RESUMO
Objective: We aimed to compare C-MAC videolaryngoscope [VLC] with Macintosh laryngoscope with regard to the laryngoscopic view, the need for external laryngeal manipulation, requirement of airway adjuncts like stylet, time required to complete the tracheal intubation and the hemodynamic changes in Mallampati class 2 and 3 patients
Methodology: Sixty patients who were admitted for elective surgery requiring general anesthesia with endotracheal intubation were randomly allocated to proceed with endotracheal intubation using the conventional Macintosh laryngoscope [Group A] or the C-MAC VLC [Group B]. Following a standardised general anesthetic protocol, time for intubation, laryngoscopic view, need for external manipulation, and hemodynamic parameters during and after intubation were registered during study period
Results: It was observed that C-MAC VLC improves the laryngoscopic view in predicted difficult airway setting, and thus reduces the need for external laryngeal manipulation and the use of stylet. However, the hemodynamic stress response was significant with C-MAC VLC than Macintosh laryngoscopy. There was significant reduction in time taken for intubation with conventional Macintosh laryngoscope when compared with C-MAC® VLC. The median total intubation time for the Macintosh and C-MAC® VLC were 23.8 and 35.33 sec respectively [p = 0.000]
Conclusion: C-MAC® videolaryngoscope improves laryngoscopic view in difficult airway settings compared to the conventional Macintosh laryngoscope, but at the cost of prolonged time taken for intubation and increased hemodynamic stress response. Large scale studies may be required to determine the ultimate success of intubation with this new tool
RESUMO
Broncho-esophageal fistula (BEF) are quite rare in adults, more so the congenital variety. The common causes of BEF in adults include infections, trauma, and malignancies. We report a rare case of congenital BEF manifesting in adulthood with repeated pulmonary infections. We emphasize mainly on the preoperative preparation and perioperative management of this patient. It is essential to have a high index of suspicion to diagnose congenital BEF in adults. Anesthesiologists play an important role in successful management of these cases.