A comparative study of haemodynamic effects of single-blinded orotracheal intubations with intubating laryngeal mask airway, Macintosh and McGrath video laryngoscopes.

INTRODUCTION: The efficacy of an intubation technique is crucial to the success of ventilation therapies. Intubating laryngeal mask airway (ILMA), Macintosh and McGrath techniques are yet to be evaluated thoroughly. Orotracheal intubations with ILMA, McGrath, and Macintosh laryngoscopes are compared based on haemodynamic changes, time taken for intubations, and success rate. MATERIAL AND METHODS: This is a prospective, single-blinded, randomised controlled trial. Primary outcome: identification of the most efficient intubation technique. Secondary outcomes: haemodynamic parameters, time taken for intubation and the rate of success of intubation. Patients enrolled: 90. Groups: 3. Each participant is randomly assigned to a group. Inclusion criteria: both sexes, age: 18-55 years, ASA: I or II, Mallampati < III, Mouth opening > 2 fingers, BMI < 40 kg m-2, any elective surgery, general anaesthesia requiring endotracheal intubation. The haemodynamic changes, time taken for intubations, and success rate during ILMA, Macintosh and McGrath intubations were recorded and statistically analysed. RESULTS: Macintosh and ILMA raised the heart rate (min-1) more than McGrath at the second minute (95% CI: 76.50 ± 1.34 [McGrath] < 81.73 ± 1.46 [Macintosh] < 90.42 ± 1.24 [ILMA]). ILMA required the longest intubation time (s) (95% CI: 71.64 ± 2.14 [ILMA] > 40.26 ± 1.36 [McGrath] > 30.63 ± 1.53 [Macintosh]). Macintosh and McGrath intubations were all successful, whereas ILMA recorded two failures. However, the observed failures were statistically insignificant (95% CI: 93.33 ± 4.35%). CONCLUSIONS: McGrath intubation is the most efficient technique based on its haemodynamics. ILMA required the longest intubation time and statistically, rates of success of the techniques are alike.

Management of A Patient with Kommerrell's Aneurysm Causing Tracheal and Esophageal Compression.

SUMMARY: Tracheal and esophageal compression is a well-recognized complication of aneurysms of the aortic arch. Most of the patients present with dysphagia and/or respiratory insufficiency. In the adult population a right-sided aortic arch is often asymptomatic unless aneurysmal disease develops. This usually occurs at the level of the take-off of an aberrant left subclavian artery and is known as a Kommerell's aneurysm. In spite of its rarity, this condition is clinically relevant because of the mortality associated with rupture, the morbidity caused by compression of mediastinal structures, and the complexity of surgery. In many cases, surgical resection of the aneurysm relieves the symptoms. We present a case in which tracheal compression and bilateral vocal cord palsy caused by an aneurysm arising from Kommerrell's diverticulum. The patient developed respiratory embrassement after extubation and was subsequently treated with continue positive airway pressure (CPAP) with a favorable result.