Quest for an Ideal Intubating Device

 The first scientific report of tracheal intubation and artificial respiration is attributed to Vesalius, who in 1543 performed this in animals.1 The first perioperative use of tracheal intubation was described by Macewen in 1880 to prevent aspiration during the removal of a tumor from the base of the tongue. However, regular perioperative use of tracheal intubation in anesthetized patients started only in the early 1900s.2 Until then, even oral surgery was performed without a definitive airway, thus predisposing patients to the risk of aspiration. As the use of tracheal tubes and intubation gained popularity, a proportional need to develop equipment that could help in placing a tracheal tube into the trachea arose. In 1913, Chevalier Jackson reported a high rate of success for the use of direct laryngoscopy as a means to intubate the trachea

Anesthetic management of caesarean section in a patient with double outlet right ventricle

Double outlet right ventricle (DORV) is a rare congenital heart defect involving the great arteries. In DORV, both aorta and pulmonary artery arise from the right ventricle resulting in admixture of blood. We report a 22-year-old parturient with DORV and severe pulmonary stenosis who underwent caesarean delivery at 36 weeks gestation with low dose combined spinal-epidural anesthesia. This lady was assessed by echocardiogram to have situs inversus, dextrocardia, severe pulmonary artery stenosis (gradient = 146 mm Hg), DORV with subarterial VSD (1 cm). She had 95% room air saturation and her blood investigations were within normal limits. We established a peripheral venous access and radial arterial line for continuous blood pressure monitoring. Combined spinal epidural anesthesia was considered a better option. Epidural catheter was secured at L 2 -L 3 space and fixed after giving test dose 3 mL 2% lignocaine. Subarachnoid block administered at L 3 -L 4 level using 1.2 mL of 0.5% heavy bupivacaine. A sensory block of T 10 was obtained which was supplemented with 4 mL 0.75% ropivacaine to obtain a level of T 6 . Patient tolerated the procedure well. She was shifted to post-operative ICU. Post-operative pain was managed with epidural 0.2% ropivacaine at 4 mL/h. Patient remained hemodynamically stable throughout the procedure and in the postoperative period while she was being followed up for subsequent 48 h

Anaesthesia machine: Checklist, hazards, scavenging

From a simple pneumatic device of the early 20 th century, the anaesthesia machine has evolved to incorporate various mechanical, electrical and electronic components to be more appropriately called anaesthesia workstation. Modern machines have overcome many drawbacks associated with the older machines. However, addition of several mechanical, electronic and electric components has contributed to recurrence of some of the older problems such as leak or obstruction attributable to newer gadgets and development of newer problems. No single checklist can satisfactorily test the integrity and safety of all existing anaesthesia machines due to their complex nature as well as variations in design among manufacturers. Human factors have contributed to greater complications than machine faults. Therefore, better understanding of the basics of anaesthesia machine and checking each component of the machine for proper functioning prior to use is essential to minimise these hazards. Clear documentation of regular and appropriate servicing of the anaesthesia machine, its components and their satisfactory functioning following servicing and repair is also equally important. Trace anaesthetic gases polluting the theatre atmosphere can have several adverse effects on the health of theatre personnel. Therefore, safe disposal of these gases away from the workplace with efficiently functioning scavenging system is necessary. Other ways of minimising atmospheric pollution such as gas delivery equipment with negligible leaks, low flow anaesthesia, minimal leak around the airway equipment (facemask, tracheal tube, laryngeal mask airway, etc.) more than 15 air changes/hour and total intravenous anaesthesia should also be considered

Airway management in an infant with congenital trismus: the role of retrograde intubation

Congenital trismus is a serious anomaly, and establishment of an airway for surgical correction is a challenge. In the case of limited mouth opening, the nasal route is the only available option to secure the airway via the supraglottic route. Various airway management options include blind intubation, retrograde intubation and fibre-optic intubation, failing which a tracheostomy might be needed. We present the airway management of a seven-month-old infant with congenital trismus who was scheduled for corrective surgery. After several unsuccessful attempts at blind nasal intubation, with the infant on spontaneous ventilation, breathing sevoflurane in oxygen, we managed to secure the airway successfully by retrograde intubation.Keywords: congenital trismus, retrograde intubation, blind nasal intubationSouth Afr J Anaesth Analg 2012;18(5):267-26