Vansh Priya

Saviour of stylet injuries: 'Ryle's tube'

How to cite this article: Kaushal A, Bindra A, Singh S, Saeed Z. Modification of intravenous cannula for arterial line insertion: Simple yet effective technique. Indian J Anaesth 2018;62:397-9.

Ultrasound guided internal jugular vein cannulation in infants: Comparative evaluation of novel modified short axis out of plane approach with conventional short axis out of plane approach

Background and Aims: Central venous cannulation (CVC) through right internal jugular vein (IJV) route is routinely performed in paediatric patients undergoing major surgery and in those admitted to intensive care units. A novel technique (modified short-axis out-of-plane [MSA-OOP]) to improve first pass success rate of ultrasound-guided IJV CVC in neonates and infants is being compared with conventional SA-OOP method. Methods: A total of 120 patients were enroled in the study over a period of 6 months. All paediatric patients with age <1 year and weight <10 kg who underwent a major surgery requiring CVC were included. Patients were randomised to either of the two approaches of ultrasound-guided IJV cannulation; SA-OOP and modified SA-OOP (MSA-OOP). In modified approach, the midline of probe footprint was marked with a radio-opaque barium wire that casted a central acoustic shadow on ultrasound screen. Results: In MSA-OOP group, 83.1% of patients were cannulated in the first attempt as compared to 49.2% patients in group SA-OOP. Patients in MSA-OOP group required significantly fewer attempts for successful CVC as compared to patients in the SA-OOP group ( MSA-OOP: median = 1, interquartile range [1-1]; SAOOP: median = 2, interquartile range [1-2], P < 0.001, Mann–Whitney U-test). Conclusion: The use of MSA-OOP ultrasound technique for IJV CVC cannulation results in a higher first-attempt success rate and reduces the number of cannulation attempts.

Glomus Jugulare Tumor: Selective Catecholamine Screening–A Golden Miss?

Glomus jugulare tumor is a type of paraganglioma which has an association with catecholamine secretion but only in < 5% of cases. Any such occult or undetected catecholamine-secreting tumor poses anesthetic challenges in the perioperative period. A routine catecholamine assay and rigorous hemodynamic monitoring in such cases minimize perioperative anesthetic complications.

Use of malfunctioning fibre-optic bronchoscope as a rescue bougie!

We describe successful management of an anticipated difficult airway using a dysfunctional FOB with a videolaryngoscope. A 19-year-old male who had sustained burns over face, neck, chest and upper limbs 5 years back was scheduled for release of contracture over axilla and chest under general anaesthesia [Figure 1]. The patient had undergone post-burn neck contracture release and skin grafting 3 months back under general anaesthesia where FOB under spontaneous ventilation was used to secure the airway.

Ease in bag and mask ventilation: Is ankyloglossia in a child with micrognathia a blessing in disguise?

Anesthesia: Essays and Researches ¦ Volume 11 ¦ Issue 3 ¦ July-September 2017 803 This is an open access article distributed under the terms of the Creative Commons Attribution‐NonCommercial‐ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non‐commercially, as long as the author is credited and the new creations are licensed under the identical terms. Access this article online

Acquired tracheoesophageal fistula with undiagnosed tracheal stenosis: A simple innovation to avoid tracheostomy!

experience in a patient with Goldenhar-Gorlin syndrome. J Anesth Crit Care Open Access 2015;2:65. 2. Oakes ND, Dawar A, Murphy PC. Difficulties using the C-MAC paediatric videolaryngoscope. Anaesthesia 2013;68:653-4. 3. Cavus E, Thee C, Moeller T, Kieckhaefer J, Doerges V, Wagner K. A randomised, controlled crossover comparison of the C-MAC videolaryngoscope with direct laryngoscopy in 150 patients during routine induction of anaesthesia. BMC Anesthesiol 2011;11:6. 4. Aziz MF, Dillman D, Fu R, Brambrink AM. Comparative effectiveness of the C-MAC video laryngoscope versus direct laryngoscopy in the setting of the predicted difficult airway. Anesthesiology 2012;116:629-36. 5. Mutlak H, Rolle U, Rosskopf W, Schalk R, Zacharowski K, Meininger D, et al. Comparison of the TruView infant EVO2 PCDTM and C-MAC video laryngoscopes with direct Macintosh laryngoscopy for routine tracheal intubation in infants with normal airways. Clinics (Sao Paulo) 2014;69:23-7. How to cite this article: Shukeri WF, Zaini RH, Soon CE, Hassan MH. Overcoming airway challenges with the C-MAC® video laryngoscope in a child with Goldenhar syndrome. Indian J Anaesth 2016;60:868-9. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Elastomeric balloon pump: Use of triway to fill!

Sir, Elastomeric infusion pumps, also known as balloon pumps, of volume ranging from 100 to 400 ml, are designed to deliver medications (local anaesthetics, opioids and anticancer drugs) to ambulatory patients through intravenous, intra-arterial, subcutaneous or epidural route.[1] Elastomeric balloon reservoirs can be filled by syringes manually. The operation of these devices may be time consuming and cumbersome and may potentially introduce infection as it requires multiple attempts of loading of diluents and drugs in the reservoir pump. The filling instructions as provided by various manufacturers recommend the use of syringe for filling the pump under complete aseptic precautions. Filling of the pump requires that the entire unit to be kept in a vertical position without grasping the infusor device as shown in Figure 1.[1] Figure 1 Conventional filling method We suggest an alternate simple, convenient and less time consuming method of filling the elastomeric pumps. We employed a sterile, plastic collapsible bottle 500 ml normal saline, an intravenous drip set, a triway and 20 ml or 50 ml syringe with Luer lock as shown in Figure 2. Figure 2 Components needed for new assembly The triway is connected to filling port of infusion pump. The main port of triway is connected to the drip bag and the side port to the syringe as shown in Figure 3. Strict aseptic precautions among others should be exercised during assemblage of components and during filling of reservoir pump. Using this simple assembly, elastomeric infusion pumps can be filled with relatively much more ease. Figure 3 Assembly of components Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

A 'Y'- shaped connector as an indispensable component of paediatric bronchoscopy mask: A novel innovation!

Fibre‐optic bronchoscopy (FOB) has widespread diagnostic and therapeutic role in the form of its use in difficult intubation, bronchoalveolar lavage or biopsies. FOB‐guided intubation in paediatric patients with difficult airway could be a challenge and the presence of craniofacial dysmorphisms presents additional challenges.[1,2] Although awake FOB‐guided intubation is recommended for intubation of patients with difficult airways, same may not be feasible in paediatric patients primarily because of cooperation issues.[3] Some practitioners prefer performing fibre‐optic intubation on anaesthetised and paralysed patients.[2] Smaller airways, easy airway collapsibility at end expiration and reduced functional residual capacity make them susceptible to frequent desaturation during FOB, thus requiring frequent interruptions resulting in delay and at times abandonment of procedure.

Laparoscopic port as an integral component of endoscopy mask: A novel innovation!

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