Ventilatory Strategies in Traumatic Cervical Spinal Cord Injury: Controversies and Current Updates.

Ventilatory management of patients with traumatic cervical spinal cord injury (CSCI) is a complex and controversial area of critical care medicine. Despite significant advances in our understanding of the pathophysiology of CSCI and the development of novel interventions, there remains a lack of consensus about the optimal approach to ventilatory management in these patients. Some of the key controversies in CSCI ventilatory management include timing of tracheal intubation, non-invasive ventilation versus invasive ventilation, high versus low tidal volume, and early versus late tracheostomy. The objective of this review is to discuss the existing controversies and provide an insight on the current evidence.

Thoracic Epidural Anesthesia for Modified Radical Mastectomy in a High-Risk Patient: A Case Report With Literature Review.

Surgery is one of the mainstays of treatment in breast cancers. Typically, modified radical mastectomy (MRM) is done under general anesthesia (GA). However, GA is not a reasonable choice in patients with multiple comorbidities and difficult airways. Thoracic epidural anesthesia (TEA) is a reasonable and safe alternative to GA as it involves blunting of stress response and avoidance of airway handling apart from hemodynamic stability, lower analgesic consumption, superior postoperative analgesia, reduced postoperative nausea and vomiting, earlier resumption of feeding, and shorter duration of hospitalization. We report a case of advanced breast cancer in a 57-year-old female with a co-existing difficult airway, bronchial asthma, and hypertension in whom MRM was conducted successfully under TEA. We also present a comprehensive review of literature on the use of TEA for MRM.

King Vision video laryngoscope for severe post burn contracture neck: an encouraging experience / Videolaringoscópio King Vision para contratura grave do pescoço após queimadura: uma experiência encorajadora

Abstract Background and objectives Managing the airway of post burn contracture of the neck has always been challenging to anesthesiologists as it limits the alignment of oro-pharyngo-laryngeal axes because of functional and anatomical deformities that occur as a result of long standing contractures. Here the role of the King Vision video laryngoscope which is the latest in the series of video laryngoscope has been evaluated for such patients. Case report A 35 year old male patient with post burn contracture of neck was scheduled for release of the contracture. As the patient had had fixed flexion deformity of the neck we did not attempt the conventional laryngoscopy. Instead we opted for King Vision video laryngoscope. Conclusion We therefore conclude that King Vision videolaryngoscope can be used for difficult airway situations like post burn contracture of neck.

Resumo Justificativa e objetivos O manejo de vias aéreas em contratura de pescoço após queimadura sempre foi um desafio para os anestesiologistas, pois a contratura limita o alinhamento do eixo orofaringolaríngeo devido às deformidades funcionais e anatômicas que ocorrem como resultado de contraturas de longa duração. Relato de caso Paciente do sexo masculino, 35 anos de idade, com contratura do pescoço após queimadura foi programado para liberação da contratura. Como estava com deformidade fixa em flexão no pescoço, não tentamos a laringoscopia convencional e optamos por usar o videolaringoscópio King Vision. Conclusão O videolaringoscópio King Vision pode ser usado em situações de via aérea difícil como a contratura de pescoço após queimadura.

[King Vision video laryngoscope for severe post burn contracture neck: an encouraging experience]. / Videolaringoscópio King Vision para contratura grave do pescoço após queimadura: uma experiência encorajadora.

BACKGROUND AND OBJECTIVES: Managing the airway of post burn contracture of the neck has always been challenging to anesthesiologists as it limits the alignment of oro-pharyngo-laryngeal axes because of functional and anatomical deformities that occur as a result of long standing contractures. Here the role of the King Vision video laryngoscope which is the latest in the series of video laryngoscope has been evaluated for such patients. CASE REPORT: A 35 year old male patient with post burn contracture of neck was scheduled for release of the contracture. As the patient had had fixed flexion deformity of the neck we did not attempt the conventional laryngoscopy. Instead we opted for King Vision video laryngoscope. CONCLUSION: We therefore conclude that King Vision videolaryngoscope can be used for difficult airway situations like post burn contracture of neck.

A comparative evaluation of the Airtraq and King Vision video laryngoscope as an intubating aid in adult patients.

Airtraq has been shown to improve ease of intubation in patients with normal and difficult airway. King Vision video laryngoscope is a newly introduced intubating device with an attached monitor. We here hypothesized that the King Vision video laryngoscope with channeled blade performs better during intubation as compared to Airtraq. In this study, we performed a comparison between the King Vision video laryngoscope and the Airtraq with regard to time needed for intubation, number of attempts required to intubate, and complications. Fifty ASA grade I and II adult patients posted for a routine surgical procedure were randomly divided into two groups of 25 patients each. All patients were anesthetized using similar techniques. The time required to intubate patients was significantly shorter when the King Vision video laryngoscope with channeled blade was used as compared to the Airtraq (p < 0.05). The number of attempts to successfully intubate patients was also significantly lower (p < 0.05) for the King Vision video laryngoscope than for the Airtraq. The use of the Kings Vision video laryngoscope with channeled blade should be encouraged in difficult intubation situations in adult patients with a mouth opening of more than 18 mm.

Comparison of the Airtraq and McCoy laryngoscopes using a rigid neck collar in patients with simulated difficult laryngoscopy.

STUDY OBJECTIVE: To determine the efficacy of the Airtraq versus the McCoy laryngoscope as intubation devices with the neck stabilized by a rigid cervical collar. DESIGN: Prospective, randomized, double-blinded study. SETTING: Jawaharlal Nehru Medical College. PATIENTS: 60 ASA physical status 1, 2, and 3 patients, aged 18-70 years, scheduled for various surgical procedures requiring tracheal intubation for surgical anesthesia. INTERVENTIONS: Patients were randomly allocated to undergo intubation with the McCoy (n = 30) or Airtraq (n = 30) laryngoscope. MEASUREMENTS AND MAIN RESULTS: Differences in intubation times between the Airtraq and the McCoy laryngoscope, modified Cormack-Lehane score, percentage of glottic opening (POGO) score, and airway trauma were compared. Overall intubation success rates were 100% with both devices and a similar number of intubation attempts were required. However, the mean (SD) time required for successful intubation was shorter with the Airtraq (28.73 ± 6.39 sec) than the McCoy laryngoscope (39.11 ± 14.01 sec; P < 0.0001). The frequencies of intubation complications were similar. Esophageal intubation occurred in 4 cases but only with the McCoy laryngoscope. CONCLUSION: Intubation time was shorter with the Airtraq than the McCoy laryngoscope, even though the overall success rates between the two devices were similar.

Efficacy of clonidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block: A prospective study.

BACKGROUND AND AIMS: Bupivacaine has been the most frequently used local anaesthetic in brachial plexus block, but ropivacaine has also been successfully tried in the recent past. It is less cardiotoxic, less arrhythmogenic, less toxic to the central nervous system than bupivacaine, and it has intrinsic vasoconstrictor property. The effects of clonidine have been studied in peripheral nerve blockade. The purpose of this study was to evaluate the effects of clonidine on nerve blockade during brachial plexus block with ropivacaine using peripheral nerve stimulator. METHODS: Sixty patients were randomly divided into two groups, Group A and B. Group A received 30 ml of 0.5% of ropivacaine with 0.5 ml normal saline while Group B received same amount of ropivacaine with 0.5 ml (equivalent to 75 µg) of clonidine for supraclavicular brachial plexus block. The groups were compared regarding quality of sensory and motor blockade, duration of post-operative analgesia and intra and post-operative complications. RESULTS: There was a significant increase in duration of motor and sensory block and analgesia in Group B as compared to Group A patients (P < 0.0001). There was no significant difference in onset time in either group (P = 0.304). No significant side effects were noted. CONCLUSION: The addition of 75 µg of clonidine to ropivacaine for brachial plexus block prolongs motor and sensory block and analgesia without significant side effects.