Comparison of Nitroglycerin versus Lignocaine Spray to Attenuate Haemodynamic Changes in Elective Surgical Patients Undergoing Direct Laryngoscopy and Endotracheal Intubation: A prospective randomised study

Objectives: This study aimed to compare the effects of nitroglycerin (NTG) versus lignocaine spray in blunting the pressor response during direct laryngoscopy and endotracheal intubation. Methods: This study was conducted between January and June 2018 in the Department of Anesthesiology, Teerthankar Mahaveer Medical College, Moradabad, India. A total of 90 elective surgical patients of American Society of Anesthesiologists physical status grades I or II were divided into three groups, comprising two treatment groups and one control group. Patients in the treatment groups received either one puff (1.5 mg/kg) of lignocaine 10% spray or one puff (400 μg) of NTG spray in the oropharynx one minute prior to the induction of anaesthesia. Haemodynamic variables and mean rate pressure product at baseline and one, two, three, four and five minutes post-induction were compared. Results: There was a significant reduction in mean heart rate at 3–5 minutes in both treatment groups compared to the control group (P <0.050), as well as lower increases in mean arterial pressure at 1–3 minutes (P <0.050). However, at 2–4 minutes, there was a significantly greater decrease in mean systolic blood pressure in the NTG group compared to both the lignocaine and control groups (P <0.050). Moreover, a greater decrease in mean rate pressure product response at 1–5 minutes was observed in the NTG group compared to the lignocaine and control groups (P = 0.001). Conclusion: The NTG spray was more effective than lignocaine in attenuating blood pressure increases and rate pressure product during elective laryngoscopy and intubation.Keywords: Endotracheal Anesthesia; Intubation; Laryngoscopy; Lignocaine; Nitroglycerin; Comparative Effectiveness Research; India

A prospective, randomized, Single-blinded, comparative study of Classic Laryngeal Mask Airway and ProSeal Laryngeal Mask Airway in pediatric patients

Context: ProSeal Laryngeal Mask Airway (PLMA) is extensively being used in pediatric anesthesia. Aims: To evaluate the efficacy of PLMA as compared to Classic Laryngeal Mask Airway (CLMA) for airway maintenance in pediatric patients. Settings and Design: A prospective, randomized, Single-blinded study was conducted in a tertiary care teaching hospital. Materials and Methods: Sixty ASA I and II children were included. Patients were randomized to either size 2 PLMA or size 2 CLMA groups. Parameters noted were time for insertion, number of attempts, airway sealing pressure, blood pressures (systolic, diastolic, and mean), pulse rate, end-tidal carbon dioxide (EtCO 2 ), peripheral oxygen saturation (SpO 2 ), and postoperative change in abdominal circumference, and airway trauma. Statistical analysis used: Parametric data were analyzed with the unpaired t-test and non-parametric data were analyzed with the chi-square (c2 ) test. Unless otherwise stated, data are presented as mean (SD). Significance was taken as P < 0.05. Results: There was no statistical difference between the two groups for the success rates at the first attempt of insertion, airway sealing pressure, hemodynamic responses, SpO 2, EtCO 2 and postoperative changes in abdominal circumference. Patients in the PLMA group had longer time of insertion and higher incidence of airway trauma. Conclusions: The PLMA and the CLMA were comparable for hemodynamic and ventilatory parameters and change in abdominal circumference; however, the time taken for insertion and airway trauma was more with PLMA

Comparison of three supraglottic devices in anesthetised paralyzed children undergoing elective surgery

Context: The newest variation of the i-gel supraglottic airway is a pediatric version. Aims: This study was designed to investigate the usefulness of the size 2 i-gel compared with the ProSeal laryngeal mask airway (PLMA) and classic laryngeal mask airway (cLMA) of the same size in anesthetized, paralyzed children. Settings and design: A prospective, randomized, single-blinded study was conducted in a tertiary care teaching hospital. Methods: Ninety ASA grade I-II patients undergoing lower abdominal, inguinal and orthopedic surgery were included in this prospective study. The patients were randomly assigned to the i-gel, PLMA and cLMA groups (30 patients in each group). Size 2 supraglottic airway was inserted according to the assigned group. We assessed ease of insertion, hemodynamic data, oropharyngeal sealing pressure and postoperative complications. Results: There were no differences in the demographic and hemodynamic data among the three groups. The airway leak pressure of the i-gel group (27.1±2.6 cmH 2 O) was significantly higher than that of the PLMA group (22.73±1.2 cmH 2 O) and the cLMA group (23.63±2.3 cmH 2 O). The success rates for first attempt of insertion were similar among the three devices. There were no differences in the incidence of postoperative airway trauma, sore throat or hoarse cry in the three groups. Conclusions: Hemodynamic parameters, ease of insertion and postoperative complications were comparable among the i-gel, PLMA and cLMA groups, but airway sealing pressure was significantly higher in the i-gel group

Predicting difficult intubation in apparently normal subjects: An anthropometric study

One of the major problems faced by health care professionals is the prediction of airway difficulties in apparently healthy subjects. Failed endotracheal intubation is a well-known reason for increased morbidity of patients including brain damage or even death. This study is focused on parameters used for prior determination of airway for predicting difficult intubation in healthy Indian populations. This study was done on 500 healthy individuals. Neck parameters were measured including inter-incisal distance, neck circumference, thyro-mental distance and sterno-mental distance. Mallampati classification and mandibular protrusion test were also carried out. Statistical analysis was done using SPSS software (V.25). MC class 3 and 4 percentages were higher in males in comparison to females. Mandibular protrusion test grade A and B percentage was higher in females while class C percentage was higher in males. The comparison of baseline values of the neck parameters (inter-incisal distance, neck circumference, thyro-mental distance and sterno-mental distance) was statistically significant (&lt;0.05) in both genders. The purpose of the study is to find out the baseline values of parameters involved in assessing methods for difficult intubation in healthy Indian population.&nbsp