ABSTRACT
Background: The aim of this study is to predict difficult airway on the basis of various airway assessment parameter in the paediatric population between 5-12 years age group. To assess the value of modified Mallampati test (MMT), upper-lip-bite test (ULBT), thyromental distance (TMD), ratio of height to thyromental distance (RHTMD) from which Cormack Lehane grade was derived to predict difficult airway i.e. difficult intubation in paediatric patients ranging from 5-12 years age. Material and Methods: 100 ASA grade I & II paediatric patients of either sex between the age group of 5-12 years posted for elective surgery under general anaesthesia requiring endotracheal intubation were included in the study. Modified Mallampati test, upper lip bite test, thyromental distance and ratio of height to thyromental distance of the patients were measured and recorded. All the distances were measured with the help of a flexible measuring tape so as to measure the distances accurately. Results: Modified Mallampati test has the highest sensitivity (75%) and specificity (92.05%) among all the other screening tests. It also has high positive predictive value (56.25%), negative predictive value (96.43%) and diagnostic accuracy (90%). Upper Lip Bite test has high specificity (79.55%) and negative predictive value (93.33%) with high diagnostic accuracy (77%). It has a sensitivity of 58.33% which is similar to the sensitivity of thyromental distance and ratio of height to thyromental distance. Thyromental distance has high specificity (65.90%) with high negative predictive value (92.06%). Conclusion: Modified Mallampati test is a useful bedside screening test for predicting difficult intubation in patients between 5-12 years age group. The Upper Lip bite test and thyromental distance has high specificity with high negative predictive value and diagnostic accuracy. The ratio of height to thyromental distance is least useful predictor of airway assessment.
ABSTRACT
Background: Dexmedetomidine attenuates the hemodynamic stress response tolaryngoscopy and intubation more effectively compared with Lignocaine without any deleterious effects. To study the efficacy of Lignocaine 1.5 mg/kg & Dexmedetomidine 1 μg/kg in attenuating the hemodynamic pressure response to laryngoscopy & intubation. Material and Methods: A total of 100 American Society of Anesthesiologists (ASA) physical status I and II patients aged between 18 and 50 years undergoing elective surgery were enrolled in the study. Patients posted for elective surgery were randomly selected and divided into two groups. Group L = 50 Patients had given 1.5mg/kg Lignocaine; Group D = 50 Patients had given 1µg / kg Dexmedetomidin. Results: In Dexmedetomidine group, HR, SBP, DBP and MAP showed significant decrease throughout the study period, as compared to Lignocaine group. The statistical analysis shows that, in Dexmedetomidine group, HR, SBP, DBP and MAP showed significant decrease throughout the study period, as compared to Lignocaine group. Conclusion: Newer agents like Dexmedetomidine, a centrally acting alpha-2 agonist suppresses reflex sympathetic stimulation caused by laryngoscopy & intubation more effectively than Lignocaine. Thus, it is concluded that Dexmeditoedine is a better drug compared to Lignocaine in attenuating pressure response to laryngoscopy & intubation.