Qazi Ehsan Ali

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.

Airtraq® optical laryngoscope for tracheal intubation in patients with severe ankylosing spondylitis: A report of two cases

Airway management in patients of ankylosing spondylitis remains a challenge for anaesthesiologists. Many new airway devices have been used for securing airway in these patients. The Airtraq® optical laryngoscope is one of the new rigid laryngoscopes with a proximal view finder that reflects an image transferred from the distal tip of the blade through a series of lenses, prisms and mirrors. We report two cases of ankylosing spondylitis who were scheduled for total hip replacement and subtotal thyroidectomy and were successfully intubated using the Airtraq® laryngoscope.

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.

Airtraq® Optical Laryngoscope for Tracheal Intubation in a Patient with Giant Lipoma at the Nape: a Case Report

BACKGROUND AND OBJECTIVES Lipoma is a progressively increasing disease which may appear anywhere in the body. Its appearance at the back of the neck, especially when it is large enough to cause restriction of neck extension, poses challenges to anesthesiologists in airway management whenever needed. This paper evaluates the role of Airtraq® in restricted neck movement. CASE REPORT Case with a huge lipoma of 14×12cm at the nape, and its surgical removal during an elective operation theatre posed difficulty in securing the airway by conventional laryngoscopy. To overcome the problem we successfully used a newly developed device, the Airtraq®, which is an optical laryngoscope for securing the airway. CONCLUSION Airtraq® can be used for elective intubation in patients with restricted neck movements.

King Vision video laryngoscope versus Lightwand as an intubating device in adult patients with Mallampatti grade III and IV patients.

STUDY OBJECTIVE Anticipated and unanticipated difficult airways are often encountered by anesthesiologists in their clinical practice. There are various devices available in such situations. We aim to compare King Vision video laryngoscope and Lightwand for their performance as an intubating device in predicted difficult intubation. DESIGN Prospective, randomized, single blind study. SETTING Jawaharlal Nehru Medical College. PATIENTS Sixty ASA 1 and 2 with Mallampati grade III and IV. INTERVENTIONS Patients were divided into 2 groups of 30 patients each. Patients of King Vision group [n=30] and Lightwand group [n=30] were intubated using respective devices. Primary outcome measure was time taken to intubate whereas secondary outcome measure ware number of attempts for intubation, no of adjustment maneuvers, changes in heart rate and mean arterial pressure and airway trauma. MEASUREMENTS AND MAIN RESULTS Mean intubation time using King Vision video laryngoscope (19.50±6.73 seconds was lower than the intubation time using Lightwand 25.40±7.42 s, P=.00). The difference between number of attempts, success of intubation, numbers of adjustment maneuvers were comparable. There was a significant rise in heart rate within the groups from the pre-induction values. However inter group variations were similar. In addition, there was a significant rise in mean arterial pressure within the groups from the pre-induction values. Inter group variations show less increase in mean arterial pressure with Lightwand at immediate post intubation (P=.0234) and at 3 min and 5 min post intubation anesthesia.

Airway management in severe post-burn contracture of the neck using Airtraq: A case series.

Burns due to a variety of reasons are an important medico-social issue in developing countries, including India. Patients with chronic contracture of the neck and face following burns are among the most common patients visiting plastic and cosmetic surgery clinics in our hospital for reconstruction procedures. The airway management in these patients is difficult and challenging because of restricted neck movements and reduced mouth opening due to this fixed flexion deformity of the neck. Securing the airway in a timely and effective manner is a priority in these patients. The options are limited, and range from awake fibreoptic to release of contractures under ketamine anaesthesia.[1] Certain newer airway devices are presently available and have been used to facilitate airway management in difficult situations. There has been no case series available on the use of Airtraq in post-burn contractures of the neck and face. The Airtraq® optical laryngoscope is a recently introduced airway device to facilitate tracheal intubation in patients with both normal and difficult airways. The Airtraq® is anatomically shaped and standard Endotracheal tubes of all sizes can be used [Figure 1]. We report a series of five cases with severe contracture of the face and neck presenting with difficult airway, as these patients presented with, specifically, fixed flexion deformity of the neck and distortion of the mouth opening and were successfully intubated using Airtraq®.

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 video stylet and flexible fibre-optic bronchoscope in the performance of intubation in adult patients

Background and Aims: Video Stylet (VS) is a new intubating modality that provides real-time video of endotracheal intubation (ETI). This device does not need alignment of the oral, pharyngeal and tracheal axes to view glottis and can be used in patients with limited mouth opening. The aim of this study was to compare flexible fibre-optic (FO) bronchoscope with VS in elective surgical patients in apparently normal airway patients requiring oral ETI. Methods: Sixty patients undergoing elective surgery under general anaesthesia of age group 20–60 years, weight 40–70 kg, American Society of Anesthesiologist 1 and 2 and modified Mallampatti I and II were included in the study. Patients in group FO (n = 30) were intubated by flexible FO bronchoscope, whereas patients in group VS (n = 30) were intubated by VS. Primary outcome measure was time taken for intubation (TTI). Secondary outcome measures were successful intubation, haemodynamic response and post-operative complications if any. Results: Average TTI in cases of FO group was 38.2 s (95% confidence interval [CI] 36–41) and in VS group was 19.7 s (95% CI 19–21; P = 0.0001). Three patients required a second attempt for successful intubation in FO group compared to eight in VS group (P = 0.2), with no failures in any group. Haemodynamic response and complications rate were greater in VS group; however, the differences were not statistically significant. Conclusion: VS takes lesser time to intubate than flexible FO bronchoscope.

King vision video laryngoscope: A suitable device for severe ankylosing spondylitis

Abstract Ankylosing spondylitis is a chronic, autoimmune disease affecting the spine. Involvement of the cervical spine, atlanto occipital, temporomandibular and cricoarytenoid joints leads to difficulty in airway management and securing airway by conventional laryngoscopy. We report a case of severe ankylosing spondylitis with severe restriction in neck movements and limited mouth opening. Conventional laryngoscopy and endotracheal intubation was impossible in this patient as there was no movement at the atlanto-occipital join. So, we decided to use King Vision™ video laryngoscope for intubation which proved to be of great use.

Subarachnoid block in a patient with extensive neurofibromatosis at the back

Abstract Neurofibromatosis is an autosomal dominant disease characterized by widespread effects on different systems of the body. A 65 year old male who had to undergo surgery on the left thigh had neurofibromatosis type 1 with extensive neurofibromas all over his body, including the entire back. Patient was given spinal anaesthesia, at L3–L4 intervertebral space. Successful subarachnoid block was obtained and the surgery was performed successfully without any untoward complications.