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Ultrasound imaging of the airway and its applications
Anusha Cherian, Pankaj Kundra
September-December 2018, 1(1):17-24
Airway ultrasound (US) provides a dynamic assessment of the airway. In conjunction with other imaging techniques such as computerised tomographic (CT) scan and magnetic resonance imaging (MRI), ultrasonography of the airway can influence airway management decisions. There is some evidence to support its use in the prediction of difficult airway by measuring pre-tracheal soft-tissue thickness and pre-epiglottis space thickness. However, the dynamic scan of vocal cord movements may replace direct visualisation techniques in the future. In addition, measurements of the subglottic diameter by US have been shown to predict endotracheal tube size as accurately as MRI or CT scan. US-assisted or US-guided front of the neck procedures such as percutaneous dilatational tracheostomy is safer and more accurate with decreased rate of complications. Localisation of cricothyroid membrane with US in difficult necks may become a life-saving procedure when complete ventilation failure is encountered. The use of US to overcome airway challenges is growing at a rapid pace adding newer dimensions to its use.
  2,746 594 -
Voice loss following endotracheal intubation: The anaesthesiologist's dilemma
Nalini Kotekar, Sriram Vyshnavi
May-August 2019, 2(2):57-63
Endotracheal intubation is a routine procedure performed by anaesthesiologists worldwide. It is as routine as the placement of a peripheral intravenous catheter. Albeit the gold standard for securing the airway, endotracheal intubation comes with it's share of adverse effects, one of the worst being loss of voice or aphonia. A literature search in major medical databases revealed useful information about the aetiopathogenesis, various mechanisms and risk factors leading to vocal symptoms and acoustic variations. Patient risk factors such as age and co-morbid conditions and anaesthetic considerations such as size of endotracheal tube, number of attempts, mean cuff pressure, anaesthetic agents used and nature and duration of surgery all seem to have a role in this intriguing problem. This review also includes cases we have personally come across in our practice. Based on our experience of cases that we have come across, we propose an algorithm to avoid such a problem.
  2,632 224 -
Describing and displaying numerical and categorical data
Sudheesh Kannan, Pradeep A Dongare, Rakesh Garg, SS Harsoor
May-August 2019, 2(2):64-70
The set of observations recorded during research work is termed data. Data can be described as numerical or categorical. While numerical data are further divided into discrete or continuous, categorical data are further divided into nominal or ordinal data. These data may be represented in a textual manner or with the help of illustrations (tables or graphs). The selection of a proper mode of representation of data helps in the optimal understanding of results. The level of importance of each parameter determines the mode of representation. The present article attempts to introduce the various methods of data presentation and throw some light on the benefits and limitations of each mode of data presentation.
  2,533 206 -
Descriptive statistics: Measures of central tendency, dispersion, correlation and regression
Zulfiqar Ali, S Bala Bhaskar, K Sudheesh
September-December 2019, 2(3):120-125
Large data obtained from research are subjected to statistical analysis so that outcomes can be extrapolated to the larger population. Towards this end, such large data have to be consolidated into smaller, simpler expressions of measures, representing the outcomes of the whole sample. These form the descriptive statistics, which will later on help in inferential statistics, involving the different variables within one group and more than one group. Their distribution features are analysed and are described as sums, averages, relationships and differences. These measures are classified as those of central location and those of dispersion. Mean, Median and Mode are the three main measures of central tendency and Range. Percentile, variance, standard deviation, standard error and confidence interval are measures of dispersion. Correlation and regression can be used to describe the relationship between two numerical variables. Correlation is a measure of association and regression is used for prediction. Regression analysis helps to assess 'influential' relationships between the data. Changes among one or more variables might affect other variables.
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Comparison of the efficacy of lignocaine viscous gargle versus ketamine gargle for the prevention of post-operative sore throat after classic laryngeal mask airway insertion: A prospective randomised trial
Sangeeta Dhanger, Bhavani Vaidiyanathan, Idhuyya Joseph Rajesh, Debendra Kumar Tripathy
September-December 2018, 1(1):13-16
Background and Aims: Post-operative sore throat (POST) after general anaesthesia has been ranked as the eighth most important problem of the current clinical anaesthesiology. In comparison to endotracheal intubation, use of the laryngeal mask airway (LMA) has reduced the incidence of POST but has not been able to completely eliminate it. The aim of this study was to compare the efficacy of viscous lignocaine versus ketamine gargle for the prevention of POST after classic LMA insertion. Patients and Methods: A total of 90 patients scheduled for surgery under general anaesthesia using classic LMA were randomised into two groups of 45 each; Group L (lignocaine) and Group K (ketamine). While patients in Group L received 30 mL of 2% lignocaine viscous gargle 10 min before anaesthesia, patients in Group K received 5% ketamine 1 mL (50 mg) diluted in 29 mL of water. POST was graded at 0, 1, 2, 4, 6, 12, 18 and 24 h after operation on a 4-point scale (0–3). Statistical analysis was done using SPSS software version 16. All data were analysed for normal distribution using the Shapiro–Wilk test, categorical data by the Chi-square test and parametric data by Student's t-test. P < 0.05 was considered to be statistically significant. Results: Incidence as well as the severity of POST was significantly less in the lignocaine group (17.5% mild grade) in comparison to ketamine group (15% moderate grade and 25% mild grade). Conclusion: We conclude that compared to ketamine gargle, 2% lignocaine viscous gargle effectively reduces the incidence as well as the severity of POST following placement of classic LMA.
  1,682 258 -
Comparison of channelled blade with non-channelled Blade of King Vision™ videolaryngoscope for orotracheal intubation: A randomised, controlled, multicentric study
Amit Shah, Apeksh Patwa, Vijitha Burra, Deepshikha Shah, Bhavin Gandhi
January-April 2019, 2(1):10-16
Introduction: We conducted a randomised, controlled, prospective, multicentric comparison of channelled blade versus non-channelled blade of the King Vision™ videolaryngoscope for orotracheal intubation. Patients and Methods: A total of 66 patients included in the study were divided into two groups as follows: Group CH for intubation with channelled blade and Group NC for intubation with non-channelled blade. We compared the intubation time, ease of intubation and best laryngeal view obtained. Ease of intubation was categorised into ease of device insertion and ease of passage of endotracheal tube. Various impingements which occurred at the laryngeal inlet were observed and manoeuvres used to accomplish intubation were noted. Results: The grade of laryngeal exposure and time of laryngeal exposure were similar in both types of blade. We found a shorter intubation time of 15.24 ± 10.6 s in Group CH, whereas it was 28.57 ± 14.09 s in Group NC (P < 0.001). Impingement of the endotracheal tube at the glottic inlet was similar in both the groups, but manoeuvring of the device was not needed after laryngeal exposure in the case of the non-channelled blade. Manoeuvres needed to accomplish successful intubation were different in each group. Intubation with channelled blade requires anticlockwise rotation of the endotracheal tube as it is advanced in the slot while slight withdrawal and redirection towards the centre was needed most often with the non-channelled type of blade. Conclusions: We conclude that when used with the channelled blade, the King Vision videolaryngoscope requires shorter intubation time as compared to its use with the non-channelled blade. Anticlockwise rotation of the advancing endotracheal tube within the channel slot overcomes major impingement at the larynx and facilitates intubation with the use of channelled blade while slight withdrawal and redirection towards the centre are needed for successful intubation using the non-channelled blade.
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Bedside clinical tests as a screening tool for predicting difficult laryngoscopy and intubation: An observational study
Hemlata V Kamat, Manoj Raju Prabandhankam, Bhumika Pathak, Ajay Phatak
September-December 2018, 1(1):9-12
Context: Morphological characteristics of the airway in a population have regional variations making airway assessment and management a crucial aspect of anaesthesia practice. Aims: (1) To determine the incidence of difficult laryngoscopy and intubation using Cormack–Lehane grading and Intubation Difficulty Scale (IDS). (2) To assess the accuracy of bedside clinical tests in predicting difficult laryngoscopy and intubation. Settings and Design: Prospective observational study was carried out on 200 patients aged 18–70 years, undergoing planned surgical procedures under general anaesthesia requiring endotracheal intubation. Pregnant women, patients with head-and-neck pathology, and patients with trauma were excluded from the study. Patients and Methods: All patients underwent preoperative airway assessment and standard induction procedure. Cormack–Lehane grading was noted during first laryngoscopy and process of intubation evaluated by IDS. Statistical Analysis Used: Descriptive statistics used to depict baseline profile. Chi-square, Student t-test and logistic regression used to determine adjusted effects. Analysis was performed using STATA (14.2). Results: The incidence of difficult laryngoscopy was 15.5% and difficult intubation was 12.5%. Univariate analysis showed body mass index (BMI) >25 kg/m2, neck circumference (NC) >36 cm and modified Mallampati score 3/4 as significant predictors. Logistic regression showed interincisor gap (IIG) (P < 0.001) and NC (P < 0.001) as significant predictors. Conclusions: NC and IIG are rapid, simple bedside tests to predict difficult intubation. Bedside clinical tests have poor discriminative power but still have a role in choosing alternative methods for airway management, making judicious use of time and resources while causing minimum discomfort to the patient.
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Creating the Indian airway guidelines and beyond
Sheila Nainan Myatra, Venkateswaran Ramkumar
September-December 2018, 1(1):1-3
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Types of data, methods of collection, handling and distribution
Umesh Goneppanavar, Zulfiqar Ali, S Bala Bhaskar, Jigeeshu V Divatia
January-April 2019, 2(1):36-40
Statistics is assumed to be a tough nut to crack by novices and young researchers mainly because of the lack of understanding of the fundamentals. This article describes the types of data and the methods for compiling the raw data in an orderly fashion, followed by appropriate handling of the collected data to ensure completeness and quality. Once the data are entered into statistical software, distribution of the data should be assessed to apply appropriate statistical tests. Since the type and nature of distribution of data are the main determinants of the type of statistical test to be applied, researchers should have a thorough understanding of these aspects to help derive meaningful outcome from their research.
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Role of simulation as a teaching-learning tool for interns
Sarbari Swaika, Siddhartha Chakraborty, Swapnadip Sengupta, Soumitra Mukherjee, Supriyo Choudhury
September-December 2018, 1(1):4-8
Background: Simulation is a realistic representation of real-world dynamics or processes that reflect or parallel patient scenarios. Simulation-based medical education enables knowledge, skills and attitudes to be acquired by all health-care professionals. It has been widely adopted as a training and assessment tool in medical education. The aim of the study was to compare simulation-based versus apprenticeship-based teaching-learning tool on patient. Patients and Methods: In this prospective randomised interventional study, 30 interns were randomly assigned to perform laryngoscopy and endotracheal intubations (L and EI) on patients (Group 1) or on an airway mannequin (Group 2) up to 5 times over 3 successive days. Following this, all interns regardless of their group allocation performed up to 10 intubations on patients. They were assessed and scored by two observers using a rating scale and every attempt scored as 'Success' (1 point) or 'Failure' (0 point). Average scores of intubations of two groups were compared using the paired t-test. Results: Average scores of intubations on 10 patients by two independent observers were 6.220 (standard deviation [SD] 1.1428) in Group 1 and 7.147 (SD 0.6520) in Group 2 and 6.307 (SD 1.1317) in Group 1 and 7.193 (SD 0.6170) in Group 2, respectively (P = 0.012 and 0.014 for Observers A and B, respectively). The score of attempt 1 and attempt 10 was observed by a single observer between groups, and significant difference (P = 0.021) was found at attempt 1 between groups with the mannequin group scoring better. At attempt 10, there was no significant difference between the groups. Conclusion: The mannequin group acquired better skills in airway management with respect to L and EI.
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Correlation between ultrasonographic evaluation of the airway and Cormack-Lehane view by direct laryngoscopy in the Indian subpopulation
Gagan Kumar Narula, Abdul Nasser
May-August 2019, 2(2):71-76
Background: An important aspect of airway management is assessment of the airway to predict difficult intubation. Ultrasonography has recently emerged as a noninvasive tool that is helpful for preoperative airway assessment and management. Patients and Methods: In this study, four sonographic measurements, namely (a) distance of the pre-epiglottic space (PES), (b) distance from epiglottis to the vestibular ligaments' midpoint (EVL), (c) skin to hyoid bone distance (DSHB) and (d) distance from the skin to epiglottis midway between hyoid bone and thyroid cartilage (DSEM) were correlated with the Cormack-Lehane grade obtained by direct laryngoscopy. Results: Of the 77 patients included for data analysis, 19 patients (24% of total) had difficult intubation. Of those with difficult intubation, 63% were female. Pearson's analysis revealed a correlation of Cormack-Lehane grade as weak negative with PES, weak positive with EVL, very weak positive with DSHB and very weak negative with DSEM. To predict difficult airway, the cutoff values for PES, EVL, DSHB and DSEM as determined by the Youden index were found to be 2.8 mm (sensitivity 21.1% and specificity 84.5%), 9.3 mm (sensitivity 36.8% and specificity 86.2%), 12.7 mm (sensitivity 42.1% and specificity 79.3%) and 6.8 mm (sensitivity 21.1% and specificity 87.9%), respectively. The area under the curves of PES, EVL, DSHB and DSEM were all below 0.6. Conclusion: PES, EVL, DSHB and DSEM are poor in predicting difficult intubation. These parameters can, however, be used to rule out difficult intubation because they are all highly specific.
  1,468 182 -
Teaching and training in airway management: Time to evaluate the current model?
Joanne Spaliaras, Agathe Streiff, Glenn Mann, Tracey Straker
January-April 2019, 2(1):28-35
Management of the airway is central to the practice of anaesthesiology and yet surveys reveal that trainees frequently feel poorly trained in this area. Good skills in airway management include not only technical proficiency with an increasingly complex and wide range of equipment but also the clinical judgement and experience to use them appropriately. Lapses in judgement, education and training are leading causes of patient morbidity and mortality. It is now more imperative than ever for anaesthesiology training programmes to carefully review their curricula and evaluate the educational tools being used for effective advanced airway education of the next generation of airway specialists. Residency programmes have also seen the need to incorporate a formalised airway rotation into their curricula. One to 2-year long airway fellowships are now being advocated to provide the trainee a unique opportunity to master the advanced clinical knowledge and techniques necessary to successfully manage the most challenging clinical scenarios in airway management. It is essential for educators and practitioners alike to consider innovative models of training, advancing and retaining of skills. Such advanced skills can ensure the safe airway management and delivery of quality care to patients of all ages and medical complexity. Before preparation of the manuscript, a PubMed and Cochrane search of the scientific literature published in the past 10 years with the terms 'anesthesiology training', 'airway management education' and 'advanced airway management skills' was conducted.
  1,438 182 -
Oral appliances in the management of obstructive sleep apnoea syndrome
Puppala Ravindar, Kethineni Balaji, Kanamarlapudi Venkata Saikiran, Ambati Srilekha, Kondapaneni Alekhya
September-December 2019, 2(3):109-119
Obstructive sleep apnoea (OSA) is a term used to describe repetitive episodes of complete or partial upper airway obstruction that occur during sleep. It is a highly prevalent medical disorder and a challenge to treat. The treatment options include continuous positive airway pressure, oral appliances and surgical interventions depending on the severity of the condition. Among these, oral appliances are commonly used as primary therapy for the treatment of OSA because these appliances are designed to either encourage maxillary transverse development or advance the mandible, which will significantly reduce the OSA. This narrative review emphasises the role of various oral appliances in the treatment of OSA and will serve as a guide to clinicians in choosing the proper dental appliance.
  1,457 155 -
Comparison of high-flow nasal cannula versus conventional oxygen therapy following extubation after paediatric cardiac surgery
Vijitha Burra, Adalagere Sathyanarayana Lakshmi, Anand V Bhat, V Prabhakar, N Manjunatha
January-April 2019, 2(1):4-9
Background: Respiratory complications after cardiac surgery increase morbidity, mortality and length of hospital stay. Oxygen administered using a high-flow nasal cannula (HFNC) improves oxygenation because of its ease of implementation, tolerance and clinical effectiveness. We sought to compare this technique with conventional oxygen therapy (OT) after extubation following paediatric cardiac surgery. We compared HFNC versus conventional OT in postoperative paediatric cardiac surgical patients. Our primary objective was to evaluate the relative efficiency of improving PaCO2elimination in the first 48 h following extubation. Patients and Methods: A single-centre, prospective, unblinded, randomised controlled trial was conducted in a 15-bedded post-cardiac intensive care unit on 50 paediatric cardiac surgical patients <2 years of age undergoing elective surgery with Risk Adjustment for Congenital Heart Surgery score ≥2. At the start of weaning off ventilation, patients were randomly assigned to either of the following groups: HFNC or OT. Arterial blood samples were collected before and following extubation at the following time points: 1, 6, 12, 24 and 48 h. While the primary outcome was comparison of arterial PaCO2post-extubation, the secondary outcomes were PaO2and PaO2/FIO2 ratios and any complications associated with either technique. Continuous data were expressed as mean ± standard deviation and compared using independent samples t-test or the Mann–Whitney U-test. Chi-square test was used for categorical parameters. Results: Demographic and clinical variables were comparable in the two groups. PaO2and PaO2/FIO2 ratios were significantly improved in the HFNC group (P < 0.05) with lesser requirement of FIO2(P < 0.05) in comparison to conventional OT. No complications were observed during HFNC therapy, nor was there any treatment failure. Conclusion: Compared with conventional OT, the use of HFNC following extubation in paediatric cardiac surgical patients appears to be safe, improves oxygenation and carbon dioxide elimination with lesser inspired oxygen concentration.
  1,381 193 -
Does prewarming of tracheal tubes prevent epistaxis following nasotracheal intubation? A prospective, randomised, single-blind study
Anuja Agrawal, Bhavika Sangada, Dinesh Chauhan, Tejash Sharma
May-August 2019, 2(2):77-80
Introduction: Nasotracheal intubation has always been considered more traumatic than orotracheal intubation. According to previous studies, warming of endotracheal tubes is a good practice because it softens the tube and increases its flexibility, thereby resulting in less trauma. We aimed to study whether prewarming of nasotracheal tube resulted in less nasal trauma and epistaxis as compared with a tracheal tube at the room temperature. Our primary aim was to evaluate trauma and epistaxis due to nasotracheal intubation. The secondary aim was to observe the grade of epistaxis, ease of nasotracheal intubation, time taken to intubate, number of attempts to intubate and need for Magill's forceps for intubation. Patients and Methods: This prospective, randomised, single-blind study was conducted on 30 participants. Randomisation was done by a concealed envelope method. All participants belonged to the American Society of Anesthesiologists Physical Status I and II. They were allocated to one of two groups (n = 15 in each group). Patients in Group A were intubated with normal nasotracheal tubes at room temperature, while those in Group B were intubated with prewarmed nasotracheal tubes. The tracheal tubes were warmed at 45°C for 60 min. Institutional protocol for general anaesthesia was followed in both groups. Statistical analysis was performed using Medcalc software for Windows version (Belgium). Results: Intubation was significantly easier in Group B (15) compared to Group A (5) (P < 0.0005). Time taken for intubation was significantly shorter in Group B (44.73 ± 11.02 s) as compared to Group A (74.46 ± 21.27 s) (P < 0.0001). The incidence of epistaxis was significantly higher in Group A (9) as compared to Group B (1) (P < 0.005). Conclusion: Incidence of epistaxis following nasotracheal intubation was significantly less with prewarmed tracheal tubes as compared to normal tracheal tubes.
  1,390 158 -
Clinical techniques to prevent cough at emergence from general anaesthesia: A meta-analysis
Alex Joseph, Rajkumar Rajendram
September-December 2019, 2(3):126-134
Brief summary: Various techniques can reduce the incidence of cough at tracheal extubation. Whilst effect size differs between treatments, homogeneity was identified within each subgroup of treatments. This meta-analysis allows anaesthesiologists to make informed choices on the use of techniques to prevent emergence cough. Background: Cough at extubation increases the risk of morbidity following surgical procedures. So, prevention of cough may aid perioperative risk management. Several techniques have been described for prevention of cough at or immediately after tracheal extubation. This meta-analysis compares various pharmacological methods for prevention of cough at emergence from general anaesthesia and aims to establish an evidence base for the rational use of these techniques. Methods: Several electronic databases (1966-2018) were searched systematically for randomised controlled trials that reported the incidence of cough at extubation. The quality of the studies identified was assessed using the Jadad methodology. Six techniques to prevent cough were analysed using the Mantel-Haenszel fixed-effects model. The odds ratio (OR) and number needed to treat (NNT) were used as the summary efficacy measures. Results: Of 1114 articles screened, 22 comparisons in 17 studies (1007 patients) were included in the final analysis. Significant heterogeneity of effect was observed when all studies were analysed together. However, there was homogeneity within each treatment subgroup. This reflected significant effect-size differences between techniques. The largest effect-sizes were seen with endotracheal tube cuff inflation with alkalinised lignocaine (pooled OR 0.052; 95% CI 0.027-0.102; NNT 1.67) and topical lignocaine (pooled OR 0.065; 95% CI 0.015-0.274; NNT 2.35). Conclusion: The incidence of cough at extubation of the trachea can be reduced. The overall effect size of the studied strategies was useful (pooled OR 0.149; 95% CI 0.13-0.18; NNT 2.62). No single technique prevented cough in all patients but cuff inflation with alkalinised lignocaine and topical 4% lignocaine were most effective.
  1,383 153 -
Correlation of anticipated difficult airway with concurrent intubation: A prospective observational study
Gayatri Rajeev Sakrikar, Prerana Nirav Shah
January-April 2019, 2(1):22-27
Background: Neither all anticipated difficult airways prove to be difficult intubations nor can all difficult intubations be accurately predicted. We conducted this prospective observational study to evaluate the incidence of anticipated difficult airway and concurrent difficult intubation and look for any correlation between them. Patients and Methods: In this study, 352 patients aged >18 years posted for elective surgery requiring general anaesthesia with the placement of endotracheal tube were recruited after obtaining the Ethical Committee approval and written informed consent. The airway was examined at the time of preanaesthetic check up and assigned the modified Mallampati class and Wilson's score. The modified Mallampati Class III/IV and Wilson's score of >4 were considered a difficult airway. Concurrent intubation was graded according to the Cormack–Lehane classification on laryngoscopy. Other parameters such as the duration of laryngoscopy, time taken for intubation and number of attempts were also noted. The incidence of anticipated and unanticipated difficult airway was calculated separately for each score along with its sensitivity, specificity, positive predictive value and negative predictive value. The significance of this association was analysed using the Chi-square test. Results: The incidence of the anticipated difficult airway by the modified Mallampati classification was 6.8%, whereas that by Wilson's score was 2.5%. The incidence of actual difficult intubation was 13%. Actual difficult airways out of those anticipated by the modified Mallampati classification were only 8, whereas those anticipated by Wilson's score were 27. Correlation between them was calculated using the Chi-square test with P < 0.05 considered as statistically significant. Conclusions: Modified Mallampati classification could fairly predict the true-negative results and Wilson's score even though not routinely used is a better indicator for true-positive values. Thus, Wilson's score should be included in routine preanaesthetic evaluation.
  1,274 181 -
Airway assessment by ultrasonography: Is it the final answer?
Arindam Choudhury, Rohan Magoon
May-August 2019, 2(2):55-56
  1,168 242 -
Is neck roentgenogram essential for airway assessment in thyroid swelling? A 3-year audit in a tertiary care centre
Radhakrishna Shetty Sumalatha, Balaram Chandana, Kandavar Siri
January-April 2019, 2(1):17-21
Introduction: Thyroid swelling leading to airway compromise offers a challenge to the anaesthesiologist. Neck roentgenograms are routinely done as a part of preanaesthetic evaluation in thyroid swellings in our institute. With this audit, we wished to analyse whether routine neck roentgenograms had any role in the airway assessment and management for thyroidectomy. Methodology: After obtaining clearance from the Institutional Ethics Committee, data of all patients who underwent thyroidectomy under general anaesthesia between January 2015 and December 2017 were collected from the Medical Records Department. We collected demographic details along with the details of anaesthetic management of these patients. Our primary objective was to know whether neck roentgenogram was essential in thyroidectomy, and the secondary objective was to analyse the airway management in these patients. Qualitative data were represented as frequencies and percentages and quantitative data as mean and standard deviation. Chi-square test was used to compare the qualitative variables and t-test for quantitative variables, and P < 0.05 was considered statistically significant. Results: A total of 317 thyroidectomies were conducted in our hospital between January 2015 and December 2017. Neck X-ray was done in 275 patients (86.75%), whereas the X-ray was not found or documented in 15 patients (5.45%). X-rays of only 42 patients (16.15%) had positive findings. In 66.7% of the cases with positive finding on neck X-ray, airway was managed with direct laryngoscopy and intubation without any difficulty. Conclusion: We conclude that neck roentgenographs are not a sensitive method for predicting difficult airway in patients with thyroid swelling and could be avoided in routine practice to decrease radiation exposure.
  1,076 146 -
Assumptions and numbers: The balancing act of statistics
S Bala Bhaskar
September-December 2018, 1(1):25-26
  965 163 -
Evidence-Based Medicine: New Paradigm Towards Sound Medical Practice
Venkateswaran Ramkumar
January-April 2019, 2(1):1-3
  943 150 -
Failed ventilation due to intratracheal U-shaped kinking of the nasal Ring–Adair–Elwyn tube
Rajeev Puri, Anamika Mishra, Trilok Chand, Naveen Singh
September-December 2018, 1(1):33-35
This report describes a case of failed ventilation in a patient who was intubated nasotracheally with a previously used ivory polyvinyl chloride nasal Ring–Adair–Elwyn (RAE) tube while undergoing general anaesthesia for mandibular surgery. This mishap occurred because of the mechanical U-shaped kinking of the tube below the vocal cords which was diagnosed with difficulty at laryngoscopy. On close inspection of the glottic opening at laryngoscopy, a U-shaped fold of the terminal end of the tracheal tube was observed. Reintubation with another fresh nasal RAE tube was followed by uneventful anaesthesia and surgery.
  966 118 -
Successful airway management of impossible mask ventilation using ProSeal™ laryngeal mask airway and C-MAC® videolaryngoscope
Stalin Vinayagam, Pankaj Kundra, Perika Tilak
September-December 2018, 1(1):27-29
Fibrous dysplasia of the maxilla is a benign condition which presents as gross facial deformity and poses a great challenge to anaesthesiologists. The primary anaesthetic concern is difficult mask ventilation which requires a tailor-made approach for securing the airway, particularly in paediatric patients. Herewith, we report the successful airway management of a case of impossible mask ventilation in a paediatric patient with fibrous dysplasia of the maxilla using ProSeal™ laryngeal mask airway and C-MAC® videolaryngoscope.
  900 155 -
Comparative performance of I-gel and laryngeal mask airway supreme: A randomised, controlled study
B Uma, Uttam Chand Verma, Rajesh Singh Rautela, Anjali Kochhar
May-August 2019, 2(2):81-88
Patients and Methods: In a randomised, controlled study, we compared the performance of i-gel against the laryngeal mask airway (LMA) Supreme in 60 anaesthetised and paralysed patients for non-laparoscopic surgical procedures. Results: The primary outcome measure, the oropharyngeal leak pressure (OLP), was significantly higher for i-gel as compared to LMA Supreme (mean [standard deviation] 26.23 [4.09] vs 21.73 [3.19] cm H2O, respectively; P < 0.0001). Twenty-four (80%) of LMA Supreme and 22 (73.3%) of i-gels were successfully placed with similar ease on the first attempt to achieve an effective airway. The time taken for inserting the LMA Supreme was significantly less than that required for i-gel (mean [SD] 7.89 [1.6] s vs 11.48 [4.86] s, respectively; P < 0.0001). Gastric tube insertion was easier in the LMA Supreme as compared to i-gel (96.7% vs 63.3% respectively; P < 0.0001). There were no differences in the positioning of the supraglottic airway devices as evaluated fibreoptically. Postoperative sore throat was comparable with both devices. Conclusion: We conclude that while both these devices are suitable for routine use during maintenance of anaesthesia, a significantly higher OLP might provide the i-gel an advantage in this respect.
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Anaesthetic management of panfacial injury using submental endotracheal intubation
Mahendrabhai Gautam Vaishali, Vijaykumar Desai Pushkar
January-April 2019, 2(1):41-44
Hernandez first described the submental route for endotracheal intubation in 1986 as a valuable alternative to tracheostomy for maxillofacial procedures. Over a 5-year period, we have successfully managed 25 patients of panfacial trauma using the submental route of endotracheal intubation without facing significant adverse outcomes. Submental intubation is contraindicated in patients suffering from neurological deficits who may require prolonged ventilation postoperatively. However, patients who require ventilation for short procedures may be managed using the submental route for endotracheal intubation without significant perioperative comorbidities.
  933 104 -