ABSTRACT
Background: To compare the safety and efficacy of Macintosh, McCoy and Truview laryngoscope in simulated difficult laryngoscopy using rigid neck collar in overweight patients. Methods: It was a Prospective, randomized, controlled clinical trial conducted in a tertiary care teaching hospital. Overweight patients (BMI= 25-29.9) with American Society of Anesthesiologists physical status I and II, age 18 to 60 years and scheduled recruited for elective surgery requiring general anesthesia with oral endotracheal intubation were included. The patients were divided into three groups comprising of 40 patients each in which Macintosh, McCoy and Truview laryngoscopes were used respectively. Difficult laryngoscopy was simulated using rigid neck collar. The primary outcome measure was modified Intubation Difficulty Score (IDS ). The secondary outcome measures were number of attempts, ease of intubation, overall success rate, time of intubation, Percentage of Glottic Opening score, hemodynamic parameters and complications. Results: The mean Intubation Difficulty Score was significantly lower with Truview Laryngoscope (1.68) as compared to Macintosh (4.21)and MacCoy (3.03) laryngoscopes. The median Percentage of Glottic Opening score was also significantly improved in the Truview group(78.21) compared to the other groups. Number of successful first intubation attempt was significantly higher in the Truview group(63.16%) compared to the other groups. The overall success rate was similar among groups. However, the time of intubation was significantly higher for Truview (41.21±2 sec) compared to Macintosh and McCoy laryngoscopes. Conclusion: The Truview laryngoscope allowed better glottic visualization, greater ease of intubation, fewer intubation attempts, but a longer intubation time compared to Macintosh and MacCoy laryngoscopes.
ABSTRACT
Introduction: RA affecting ~ 1% of the world population, is associated with high level of non-adherence in clinical practice.The adherence to RA treatment therapy is affected by multiple factors. The present study evaluated the factors affectingadherence to medications among RA patients.Methodology: The prospective study was conducted from April 2014 to March 2015. Male and female subjects, aged≥18 years, and diagnosed with RA were included in the study. Demographic data, disease- and treatment-related data,adverse event profile and investigation data were obtained from all the participants. Adherence to medication of thesubjects was measured using adherence questionnaire. All the subjects were followed up at one month and at the end of6 months. McNemar’s test was used to analyse the difference in adherence from baseline to follow up. All the statisticalanalyses were performed using SPSS statistical software, version 17.0.Results: The study included 124 subjects, with a male to female ratio of 0.25:1, mean age of 45 years and RA duration of5 years. Mono and combination drug therapies were used in 59.1% and 41.9% of the subjects respectively. Methotrexatewas the most frequently used drug as a part of the regimen (82.3%). Among the subjects, 88 (71%) were found to beadherent. The comparison of various factors revealed significant difference only for the duration of RA (P 0.04).Conclusion: The adherence to antirheumatic medications among RA patients remains moderate and factors such asrural residence and older age (>45 years) can be associated with good adherence to RA medication. The study alsocorroborates the previous literature evidence suggesting methotrexate as the commonly used drug for managing RA.
ABSTRACT
The Tulip® airway is a recently introduced single sized ventilating oropharyngeal airway. Methods: We performed a randomized, controlled study of lung ventilation by anaesthesia residents using either Tulip GT® airway or face mask with Guedel airway in 100 anaesthetised patients, where the ease of insertion, intracuff pressure and volume were measured, as were the end-tidal carbon dioxide levels, airway pressures and tidal volumes over first three breaths. Results: Successful ventilation was observed with Tulip airway which provided a patent airway in comparison to facemask with a Guedel airway but 15 patients required additional cuff volume in Tulip airway. Conclusion: We conclude Tulip® airway can be used as an adjunct for airway management even by inexperienced users.
ABSTRACT
Background: Awake fiberoptic intubation is the gold standard technique for the management of the predicted difficult airway. The patient’s tolerance and the success of fiberoptic-assisted nasotracheal intubation depends on the effectiveness of topical anaesthesia. Aim of this prospective randomized comparative study was to compare three techniques of spray-as-you-go using topical anaesthesia, namely lignocaine injected through working channel, epidural cathether and angiographic cathether taking into consideration - severity scale, patient reaction score, intubation time, total dose of lignocaine and complications in patients during intubation. Methods: Sixty ASA 1 or 2 patients of either sex aged 18-60 yrs scheduled for elective surgery with predicted difficult airway were equally divided into three groups(n=20),received 0.1% xylometazoline in both nostrils and 10% lignocaine sprayed into nares and posterior pharyngeal wall. Thereafter patients received 6ml of 4% lignocaine in four aliquots either by working channel in group A, or via epidural catheter in group B, or via angiographic catheter in group C along with oxygen attached through three way tap proximally. Intubation time, reaction score, cough count, stridor, extra local anaesthetic requirement, severity score were recorded. Vital parameters blood pressure, SpO2, ECG, pulse rate were monitored. Results: Group A patients showed shorter intubation time (p<0.0005) with better severity score and less local anaesthetic requirement maintaining stable vital parameters with lower incidence of cough. Reaction score was better in group A than Group B & C. Conclusion: In conclusion spraying directly through the working channel along with oxygen provided effective local anaesthesia and was preferred by both patient and endoscopist.