Comparative Evaluation of Conventional Approach Versus Paraglossal Approach for Routine Anesthesia

Background: Paraglossal technique was described as early as 1930 but is seldom taught now or practiced. AIM: To evaluate the effectiveness of paraglossal technique over conventional approach and to evaluate the ease of insertion and glottic view obtained. Methods: This Randomized Controlled Trial, was done after taking informed consent 140 patients scheduled for elective surgery under general anesthesia were enrolled for the study. They were randomly divided into Group P: Intubation was performed using paraglossal approach with Miller blade and Group C: Intubation was done using conventional larynogoscopy technique with Mcintosh blade. Comparisons were made in improvement in Cormack Lehane grade, intubation difficulty score, time taken for intubation and complications if any. Results: Cormack Lehane Grade I was obtained in 97.1% subjects in paraglossal group as compared to 67.1% in group C (p=0.02). Time taken for intubation was significantly more in group C (p=0.014). The ease of intubation on Likert scale was graded as 1 (1-2) and 1 (1-1) for Group P and C respectively. Conclusion: Paraglossal approach improves the glottic visualization and also leads to successful intubation. We recommend that paraglossal approach be taught to anesthesia residents as an alternative technique so that it can be used with confidence if conventional laryngoscopy fails.

Evaluation of the Role of Pre-Operative Ketamine Gargle to Control URTI in Patients with Endotracheal Intubation

Background: Postoperative sore throat is a common and disturbing complication after endotracheal intubation, leading to patient discomfort and dissatisfaction. Objective: To find out the efficacy of ketamine gargles in reducing the incidence and severity of postoperative sore throat after endotracheal intubation. Methods: We studied the role of preoperative ketamine gargles for reducing postoperative sore throat. Patients undergoing elective abdominal and pelvic surgery under general anaesthesia with endotracheal tube were included in the study. They were randomly allocated in two groups, each group comprising of 30 patients. Group 1 received preservative free ketamine 50mg in 29 ml distilled water. Group 2 gargled with 30 ml distilled water. Patients were asked to gargle for 30 seconds, 5minutes before induction of anaesthesia. Postoperatively sore throat was assessed at 0, 4, 8 and 24 hours after extubation. The severity of sore throat was assessed from mild to severe. Results: Immediately after extubation, 90% patients in group 2 had sore throat compared to 66.7% in group 1. 24 hours after extubation, the incidence decreased to 50% in group 2 and 13.3% in group 1. Similar decrease incidence was noted at 4 and 8 hours post extubation in group 1. No patient in group 1 complained of change in voice or hoarseness of voice. Conclusion: We found that preoperative gargling with ketamine is a simple and cost effective way to reduce the incidence and severity of postoperative sore throat.