stenosis. These patients may present with respiratory insufficiency and stridor of insidious onset and progressive nature. Immediate management includes securing the airway which requires anesthesia. We present successful management of a case of post intubation tracheal stenosis using rigid bronchoscopy under a combination of regional and general anesthesia