European Journal of Molecular & Clinical Medicine

The gold standard method of airway management for general anaesthesia and resuscitation is tracheal intubation with laryngoscope. Airway manipulation or instrumentation is noxious producing adverse reflex mediated cardiovascular changes. Tuoren video laryngoscope was designed with highly angled blades that pass around the tongue and allow a “look around the corner” to the glottis opening. The view obtained includes tip of the blade and therefore allows visual guidance of the tip of the blade into the vallecula. This present study was undertaken to evaluate and compare the efficacy of Macintosh laryngoscope and Tuoren video laryngoscope with respect to time for intubation.
Methods: The present prospective randomized comparative clinical study was conducted in a tertiary care hospital amongst 100 patients belonging to ASA physical grading I and II of either gender, aged 18- 60 undergoing elective surgical procedures under general anaesthesia. They were randomized in to two groups: 1. Group ML (Macintosh laryngoscope): 50 patients and 2. Group VL (Tuoren Video laryngoscope): 50 patients.
Results: The mean age of patients in Group ML was 39.48±10.07 years and Group VL was 37.34±10.56 years.  6 Patients from Group ML required BURP while, 6 patients required lifting force in Group ML In this study, 4 patients required use of stylet while 6 patients required use of bougie in Group ML.  38 (76%) patients in Group ML and 23 (46%) patients in Group VL had slight difficulty during intubation. (IDS Score >0 & <5). The mean time taken for intubation in Group ML was 30.12±2.03 sec. and in Group VL was 20.9±1.59 sec.  The mean basal HR in Group ML was 80.36 ±11.09 and in Group VL was 81.38±10.44. Mean HR after intubation at 1 min in Group ML was increased to 97.80±12.12 while it was 87.56 ± 10.78 in Group VL. A statistically significant difference was seen in both the groups (p=0.001). Mean Arterial blood pressure after intubation at 1 min in Group ML was decreased to 106.82±5.55 while it was further decreased to 94.64± 6.61 in Group VL.
Conclusion: Finally, we conclude that Tuoren video laryngoscope when compared to Mcintosh laryngoscope improves the visualization of the larynx, is associated with less difficult airway maneuvers, lesser airway morbidity, takes less time for intubation and reduces the stress response to laryngoscopy

The LMA is an ingenious supraglottic airway device that is designed to provide and maintain a seal around the laryngeal inlet for spontaneous ventilation and allow controlled ventilation at modest levels of positive pressure. LMA has gained extensive popularity for airway management during surgery. Aim and Objective : To compare Sevoflurane and propofol for laryngeal mask airway insertion and pressor response in adults. Materials and Method : This is Prospective randomized study, conducted in Department of Anaesthesiology, Bhaskar Medical College, Moinabad, for duration of one year, included 60 patients admitted for vascular, reconstructive, gynaecological, and day care surgeries, randomly allocated into two groups of thirty each Group‘S’ for Sevoflurane and group ‘P’ for Propofol using an automated computer generated list,  after following inclusion and exclusion criteria and approved by institutional ethical committee. Results : There were 25 male and 35 female in the study and there was no significant difference was observe in the age group between the group. In our study mean time taken from induction to successful laryngeal mask insertion was significantly shorter with propofol compared with sevoflurane. In our study mean time taken from induction to successful laryngeal mask insertion was significantly shorter with propofol compared with sevoflurane. With the sevoflurane group, the LMA insertion has taken 68.12±0.49 seconds while propofol has taken 54.76 ± 0.16 seconds. Jaw relaxation has taken a long time in the sevoflurane group with P<0.001, which is highly significant. Conclusion : There was Delayed jaw relaxation with sevoflurane when compared to propofol delayed LMA insertion, thus time taken to insert LMA was more in Group S compared to group P. Hemodynamically all the patients from group S were stable compare to propofol but quality of anaesthesia provided was superior in group P

Aim: Airway management in patients with thyroid swelling undergoing thyroid  surgery.
Methodology: After approval from Institutional ethics committee, we conducted a prospective observational study including 60 consenting patients with thyroid swelling undergoing thyroidectomy. A standard OT protocol for routine pre anaesthetic check up was followed. The usual airway parameters such as mouth opening, MPC, slux, thyromental distance (TMD), neck movement were assessed. The euthyroid status of the patient was confirmed.
Results: In 54 (88.3%) patients propofol was used as induction agent. In 3 (5%) patients combination of dexmedetomidine & propofol was used as induction agent. In 2 (3.3%) patients sevoflurane and propofol was used as induction agent. In 1 (1.4%) patient etomidate was used as induction agent. 16 (26.7%) of patients required external laryngeal manoeuvre whereas 44 (73.3%) didn’t require external laryngeal manoeuvre. Highest percentage of patients 48.3% (29) were intubated in 15-30sec, 13 (21.6%). patients required 30-45 sec, 12 (20%) required less than 15 sec, while 6 (10%) patients required more than 45 sec. Maximum time required for intubation was 58 sec. 1 (1.7%) patient had complaint of hoarseness of voice post-operatively. 1 (1.7%) patient had tracheomalacia for which tracheostomy was done. 1 (1.7%) patient was not extubated due to prolonged surgery. no patient had post-extubation desaturation.
Conclusion: From this study we concluded that thyroid swelling accompanied with airway deformity is a risk factor for difficult intubation. A thorough preoperative history in all patients with thyroid swelling is mandatory and should include duration of thyroid swelling, pressure symptoms and radiological investigations of the neck and thorax.