Using a shortened uncuffed endotracheal tube as a nasopharyngeal airway: a useful adjunct during fiberoptic intubation training among anesthesia residents.

Background: Fiberoptic intubation (FOI) is considered a beneficial modality used to intubate life-threatening airway patients. This study aims at assessing the effectiveness of shortened uncuffed endotracheal tube as a nasopharyngeal airway during FOI. Methods: Between January 2019 and March 2021, this prospective randomized controlled trial has enrolled 62 adult patients (56 males and 6 females) with normal airways scheduled for elective oral FOI classified American Society of Anesthesiologists (ASA I-III), their age ranged 20-60 years. The patients were randomized into two equal groups (31 per each); in group I, FOI was carried using lingual traction, and in group II, FOI was carried out with lingual traction plus a shortened uncuffed endotracheal tube as a modified nasopharyngeal airway to maintain oxygenation. The time taken to successful tracheal intubation and other technical parameters have been measured. The heart rate (HR), mean arterial pressure (MAP), oxygen saturation (SpO2), end-tidal carbon dioxide (EtCO2), and any associated complications have been measured. Results: During insertion of the scope, the SpO2 was significantly decreased in group I (92.55 ± 7.94) compared to group II (97.42 ± 6.34), p=0.009. The heart rate, MAP, and EtCO2 were found to be insignificantly different in both groups (p>0.05). The time needed for intubation in group I (2.78±0.98 min) was prolonged compared with group II (1.95±1.02 min) p =0.002. The number of attempts was comparable in both groups, while the number of successful intubations from the 1st attempt was 12 (39%) compared to 18 (58%) in groups I and II respectively, p=0.36. The overall success rate by juniors was 71% in group I compared to 84% in group II, p=0.66 with a lower incidence of using rescue oxygen and other facilitating maneuvers. Conclusions: The modified nasopharyngeal airway is a useful modality to facilitate oral FOI by anesthesia resident trainees.

Using fentanyl and propofol for tracheal intubation during sevoflurane induction without muscle relaxants in children: A randomized prospective study.

CONTEXT: Tracheal intubation is frequently facilitated with sevoflurane induction without the use of muscle relaxants in children. AIM: The aim of this study was to compare the effects of two different doses of propofol preceded by a fixed dose of fentanyl during sevoflurane induction on quality of tracheal intubation in children. SETTINGS AND DESIGN: This was a prospective randomized study. SUBJECTS AND METHODS: Ninety American Society of Anesthesiologists I-II children aged 2-6 years were randomly assigned to one of two equal groups to receive 2 µg/kg of fentanyl with 2 mg/kg of propofol (Group I) or 2 µg/kg of fentanyl with 3 mg/kg of propofol (Group II) during sevoflurane induction. The intubating conditions and hemodynamic responses were evaluated. The time from sevoflurane induction to loss of consciousness, to intravenous line insertion, and to intubation was measured. The occurrence of any adverse effect was recorded. STATISTICAL ANALYSIS USED: Results were analyzed using Student's t-test, paired t-test, and Chi-square test. P < 0.05 was considered statistically significant. RESULTS: The incidence of excellent intubating conditions was achieved more significantly in Group II (41/45 patients, 91%) than that in Group I (31/45 patients, 69%) (P = 0.008) (95% confidence interval [CI] =0.39-0.8). Whereas, there were no significant differences between the two groups in terms of the overall acceptable intubating conditions in Group I (40/45 patients, 89%) and Group II (43/45 patients, 96%) (P = 0.81) (95% CI = 0.71-1.31). No patient developed any adverse effect. CONCLUSION: The administration of 3 mg/kg propofol preceded by 2 µg/kg fentanyl provided a higher proportion of excellent intubating conditions compared with 2 mg/kg propofol preceded by 2 µg/kg fentanyl during sevoflurane induction in children without muscle relaxants.

Subtenon block combined with general anesthesia for vitreoretinal surgery improves postoperative analgesia in adult: a randomized controlled trial.

STUDY OBJECTIVE: To evaluate the effects of subtenon block (SB) as an adjunct to general anesthesia on intraoperative oculocardiac reflex (OCR), postoperative pain, and postoperative nausea and vomiting (PONV) for vitreoretinal surgery. DESIGN: Prospective, randomized, double-blinded clinical trial. SETTING: Operating room, postanesthesia care unit, and ward at a university-affiliated hospital. PATIENTS: Eighty patients aged 40 to 65 years of American Society of Anesthesiologists I to II requesting general anesthesia for vitreoretinal surgery. Intervention and Measurements Patients were randomly assigned to 1 of 2 groups receiving either SB with mixture of 4 mL of 2% lidocaine and 0.5% bupivacaine (50:50) in group SB or subtenon injection of saline in group C after induction of anesthesia and before surgery in a double-blind manner. The time to first postoperative analgesic dose, incidence of intraoperative OCR, postoperative pain scores, perioperative analgesic requirements, number of patients requiring rescue analgesics during the 24-hour study period, incidence of PONV, and possible complications were recorded. RESULTS: Time to first postoperative analgesia was significantly longer in group SB (P= .002). Pain scores at the first 6 hours postoperatively were significantly lower in group SB (P= .002). Intraoperative and postoperative analgesic requirements were significantly reduced in group SB (P= .015). The incidence of OCR and PONV also significantly decreased in this group (P= .001 and P= .011, respectively). CONCLUSION: Use of SB combined with general anesthesia in patients undergoing vitreoretinal surgery reduces postoperative analgesic requirements and complications such as intraoperative OCR and PONV.

Parker Flex-It stylet is as effective as GlideRite Rigid stylet for orotracheal intubation by Glidescope.

OBJECTIVES: To evaluate Parker Flex-It stylet as an alternative to GlideRite Rigid stylet to aid tracheal intubation with the Glidescope.  METHODS: This prospective randomized trial was conducted at King Abdulaziz University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia between May and December 2014. Sixty American Society of Anesthesiologists I-II patients were randomly assigned to one of 2 equal groups receiving intubation by Glidescope using either  GlideRite Rigid stylet (Group GS) or Parker Flex-It stylet (Group PS). The total intubation time, ease of intubation, incidences of successful intubation at first attempt, number of intubation attempts, use of optimization maneuvers, and possible complications were recorded.   RESULTS: No significant differences between both groups regarding the total intubation time (p=0.08) was observed. Intubation was significantly easier in group PS compared with group GS as measured by visual analogue scale (p=0.001) with no significant differences between the groups regarding the rate of successful tracheal intubation from first attempt (p=0.524). However, the number of attempts at intubation and usage of external laryngeal manipulation were similar in both groups (p greater than 0.05). The incidence of sore throat, dysphagia, hoarseness, and trauma were significantly higher in group GS (p less than 0.05).  CONCLUSION: Parker Flex-It stylet is as effective as GlideRite Rigid stylet when used by experienced operators in patients with normal airways using Glidescope; however, it is easier and less traumatic.