review of hemodynamic response to the use of different types of laryngoscopes

Endotracheal intubation is the gold standard in airway management either as a means to administer general anesthesia or for mechanical ventilation in critically ill patients for protecting the airway when the airway reflexes are dysfunctional. Macintosh laryngoscope is the standard laryngoscope used for intubation though advances in science have resulted in development of laryngoscopes of different designs. The process of laryngoscopy and intubation [L and I] can result in significant hemodynamic response and this is a topic of debate and research in anesthesia. A comprehensive review of hemodynamic responses to various laryngoscope designs has been undertaken here. Tracheal intubation contributes to more hemodynamic response compared to laryngoscopy alone. The hemodynamic responses to L and I are exaggerated in the elderly and those with uncontrolled hypertension. Orotracheal intubation causes less hemodynamic response as compared to nasotracheal intubation. Laryngoscope design, duration of L and I and the forces applied on the laryngoscope all contribute to hemodynamic fluctuations. McCoy blade and videolaryngoscopes where L and I can be performed without the aid of stylets provide better attenuation of hemodynamic response compared to intubation using the Macintosh laryngoscope. Fibreoptic orotracheal intubation with the aid of combined lingual traction and jaw thrust maneuver provides superior attenuation of hemodynamic response compared to use of laryngoscope

Intubation in a patient with a large pedunculated oral lipoma: a unique experience

Patients with intraoral mass may present to anesthesiologists for various diagnostic or definitive procedures. These patients may be challenging not only due to inherent airway problems associated with tumour mass but also due to comorbid conditions. Pedunculated lipoma arising from the buccal mucosa is rare. We report the anticipated airway difficulty encountered in a 55-year-old male patient with an intraoral pedunculated lipoma made easy by the patient by facilitating the mass out of the oral cavity manually

Unusual presentation of chronic myeloid leukemia - an emphasis on adequate preanesthesia work-up

Regional anesthesia has become the primary anesthetic technique in management of trauma cases and is reported to have several advantages over general anesthesia. However, it is contraindicated in the presence of conditions associated with coagulopathy e.g. disseminated intravascular coagulation [DIG]. While sepsis and trauma are more common causes of DIG, physicians must also be aware of rare causes like haematological malignancy