Online ISSN: 2515-8260

Keywords : tracheal intubation

Assessment of Correlation Between Mentohyoid Distance and Cormack- LehaneGrading in Airway Assessment: A Predictor of Tracheal Intubation

Meenal M, Rajiba Lochan Samal, Kasturi Nanda, Sheikh Mustak Ali

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 5748-5754

Background: Airway management is the basic responsibility of each and every
anaesthesiologist. The present study was undertaken to evaluate the relationship
between Mentohyoid distance and Cormac-Lehane Grading in predicting difficult
Materials and Methods: The present study was carried among 200 patients belonging to
ASA I and II physical status undergoing elective surgery in IMS & SUM HOSPITAL.
During pre-anaesthetic check-up, patients were examined and mentohyoid distance was
measured. On the day of surgery after induction, during laryngoscopy Cormack-lehane
grading was observed, time taken for laryngoscopy and intubation was noted. The
results were statistically analysed using SPSS version 22 software. “A p-value of p <
0.05 was considered statistically significant and p-value of p<0.001 was considered
highly significant”.
Results: 12 % of the patients had CL Grade III, 45% had CL Grade I, 43% had Grade
II and 11 % had Mentohyoid distance of < 3.0 cm. and 1% had mentohyoid distance of
3 to 4 cm. The incidence of difficult intubation is around 12%. In patients who had
decreased mentohyoid distance (mandibular space), we faced difficulty during
laryngoscopy with poor CL grading III. Hence making it difficult for intubation and
more time taken for laryngoscopy.
Conclusion: Decrease Mentohyoid distance (mandibular space) has significant
association with difficult glottis exposure, hence making it difficult for intubation and
more time for laryngoscopy. Mentohyoid distance with cormack-lehane grading is a
good predictor of tracheal intubation

Assessment of intubating conditions and haemodynamic responses in children using fentanyl and propofol and its comparison with muscle relaxant technique

Dr. Arata Kumar Swain, Dr. Suryasnata Sahoo, Dr. Sabyasachi Das

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1879-1892

Background: The present study was undertaken to highlight the benefits of avoiding suxamethonium, using only the opioid-propofol technique for routine intubation in paediatric age groups.
Objective: the advent of shorteracting opioid drugs, intubating the trachea has been particularly successful when these drugs are used in combination with propofol. Propofol has been reported to possess some characteristics that provide adequate conditions for intubation in combination with fentanyl 1,2 or alfentanil 3,4 or remifentanil 5.6.
Material & Method: Sixty children of ASA grade I or II scheduled to undergo elective surgery under general anesthesia were studied. They were randomly divided into two groups of thirty patients each.
Group I: Inj. fentanyl 4 μ and 5 minutes later Inj. propofol 3mg. kg-1 was given.
Group II: Inj. propofol 3 mg. kg-1 followed by Inj. suxamethonium was given.
Intubation in all cases was done by senior anaesthesiologist, 60 secs after induction with propofol. Intubation scores were recorded according to Helbo-HansenRaulo and Trap-Anderson scoring system. Acceptable intubating conditions (i.e., excellent and good) were observed in 26 (86.7%) out of 30 patients in Fentanyl group. The systolic blood pressure and heart rate, decreased significantly after intubation at 3 and 5 minutes in group Fentanyl when compared with pre-induction values (P<0.001).
Result & Conclusion: Results of present study suggest that in premedicated healthy children administration of fentanyl 4μ in combination with propofol, after adequate waiting period of 6min, reliably provides good to excellent conditions for tracheal intubation and blunts the pressor response to intubation adequately without significant cardiovascular depression. Thus ideal intubating conditions can be achieved without muscle relaxants using fentanyl and propofol and provide an useful alternative technique for tracheal intubation when neuromuscular blocking drugs are contraindicated or should be avoided. Refinement of this technique by adjustment of the dose of fentanyl and propofol, and addition of Lignocaine may minimize incidence of coughing and might improve intubating conditions further.

A comparative study of airtraq video laryngoscopy and direct laryngoscopy for ease of intubation

Dr. Daxa H Oza, Dr. Rachana Gandhi, Dr. Payal K Berawala, Dr. Purvi D Thakkar, 5Dr. Priya R Bhagora

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2223-2231

Background: The most common route for tracheal intubation is orotracheal where an endotracheal tube is passed from oropharynx to trachea. Anatomical and physiological characteristics of the patient make intubation sometimes difficult. Video laryngoscope has more ease of intubation compared to direct laryngoscopy for both experienced and inexperienced person.
Objective: The present study was done to compare direct laryngoscopy with Airtraq videolaryngoscope in non-difficult airway for ease of intubation and study hemodynamic changes.
Materials and Method: Study was conducted on 60 patients presented for elective surgery under general anaesthesia. Patients were divided into 2 groups-V & D. In group D, direct laryngoscopy was performed with macintosh blade and in group V, videolaryngoscopy was performed with Airtraq video laryngoscope.
The number of attempts required, failure to intubate and time for intubation were noted. Any loss of airway, orodental injury to patient, cough response during intubation were noted.
The HR, SpO2, SBP and DBP were noted at induction (baseline), 1, 3, 5 and 15 min after intubation.
Result: Number of attempt require to intubate patient in both group-not significant. Average time for intubate patients with group V -23.1 second, compared to group D-20. 1 second, that was significant. It was longer in Group V. Heart rate-significantly increase at 1 min, 3 min, 5 min and 10 min in Group D patients .Systolic BP and Diastolic BP- Significantly increase at 1 min and 3 min seen in group D and receded to baseline value at 5min and thereafter. No significant difference seen in Spo2 in both group.
Conclusion: In our study, Airtraq video laryngoscope resulted in significantly lesser hemodynamic response compared to direct laryngoscope. Little more intubation time required in videolaryngoscope compared to direct laryngoscope but that didn’t affect much. Videolaryngoscope gained popularity as an intubation device in the hands of both airway experts and non-experts.