Online ISSN: 2515-8260

Keywords : endotracheal intubation


Channelled video laryngoscopic intubation with or without bougie: A comparative study

Dr. Sangeetha D, Dr. Hareesh SB, Dr. Pradeep MS

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 3086-3094

Objectives:

To assess the ease of intubation with and without bougie.
To assess Time taken for successful intubation.

Material and Methods: A randomised, prospective, comparative, interventional study, on 60 patients posted for Urological procedures under general anaesthesia with endotracheal intubation and controlled ventilation was conducted in a single centre. The patients included in the study were intubated with or without bougie using a channelled video laryngoscope after induction of anaesthesia.
Results: The demographic data such as age, sex and BMI, ASA physical status, airway assessment were matched in both the groups. The heart rates, systolic and diastolic blood pressure, SP02, ETCO2 variations post-procedure and complications were statistically comparable in both the groups. Ease of insertion was better when intubation was done with channelled video laryngoscope alone than with bougie aided channelled video laryngoscopy intubation, but was not statistically significant. Time taken for intubation was significantly higher in the bougie aided group than unaided channelled video laryngoscopic intubation. Various manoeuvres to negotiate ETT across the glottis were more frequently used in bougie aided group, but were not statistically significant.
Conclusion: Intubation with unaided channelled video laryngoscope, offered less intubation time compared to bougie assisted channelled video laryngoscopic intubation. With channelled video laryngoscope ease of intubation was better and fewer manoeuvres were required, though statistically not significant

A Effect of Nebulized Magnesium Sulphate on the Incidence of Postoperative Sore throat

Dr. Neha, Dr. Nidhi kumari, Dr.Taqui Fakhri, Dr. Divya Jyoti

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 2577-2583

Background: Postoperative sore throat (POST) is a well-recognized complication that remains unresolved in patients undergoing endotracheal intubation for general anesthesia. The wide variation in these figures is presumably due to different skills and techniques among anesthetists and to differences between patients in the definition of sore throat. Objective: The main aim is to study the attenuating effect of Magnesium sulphate nebulization on the incidence of postoperative sore throat. Materials and Methods: This is a prospective, comparative and observational study conducted in the Department of Anaesthesia and Intensive care unit, NC Medical College and Hospital over 1 year. 90 cases divided into two equal groups. Patients included in the study were of either gender belonging to American Society of Anesthesiologists (ASA) status 1 or 2 undergoing elective surgery of approximately 2 h or more duration requiring tracheal intubation. Patients in Group N were nebulized with 3 ml of normal saline and the patients in Group M were nebulized with 3 ml of 225 mg isotonic nebulized magnesium sulfate for 15 min. The incidence of POST at rest and on swallowing at 0, 2, 4, 12, and 24 h in the postoperative period was evaluated. Results: There was no significant difference in POST at rest, at 0th, 2nd, and 4th h between normal saline and MgSO4. The significant difference was seen at 24th h, where MgSO4 lessened POST. There is no significant difference in POST on swallowing at 0th and 2nd h between normal saline and MgSO4. The significant difference was seen at 4th h, where MgSO4 lessened POST. Conclusion: POST is common in patients undergoing GA with a tracheal tube for routine surgical cases for up to 24 hr. We conclude that the use of magnesium sulphate in the form of nebulization as a pre-medication agent significantly reduces the incidence of POST compared to normal saline and it was found to be safe, simple, and effective in preventing the occurrence of postoperative sore throat.

Study the efficacy of airtraq video laryngoscope versus Macintosh laryngoscope in general anesthesia

Dr. Rajesh K Vadlamudi, Dr. Venkata K Mallik, Dr. Bharath K Pamulapati, Dr. Nageswara Rao Lella

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 3444-3452

Background & Aims: Video laryngoscopes have become components of difficult airway cart. However, there is a problem with availability at all centres, expertise with the equipment and the price. We compared Airtraq video laryngoscope with conventional Macintosh laryngoscope in ease of intubation based on Intubation difficulty scale, Percent of Glottic Opening (POGO) score.
Materials & Methods: A prospective Single blinded, Randomised study with 60 Adult patients, aged 18-60 years, American Society of Anaesthesiologists (ASA) physical status I-II, scheduled for various elective surgeries requiring endotracheal intubation.
We assessed ease of tracheal intubation based on Intubation Difficulty Scale (IDS), Visualisation of glottic opening as per Percent of Glottic Opening (POGO) score and hemodynamic response to endotracheal intubation with Macintosh laryngoscope and Airtraq optical laryngoscope.
Results: The mean Intubation Difficulty Scale (IDS) score in Airtraq group is 0.2as compared to Macintosh group with mean IDS score of 1.93, with p-value <0. 0001. There is a difference in POGO grading among the groups with higher scores in Airtraq group, p-value-0. 000003.There is a difference in hemodynamic response to intubation among the groups, systolic, diastolic and mean arterial pressure were high in Macintosh group when compared to Airtraq group with p<0.05.
Conclusion: The optical Airtraq laryngoscope provides a better intubation condition with lower Intubation Difficulty Scale (IDS) score, better glottic view and no marked hemodynamic alterations to laryngoscopy as compared to Macintosh laryngoscope.

A comparative study to evaluate the efficacy of dexmedetomidine with normal saline in attenuating sympathoadrenal response to laryngoscopy and tracheal intubation

Dr. Ashwini GS, Dr. Ranjith Kumar RT, Dr. Megha GH, Dr. Dharuni Priya

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2415-2420

Introduction: Laryngoscopy and endotracheal intubation often provoke an undesirable increase in arterial blood pressure and/or heart rate1,2,3. Alpha 2-adrenergic agonists like dexmedetomidine have been extensively used to suppress the hemodynamic response to laryngoscopy and endotracheal intubation.
Methods: The study was conducted among 60 ASA grade I and II patients between 18-60 years of age, scheduled for elective surgeries under general anaesthesia. The study population was subdivided randomly into 2 groups each consisting 30 patients. Group D received Dexmedetomidine 0.5mcg/kg IV diluted to 10 ml with normal saline. Group S received Normal saline 10 ml IV.
Results: There was a significant fall in HR in group D at 5 and 10 minutes after drug administration. The mean HR increase observed at 1, 3, 5 and 10 minutes after intubation in group NS was statistically significant. The mean SBP values at 5 and 10 minutes after drug administration were significantly low in group D. The increase in SBP in group NS at 1, 3, 5 and 10 minutes after intubation was statistically significant. The mean DBP values at 5 and 10 minutes after drug administration were significantly low in group D. The increase in DBP in group NS at 1, 3, 5 and 10 minutes after intubation was statistically significant. There was a significant difference in MAP values at 5 and 10 minutes after drug administration which was statistically significant. The increase in MAP in group NS was statistically significant at 1, 3, 5 and 10 minutes after intubation.
Conclusion: We conclude that Dexmedetomidine 0.5 μg/kg before laryngoscopy and endotracheal intubation effectively attenuates the hemodynamic response as compared to normal saline without major adverse effects.

Dexmedetomidine 0.6 mcg/kg versus Magnesium Sulphate 50% 30 mg/kg for attenuation of Intubation Response

Velagalaburre Yalappa Srinivas, Mathikere Boregowda Sudarshan, Vivek Nayak, Kuzhippailil Vinod Kumar Harikrishnan, Narendra Babu Gowdagere Nagarajaiah

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 814-824

Background: Direct laryngoscopy followed by endotracheal intubation is prone to
haemodynamic fluctuations which may be detrimental in subjects with coronary artery
disease, hypertension, and cerebral vascular disease. The aim is we wanted to compare
Dexmedetomidine with Magnesium sulphate to determine the better drug with regard
to attenuation of the haemodynamic responses during laryngoscopy and endotracheal
intubation.

Efficacy of dexmedetomidine in attenuation of haemodynamic response to laryngoscopy and endotracheal intubation

Dr CH Nagaraju, Dr Gajagouni Nagaraj Goud, Dr Madanmohan Shiraboina, Dr Narugula Sadanandam

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 10267-10277

Background and Aims: Laryngoscopy and endotracheal intubation are associated with
strong sympathetic responsein the form of tachycardia and hypertension. The aim of
this study was to evaluate the efficacy of intravenous Dexmedetomidine in attenuation
of haemodynamic response to laryngoscopy and endotracheal intubation.
Materials and methods: In this prospective, randomized, double blinded study,A total
of hundred patients of ASA grade I and II between 18 to 50 years of age scheduled for
various elective surgical procedures under general anesthesiawere selected and
randomized into two groups of fifty patients each. Group C received 10 ml of normal
saline intravenously over 10 min, 10 minutes prior to induction. Group D received
injection Dexmedetomidine 0.5μg/kg body weight diluted to 10 ml normal saline
intravenously over 10 min, 10 minutes prior to induction. Baseline parameters like
Heart rate [HR], Systolic blood pressure [SBP], Diastolic blood pressure [DBP] and
Mean arterial pressure [MAP] were recorded in all patients before giving studydrug, 2
,5 and 8 minutes after studydrug, just beforeinduction, immediately after induction,
1,3,4,10 minute after laryngoscopy andintubation.
Results: There was no significant difference in the Age, Gender, body weight of patients
between Group C and Group D. After induction, In group D, there was no statistically
significant increase in the mean HR, SBP, DBP and MAP compared to basal value
whereas in group C, there was a statistically significant increase in mean HR, SBP, DBP
and MAP compared to basal value in group C.
Conclusion: In the present study, Dexmedetomidine at a dose of 0.5μ/kg body weight
given 10 minutes before induction significantly attenuated the haemodynamic responses
to laryngoscopy and tracheal intubation without significant side effects.

Endotracheal intubation in Cleft surgeries: A Comparison between Macintosh Laryngoscope and McGrath Mac Videolaryngoscope

Dr. Navaneetha Krishnan Srinivasan MBBS, MD, DNB; Dr. A Ajay Sriram MBBS, MD; Dr. Pradeep Karunagaran MBBS, MD; Dr.Porchelvan Swaminathan M.Sc,PhD,MBA, PGDCA; Dr. P U Abdul Wahab BDS, MDS

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 2, Pages 1974-1981

Background: In recent anaesthesia practice, videolaryngoscopy is gradually replacing conventional Macintosh laryngoscopy in adult and paediatric patients particularly in difficult intubation scenario. In this study, we compared McGrath Mac videolaryngoscope and conventional Macintosh laryngoscope for laryngoscopy and endotracheal intubation in cleft lip and palate surgeries.
Aim: To compare and assess the ease of placement of endotracheal tube in cleft lip and palate surgeries using McGrath Mac videolaryngoscope and Macintosh laryngoscope.  Methods: Sixty children less than 5 years of age, belonging to ASA (American Society of Anesthesiologists) I and II category, who were posted for cleft lip and palate repair were included in the study. They were randomly divided into two groups of 30 each. In group I, Macintosh laryngoscope was used for laryngoscopy and endotracheal intubation and in Group II, McGrath Mac videolaryngoscope was used. Parameters like range of visibility of  vocal cords (Cormack Lehane in Group I vs Fremantle score in Group II), requirement of external laryngeal manipulation (ELM), time taken for intubation and haemodynamic changes were assessed.Results: The time taken for endotracheal intubation was significantly higher in Group II (20.10±2.83s in Group I vs 24.57±3.52s in Group II, p<0.001). Requirement of ELM was significantly higher in Group I (24/30 vs 2/30, p < 0.001). The heart rates recorded at 1 min, 3 mins and 5 mins of laryngoscopy were significantly higher in Group I (139.7±12.06, 128.47±9.1, 119.37±8.96 vs 125.90±12.24, 120.00±8.35 and 113.03±9.76 in Group II respectively). Cormack Lehane gradings were comparable in both the groups. Conclusion: Laryngoscopy with McGrath VL significantly prolongs intubation time compared to conventional Macintosh laryngoscope in cleft lip and palate surgeries. The requirement for external laryngeal manipulation was less with McGrath VL and also less tachycardia was observed with McGrath VL than Macintosh laryngoscope.