Randomized comparison of the effectiveness of nasal intubation using a GlideScope video laryngoscope with Magill forceps versus vascular forceps in patients with a normal airway.

PURPOSE: The GlideScope® video laryngoscope (GVL) is widely used for nasotracheal intubation in dental and facial plastic surgery. The angle of the Magill forceps is different from that of the GVL blade, which suggests that the Magill forceps are not the ideal forceps for use with the GVL. The purpose of this study was to compare the effectiveness of the Magill forceps vs vascular forceps for nasotracheal intubation using the GVL. METHODS: This study included 60 patients scheduled to undergo elective surgery requiring nasotracheal intubation. Patients were assigned to one of two groups-i.e., Magill forceps (group M) or vascular forceps along with a tube exchanger (group V), by computer randomization. The primary outcome was total intubation time, defined as the time from when the anesthesiologist picked up the device to the time when three successive end-tidal CO2 waves were obtained following intubation. Secondary outcomes were blood in the endotracheal tube and trauma to the oral tissues or teeth. A blind observer assessed the presence of sore throat one hour and 24 hr after surgery. RESULTS: The total intubation time was significantly different between group M and group V (96.1 sec and 78.1 sec, respectively; mean difference, 18 sec; 95% confidence interval (CI), 13.7 to 49.7). The incidence of epistaxis in group M was significantly greater than that in group V (46.7% vs 16.7%, respectively; relative risk, 2.8; 95% CI, 1.2 to 6.8). CONCLUSION: The total intubation time was significantly less with the vascular forceps (and tube exchanger) than with the Magill forceps. Using vascular forceps also reduced the incidence of epistaxis compared with that using the Magill forceps. Using a tube exchanger and vascular forceps offers advantages over use of Magill forceps when a GlideScope video laryngoscope is used for nasotracheal intubation. TRIAL REGISTRATION: http://www.who.int/ictrp/network/cris2/en/ , CRIS, KCT0001310. Registered 29 July 2014.

Prevention of withdrawal associated with the injection of rocuronium in adults and children.

STUDY OBJECTIVE: To determine which technique prevents the withdrawal associated with rocuronium administration in adults and children. DESIGN: Blinded, randomized, prospective trial. SETTING: This study was set at an inpatient anesthesia in a university teaching hospital. PATIENTS: 200 adult patients (aged 19-63 years) and 150 children (aged 2-9 years) undergoing elective surgery requiring endotracheal intubation. INTERVENTIONS: Four groups in adult and 3 groups in children of 50 patients each were investigated. In adult study, control groups with free intravenous (IV) flow (C-F) or the occlusion of IV flow (C-O) received saline as the pretreatment of rocuronium; lidocaine groups with free IV flow (L-F) or the occlusion of IV flow (L-O) received lidocaine as the pretreatment of rocuronium, preceded by thiopental 5 seconds before. In children study, groups P and L received saline and lidocaine as the pretreatment of rocuronium, respectively, and group S received rocuronium mixed with sodium bicarbonate after the pretreatment of placebo preceded by thiopental. MEASUREMENTS AND MAIN RESULTS: The patient's response to rocuronium injection was graded using a 4-point scale. The pH and osmolality of treatment solution were measured. The incidence of no movement after rocuronium was 96% in L-O, 46% in L-F, 26% in C-O, and 18% in C-F in adult and 96% in S, 58% in L, and 8% in P in children. CONCLUSIONS: Withdrawal after rocuronium can be eliminated by the pretreatment of lidocaine during the occlusion of the IV flow in adults and addition of sodium bicarbonate in children.