A Comparative Study Between Rocuronium And Succinylcholine In Evaluating Endotracheal Intubating Conditions In Day Care Surgeries

Background: Succinylcholine has been the main neuromuscular blocking agent for the endotracheal intubation in rapid sequence induction with some adverse effects. This study was conducted to find a better alternate drug with minimal adverse effects and easy for intubations. Thus, our study aimed to compare the onset time, duration of action, intubating condition and hemodynamic effect of rocuronium bromide at the dose of 0.8 mg/kg and Succinylcholine at the dose of 1.5 mg/kg. Materials and methods: A double blinded randomized control study was conducted among 60 patients undergoing surgery each groups having 30 patients, Duration of action, Hemodynamic parameters, and intubating conditions were assessed after administering drugs in each group. Appropriate statistical tests were applied P value < 0.05 was considered to be significant Results: The mean of onset of action of succinylcholine is significantly shorter than that of rocuronium (48.07 ± 4.04 Vs 74.4 ± 9.1); and duration of action succinylcholine is significantly shorter than that of the rocuronium (3.85 ± 0.33 Vs 44.4 ± 4.7). Both the drugs significantly elevated mean Heart rate, Systolic Blood Pressure, Diastolic Blood pressure, MAP from intubation to subsequent intervals. Conclusion: The rocuronium bromide (0.8 mg/kg) has longer duration of action and slower onset of action than succinylcholine (1.5 mg/kg) with excellent intubating condition and minimal alteration in hemodynamic profile. Hence rocuronium bromide (0.8 mg/kg) can be used as an alternative to Succinylcholine (1.5 mg/kg) in selected situations.

Intubating Conditions Under Non-Depolarizing Muscle Relaxants – A Comparative Study

Introduction: In conditions like significant burns,traumatic injuries or an abdominal infection succinylcholineadministration could be hazardous as it is associatedwith dangerous hyperkalemia. Vecuronium, atracuriumand Pancuronium not only are the alternatives but alsooffer skeletal muscle relaxation at shortest intervals postintubation. We assessed the intubating conditions achievedand the hemodynamic effects of pancuronium, vecuronium,and atracurium among patients undergoing routine surgicalprocedures requiring general anaesthesia.Material and methods: A prospective randomized trial wascarried out among 60 participants aged 15-56, who were inthe good physical condition and belonged to ASA I or ASAII categories.study was conducted at Civil Hospital, AizawlMizoram. The patients were randomly allocated to 3 groups oftwenty each viz, Group A, Group B and Group C. Followinginduction of anaesthesia Inj. Pancuronium bromide 0.1 mg/kg.was given to Group A; Inj. Vecuronium 0.1 mg/kg to GroupB. and Inj. Atracurium 0.6 mg/kg to Group C. Pulse rate andblood pressure were recorded immediately and time intervalafter intubation.Results: The apnoea time was longest in group A (57±7seconds) followed by group C (50±14 seconds) and groupB (49±8 seconds). The mean pulse rate, however, variedsignificantly post-intubation across the three groups. Theintergroup comparison showed a significantly higher rise ofthe mean arterial pressure in group A compared with group Bat all corresponding tie intervals in the post intubation period.Conclusion: Though all the three skeletal muscle relaxantsprovided adequate intubating conditions, Vecuronium offeredthe shortest intubation time while the Pancuronium took thelongest time.

Intubating Laryngeal Mask Airway as an Independent Ventilatory and Intubating Device in Lateral Position: A Fibreoptic Study

Sudden airway loss during surgery in a laterally positionedpatient may have hazardous consequences. We studiedwhether the intubating laryngeal mask airway (ILMA) facilitatesfibreoptic guided tracheal intubation in patients positioned inthe lateral position. Anesthesia was induced with propofol,fentanyl, and rocuronium in 90 consenting patients of eithersex, weighing 50-70 Kg undergoing surgery. Patients wererandomized to three groups (n=30 each); Group 1 (Controlgroup) Supine position, or positioned on their right or left sides(Group 2 and Group 3 respectively) before induction of generalanesthesia. ILMA insertion and fibreoptic guided intubation wasperformed in that position. The grade of the glottic view, timerequired for intubation and number of adjusting maneuversused were recorded. Data were compared by ANOVA, multiple‘t’ test and chi(2) test. Demographic and airway measureswere similar in the three groups. The time required for ILMAinsertion (<30 secs) and success rate was similar in threegroups. The time to intubation was also similar ineach group (15.24±3.4719.68±17.29 secs, 19.35±11.83 secsin Groups 1, 2, 3 respectively; p = > 0.05), as was intubationsuccess (97.7%). Hence ILMA offers a frequent success rateand a clinically acceptable intubation time (<1 min) even in thelateral position.

Evaluation Of Intubating Conditions With Rocuronium By Priming Technique. A Randomized Double Blind Study

BACKGROUND: a prospective, randomized, double-blind study was designed to evaluate the effects of priming technique with rocuronium bromide for intubation in adult patients undergoing surgical procedures.METHODS: sixty adult patients of 20-60 years of age with asa-1 physical status posted for surgical procedures were divided in to two groups. group c received normal saline (2ml) as priming dose and group p received 0.06mg/kg rocuronium (2 ml) as priming dose and after 3 minutes intubating dose group c received 6 mg /kg (5 ml) group p received the 5.4 mg /kg (5 ml) as intubating dose .muscle relaxation was assessed with nerve stimulator for every 10 seconds and assessed visually for loss of adduction of thumb and disappearance of t1 of train of four (TOF) stimuli. By this we can note the onset time of intubation (Ti) and intubating conditions were assessed buy cooper et al scoring system. Any adverse effects were also noted.RESULTS: The mean onset of intubation time (Ti) in the group P was 52.33±6.79 sec, in the group C was 95.67±11.04 sec ,P value is 0.00 it is highly significant. Minimum Ti is 80 sec. and maximum Ti is 120 sec. intubation scores as per “cooper et al scoring”were 8 or 9 in both the groups. There were no incidences of weakness, aspiration, bradycardia, ptosis, hypotension, in either of the groups during study observation.CONCLUSION: administration of Priming dose of rocuronium before the intubating dose causes the onset of neuromuscular block is rapid and onset time of intubation is became comparable to that of suxamethonium with excellent intubating conditions and without adverse effects.

A prospective, randomized controlled study to compare the intubating conditions achieved with suxamethonium and rocuronium bromide

Background: Endotracheal intubation is required for giving general anesthesia for which adequate muscle relaxation is necessary Suxamethonium is still used as a relaxant for endotracheal intubation Rocuronium, a nondepolarizing muscle relaxant was compared here for tracheal intubating conditions Aim of the study: To compare the intubating conditions achieved in patients undergoing elective surgeries under General Anaesthesia with Suxamethonium or Rocuronium in 60 secs and complications in both groups Materials and methods: This study was conducted in Institute of Anaesthesiology and Critical care at Madras medical college, Chennai during the period 2014 – 15100 patients of ASA I and II were divided randomly into 2 groups undergoing elective surgeries: Group I - Suxamethonium Group II - Rocuronium assessed for intubating conditions after administration of the corresponding drug Results: The intubating conditions were excellent in group I Suxamethonium as against Group II Rocuronium in 60 secs According to the cooper scoring system the scores of vocal cord movement in group I (Suxamethonium) was 268 (mean) ± 0471 and in group II (Rocuronium) was 234±0557, the scores of response to intubation in group I (Suxamethonium) was 298±0141 and in group II (Rocuronium) was 270±0463 with better intubating conditions in group I receiving Suxamethonium than Rocuronium The results were significant with a p-value of<005 whereas the scores of jaw Stalin R, Raja Manikandan S A prospective, randomized controlled study to compare the intubating conditions achieved with suxamethonium and rocuronium bromide IAIM, 2018; 5(12): 72-76 Page 73 relaxation in group I patients (Suxamethonium) was 270 (mean)±0463 and group II patients (Rocuronium) was 252±0544 with better jaw relaxation Conclusion: Rocuronium can be used as an alternative when suxamethonium is contraindicated for rapid intubation but not if the anticipated difficult airway is present Rocuronium can be chosen as an alternative to it even in rapid sequence intubation in emergency cases, provided the airway is properly assessed and no anticipated difficult intubation is present

A Comparative Study of the Effect of Priming and Sevoflurane on Intubating time and Intubating Conditions with Rocuronium as Intubating Agent in Neurosurgical Patients.

Background: Rocuronium provides good intubating conditions but large doses causes prolongation of its duration of action, making it unsuitable for short surgical procedures. Aims: This study was designed to compare the effects of rocuronium with 3min priming interval and 2% sevoflurane on the time of intubation and intubating conditions. Methods: the study design is that of randomized, prospective double‑blind trial. Forty five adult patients were randomly allocated into three equal groups: Group R received 0.8 mg/kg rocuronium, Group RS received 0.8 mg/kg of rocuronium with 2% sevoflurane andGroup RP patients received a priming dose of 0.08 mg/kg of rocuronium followed by 0.72 mg/kg rocuronium 3 min later. Onset time of intubation, intubating conditions and time for loss of thumb adduction were assessed. Analysis of variance (ANOVA) test was used to compare the demographic data and intubating conditions among the groups.Intergroup comparison between R and RS,R and RP,RS and RP of the time for intubation and time for the loss of thumb adduction were done using student t test. A P value <0.05 was considered significant. Results: The onset time of intubation (loss of T1 of TOF) was 100.53+2.03s in group 62.9+1.9 s in-group RS, and 61.88+1.9s in group RP. The time for the loss of thumb adduction in R,RS,RP were 98.53+2.03, 60.93+1.9, 60+2.12 respectively. There is statistical significance p=0.001 between R and RS ,R and RP group while comparing the onset time for intubation and time for the loss of thumb adduction. Mean intubating scores were excellent in all the three groups.Conclusion: Both rocuronium (0.08mg/kg) along with 2% sevoflurane and priming principle for rocuronium provide excellent intubating conditions within 60-66 sec in neurosurgical patients.

Timely Intervention Instead of the Type of Equipment Does Change the Outcome in a Life Threatening Condition: A Case Report.

We report a case of use of semi rigid intubating bougie to intubate a patient with large thyroid swelling in life threatening airway emergency in the absence of sophisticated equipments.

Awake endotracheal intubation using a video-assisted intubating stylet in a patient with a large supraglottic mass: A case report

A 70-year-old man was scheduled for laryngeal microsurgery for supraglottic tumor. A preoperative indirect laryngoscopy demonstrated a large tumor obstructing the most of glottic opening. To prevent damage to the tumor during advancement of the endotracheal tube (ETT), an awake intubation assisted by Clarus Video System (CVS), was planned. Ten percent lidocaine spray was applied to the oropharynx. After sufficient preoxygenation, the patient was lightly sedated with continuous remifentanil and propofol infusion. The CVS, loaded with an ETT (inner diameter of 5.5 mm), was inserted orally by the anesthesiologist. The tube was carefully slid off the stylet into the glottic opening under direct vision. The anesthesiologist also confirmed that there was no damage to the tumor during intubation.

Application of Intubation Laryngeal Mask in Laparoscopic Anesthesia for Elderly Patients with Hypertension / 中国微创外科杂志

Objective To investigate the application of intubation laryngeal mask in laparoscopic anesthesia for elderly patients with hypertension. Methods A total of 80 patients ( ASA Ⅱ -Ⅲ) over 70 years old undergoing laparoscopic gastrointestinal and gallbladder surgery from March 2014 to February 2015 were selected.They were randomly divided into the intubating laryngeal mask group ( ILMA group) or endotracheal tube group ( ET group) , with 40 patients in each group.After the intubation, the two groups were anesthetized with remifentanil by target-controlled infusion ( TCI ) and sevoflurane inhalation.The ILMA group was inserted matching laryngeal mask to control respiratory ventilation and deepened to the proper depth of anesthesia.An endotracheal tube were inserted through the mask 5 min later, and then the breath was controlled via transtracheal catheter to maintain anesthesia.The ET group was inserted tracheal intubation after induction, and then the breath was controlled until extubation after the recovery of the tracheal extubation after surgery.The heart rate (HR), blood pressure (SBP and DBP) and bispectral index (BIS) were recorded at time points of before induction (T0), laryngeal mask or endotracheal tube insertion (T1), after endotracheal tube insertion (T2), skin incision (T3), beginning tissue dissection or entry of laparoscope (T4), resection of organs or tissues (T5), and tracheal extubation ( T6 ) , respectively.In addition, the recovery time, the recovery of spontaneous breathing, complications during the recovery time, such as restlessness, nausea and vomiting, were observed and compared. Results There were significant differences in HR, SBP, DBP, BIS between the two groups and among different time points (P=0.000).At time points of before operation ( T0 -T2 ) and anesthesia maintaining stage ( T3 -T6 ) , the HR, SBP, DBP and BIS were stable in both groups.At the time points of after endotracheal intubation ( T2 ) and extubation ( T6 ) , the ET group had significantly increased HR, SBP, and DBP, which were higher than the ILMA group (P<0.05).At the time point of T6, the BIS values were significantly increased in the ET group than the ILMA group (P<0.05).On postoperative recovery quality, the time from anesthesia to spontaneous breathing recovery and from end of surgery to call to open eyes was significantly longer in the ET group than the LIMA group [(130.1 ±26.1) min vs. (96.4 ±24.5) min, t=5.94, P=0.000;(16.1 ±2.7) min vs.(5.5 ±2.2) min, t=19.07, P=0.000]. Conclusion For elderly patients with hypertension undergoing laparoscopic surgery, use of intubation laryngeal mask for anesthesia is more stable and has less adverse cardiovascular reactions, with good outcomes of anesthesia recovery.

Comparison of Disposcope endscope and GlideScope vedio laryngoscope in the application of double-lumen endobronchial intubation in difficult airway / 临床麻醉学杂志

Objective To evaluate and compare the clinical applications of Disposcope (DS)en-doscope and GlideScope (GS)video laryngoscope in double-lumen endobronchial tube (DLT)intuba-tion of the patients with difficult airway.Methods Forty patients scheduled for elective thoracic sur-gery after failure to place the DLT with modified general laryngoscope 2 attempts were randomly dev-ided into 2 groups,20 cases in each group.Patients underwent DLT with DS (group DS)or GS (group GS)intubation after failure to intubation.The causes of the failure of intubation,the intuba-tion of the video laryngoscope,the time of intubation and the location of left double lumen tube were recorded.And the postoperative injury of oral mucosa,teeth and respiratory tract were observed. Results The causes of the difficulty for DLT intubation included:long,high arched palate,large epi-glottis,reduced jaw opening,protruding or loose incisors,over bite,reduced neck extension.The in-tubating achievement ratio was significantly higher in group DS than in group GS (P < 0.05 ).But there was no obvious difference between the two groups in the location success rate and intubation time.The postoperative incidence of tooth loss and oral mucosal injury was significantly higher in group GS than in group DS (P <0.05).Conclusion Both DS and GS were great helpful to intubation and location of DLT in the patients with difficult airway.But DS was more superior than that of GS in the difficult airway of reduced jaw opening,protruding or loose incisors,over bite and reduced neck extension.

A comparative study of overall efficacy and hemodynamic effects following blind oro-tracheal intubation with ILMA vs. conventional direct laryngoscopy guided intubation with Macintosh laryngoscope.

Intubating Laryngeal Mask Airway (ILMA) is a new device to guide blind oro-tracheal intubation thus offering a new approach for endotracheal intubation and is expected to produce less sympathetically driven haemodynamic stress response. The purpose of this study was to assess overall efficacy, haemodynamic advantage and complication rate with use of ILMA compared to conventional method of endotracheal intubation with use of Macintosh Laryngoscope (ML). Methods: This randomized controlled study was conducted on 60 adult patients comparable in age, sex, weight, MPC and ASA status scheduled for elective surgeries. Patients were randomly allocated into two groups of 30 each. Both the groups received similar balanced anaesthesia technique (Inj. fentanyl 2 μg/kg, propofol 2-2.5 mg/kg, rocuronium 1 mg/kg). Tracheal intubation was done using either ILMA or Macintosh laryngoscope. The intubation time, number of attempts required for successful intubation, haemodynamic changes and oro-pharyngo-laryngeal complications encountered during both the methods were recorded. Results: Time to intubation was comparatively longer in the ILMA group than laryngoscopy group (P <0.05). The success rate of intubation was 100% in both the groups. Overall haemodynamic changes in both the groups were statistically comparable (P >0.05) and ILMA appears to be offering no haemodynamic advantage over ML. The incidence of complications was rare and comparable amongst both the groups (P >0.05). Conclusions: Therefore in patients with normal airway blind intubation with ILMA is a successful and equally efficacious method without significant oro-pharyngo-laryngeal morbidity but offers no added haemodynamic advantage compared to conventional direct laryngoscopy with ML. Thus ILMA may act as a suitable alternative to ML for patients with normal airway.

El tubo endotraqueal no protege contra la aspiración de un cuerpo extraño hacia adentro de la tráquea: reporte de caso / The endotracheal tube does not protect the aspiration of a foreign body in the trachea: A case report

RESUMEN Describimos el caso del corte inadvertido de una sonda introducida por la nariz para medir la temperatura intraquirúrgica, en un paciente de 26 años. El segmento faltante de la sonda se recuperó de la tráquea, un sitio inusual en vista de la presencia del tubo endotraqueal con balón. Este caso sirve para recordar que el tubo endotraqueal con balón no protege necesariamente a la vía aérea contra la aspiración de cuerpos extraños sólidos provenientes de la vía oral o la vía nasal.

ABSTRACT We describe a case of a 26-year-old patient wherein a temperature probe introduced through the nose for intra operative temperature monitoring was inadvertently cut during the ongoing surgical procedure. The missing segment of the probe was retrieved from the trachea which formed an unusual site in spite of the presence of a cuffed endotracheal tube. The present case serves as a reminder that cuffed endotracheal tube does not necessarily protect the airway from aspiration of solid foreign bodies from the oral or nasal airway.

Effects on Intubating Conditions of Pretreatment with Remifentanil before Administration of Cisatracurium / 전남의대학술지

Cisatracurium provides superior hemodynamic stability with only minor release of histamine, and its metabolism via Hoffman elimination is independent of organ function. However, use of cisatracurium is limited because of reportedly slower onset and unsatisfactory intubating conditions. Many studies have shown that remifentanil might provide reliable intubating conditions; thus, we hypothesized that pretreatment with remifentanil before administration of cisatracurium might result in acceptable intubating conditions. Sixty healthy patients scheduled for elective surgery were enrolled and randomly divided into three groups: saline (Group I, n=20), remifentanil 0.5 microg/kg (Group II, n=20), and remifentanil 1.0 microg/kg (Group III, n=20). The anesthesia was induced with propofol 2.0 microg/kg given intravenously over 30 s followed by injection over 30 s of a different dose of remifentanil according to the study protocol. We examined the intubating condition by jaw relaxation, vocal cord state, and diaphragmatic response 90 s after administering cisatracurium. We also measured mean blood pressure, heart rate, and the onset time, which is the interval from the end of neuromuscular blocking agent administration until suppression of maximal T1 on a train-of four sequence. The mean values of the intubating condition after endotracheal intubation in Groups II and III were significantly lower than that in Group I (p<0.005), although the overall onset time of cisatracurium did not differ significantly between the three groups. Our results suggest that supplementation with remifentanil in an induction regimen with cisatracurium improves the quality of the intubating condition even though the onset time of cisatracurium is not shortened.

Effects on Intubating Conditions of Pretreatment with Remifentanil before Administration of Cisatracurium / 전남의대학술지

Cisatracurium provides superior hemodynamic stability with only minor release of histamine, and its metabolism via Hoffman elimination is independent of organ function. However, use of cisatracurium is limited because of reportedly slower onset and unsatisfactory intubating conditions. Many studies have shown that remifentanil might provide reliable intubating conditions; thus, we hypothesized that pretreatment with remifentanil before administration of cisatracurium might result in acceptable intubating conditions. Sixty healthy patients scheduled for elective surgery were enrolled and randomly divided into three groups: saline (Group I, n=20), remifentanil 0.5 microg/kg (Group II, n=20), and remifentanil 1.0 microg/kg (Group III, n=20). The anesthesia was induced with propofol 2.0 microg/kg given intravenously over 30 s followed by injection over 30 s of a different dose of remifentanil according to the study protocol. We examined the intubating condition by jaw relaxation, vocal cord state, and diaphragmatic response 90 s after administering cisatracurium. We also measured mean blood pressure, heart rate, and the onset time, which is the interval from the end of neuromuscular blocking agent administration until suppression of maximal T1 on a train-of four sequence. The mean values of the intubating condition after endotracheal intubation in Groups II and III were significantly lower than that in Group I (p<0.005), although the overall onset time of cisatracurium did not differ significantly between the three groups. Our results suggest that supplementation with remifentanil in an induction regimen with cisatracurium improves the quality of the intubating condition even though the onset time of cisatracurium is not shortened.

Hemodynamic responses and upper airway morbidity following tracheal intubation in patients with hypertension: conventional laryngoscopy versus an intubating laryngeal mask airway

OBJECTIVES: We compared hemodynamic responses and upper airway morbidity following tracheal intubation via conventional laryngoscopy or intubating laryngeal mask airway in hypertensive patients. METHODS: Forty-two hypertensive patients received a conventional laryngoscopy or were intubated with a intubating laryngeal mask airway. Anesthesia was induced with propofol, fentanyl, and cis-atracurium. Measurements of systolic and diastolic blood pressures, heart rate, rate pressure product, and ST segment changes were made at baseline, preintubation, and every minute for the first 5 min following intubation. The number of intubation attempts, the duration of intubation, and airway complications were recorded. RESULTS: The intubation time was shorter in the conventional laryngoscopy group than in the intubating laryngeal mask airway group (16.33 ± 10.8 vs. 43.04±19.8 s, respectively) (p<0.001). The systolic and diastolic blood pressures in the intubating laryngeal mask airway group were higher than those in the conventional laryngoscopy group at 1 and 2 min following intubation (p<0.05). The rate pressure product values (heart rate x systolic blood pressure) at 1 and 2 min following intubation in the intubating laryngeal mask airway group (15970.90 ± 3750 and 13936.76 ± 2729, respectively) were higher than those in the conventional laryngoscopy group (13237.61 ± 3413 and 11937.52 ± 3160, respectively) (p<0.05). There were no differences in ST depression or elevation between the groups. The maximum ST changes compared with baseline values were not significant between the groups (conventional laryngoscopy group: 0.328 mm versus intubating laryngeal mask airway group: 0.357 mm; p = 0.754). The number and type of airway complications were similar between the groups. CONCLUSION: The intense and repeated oropharyngeal and tracheal stimulation resulting from intubating laryngeal mask airway induces greater pressor responses than does stimulation resulting from conventional laryngoscopy in hypertensive patients. As ST changes and upper airway morbidity are similar between the two techniques, conventional laryngoscopy, which is rapid and safe to perform, may be preferred in hypertensive patients with normal airways.

Comparison of intubating conditions and hemodynamic responses to tracheal intubation with different effect-site concentrations of remifentanil without muscle relaxants during target-controlled infusion of propofol / 대한마취과학회지

BACKGROUND: We compared the effects of different remifentanil effect-site concentrations on intubating conditions, and cardiovascular and bispectral index score (BIS) responses to intubation at a fixed effect-site concentration of propofol without muscle relaxants. METHODS: Sixty-four patients were randomly assigned to one of three groups: remifentanil 2 (group R2, n = 22), 4 (group R4, n = 21), or 6 ng/ml (group R6, n = 21). Anesthesia was induced using target-controlled infusion of propofol 5 microgram/ml and each concentration of remifentanil. Laryngoscopy and intubation was attempted at 2.5 min following induction. Intubating conditions were assessed as excellent, good or poor using a standard scoring system. Mean arterial pressure (MAP), heart rate (HR), and BIS values were assessed. RESULTS: Excellent or good intubating conditions were obtained in 91% of group R4 and 95% of R6, both of which are higher compared with 32% of R2 (P < 0.01). MAP and HR decreased significantly after induction in all groups. After intubation, they recovered to baseline value in group R2 and R4 but were significantly less than baseline values in R6. BIS response to intubation was attenuated in group R4 and R6 but not R2. Hypotension was more frequent in group R6 than R2. CONCLUSIONS: Remifentanil target concentrations of 4 or 6 ng/ml combined with 5 microgram/ml propofol provided good or excellent conditions for tracheal intubation and prevented cardiovascular and BIS response during induction without muscle relaxants. However, the use of 6 ng/ml dose was associated with frequent occurrence of hypotension and bradycardia requiring treatment.

Unilateral vocal cord palsy occurred after difficult endotracheal intubation using intubating laryngeal mask airway: A case report / 대한마취과학회지

Airway management is important during general anesthesia. Difficulties with a direct laryngoscopy can be managed successfully in a routine manner using a laryngeal mask airway. A 65-year-old woman was scheduled to undergo gynecologic surgery. After injecting the intravenous induction agents and muscle relaxants, intubation was attempted with a direct laryngoscope. However, the vocal cords could not be observed with only the epiglottis being slightly visible. Although intubation was re-attempted by another anesthesiologist, it failed. Intubation was successfully performed via an intubating laryngeal mask airway (ILMA) after additional 100% oxygen mask ventilation. We report a case of vocal cord palsy subsequent to tracheal extubation after endotracheal intubation via ILMA.

Airway Management of Patient with Ankylosing Spondylitis and Mental Retardation : A case report

Almost all anesthesiologists are encounter a difficult airway occasionally, which is probably the most important cause of anesthesia related morbidity and mortality. The Intubating Laryngeal Mask Airway (ILMA) is a modified laryngeal mask airway with the capability for guided tracheal intubation while maintaining ventilation. We report the successful use of this device in patient with ankylosing spondylitis, mental retardation and hearing disturbance. This case suggests that ILMA is a safe and useful method for airway management in anesthetic care of uncooperative patients.

Comparison of intubating conditions according to different doses of rocuronium during propofol-remifentanil target controlled infusion / 대한마취과학회지

BACKGROUND: Many studies have shown that tracheal intubation can be facilitated by propofol-remifentanil without muscle relaxant. But low dose of rocuronium can improve intubating condition and reduce the requirement of remifentanil. This study evaluated the optimal dose of rocuronium for tracheal intubation according to different doses of rocuronium during propofol-remifentanil target controlled infusion (TCI). METHODS: Sixty, ASA I-II patients were randomly divided into three groups (n = 20). Anesthesia was induced with remifentanil 3.0 ng/ml and propofol 3.5 microgram /ml target controlled infusion. After patients lost consciousness, rocuronium was administrated 0.6 mg/kg (R0.6), 0.45 mg/kg (R0.45), 0.3 mg/kg (R0.3) for each group. Three minutes later, a laryngoscope and tracheal intubation were tried, intubating condition were measured. Also blood pressure and heart rate were measured before induction, preintubation, postintubation. RESULTS: Clinically acceptable intubation condition (excellent or good) were observed 100%, 100%, 85% of patients in the R0.6, R0.45, and R0.3 groups. Eighty five percents of patients in groups R0.6, R0.45 had excellent intubation condition. But only 35% in group R0.3 showed excellent intubating condition (P < 0.05) and 15% in group R0.3 showed poor intubating condition. There were no significant elevation mean blood pressure (MBP), heart rate (HR) after tracheal intubation in all groups. And there were no significant differences among groups. CONCLUSIONS: The optimal dose of rocuronium for clinical acceptable intubating condition could be reduced to 1.5 x ED(95) under total intravenous anesthesia with remifentanil 3.0 ng/ml and propofol 3.5 microgram/ml target controlled infusion.

Effect-site concentration of remifentanil for smooth tracheal intubation without muscle relaxants provokes hypotension under desflurane anesthesia / 대한마취과학회지

BACKGROUND: Many reports with hypnotics and opiates have been published for nonrelaxant tracheal intubation.In addition to its immediate onset and short duration time, remifentanil can well prevent responses against short and strong stimulation like tracheal intubation.However, the high concentration of remifentanil for nonrelaxant tracheal intubation can cause hemodynamic instability, thus we tried to estimate the predicted effect-site concentration of remifentanil for smooth intubation and provoking hypotension. METHODS: Forty three ASA I and II patients were randomly selected to receive an effect-site-controlled infusion of remifentanil 0, 2, 4, 6 ng/ml and propofol 2 mg/kg.Trachea was intubated after 3 minutes of manual breathing support with desflurane 6 vol%. The vital signs, end-tidal concentration of desflurane and responses of patients were recorded before intubation for 3 minutes and until 2 minutes after intubation every minute.The effective effect-site concentration (ECe) was calculated at 95% successful rate of smooth intubation and at 50% of provoking hypotension (equal to or under 55 mmHg). RESULTS: The estimation results of the logistic regression stated that 95% ECe of remifentanil for smooth intubation was 8.0 (5.0-14.3) ng/ml and 50% ECe for provoking hypotension equal to or under 55 mmHg before intubation was 5.0 (2.6-9.7) ng/ml. CONCLUSIONS: Remifentanil at 8.0 ng/ml provided good conditions for smooth intubation without muscle relaxants but could provoked hypotension.Consequently, we recommend the careful observation of the blood pressure with the use of remifentanil and the evaluation of the suitable measures to maintain the blood pressure for nonrelaxant tracheal intubation.