scholarly journals TO MEASURE THE CORRELATION BETWEEN ULTRASONOGRAPHY MEASURED HYOMENTAL DISTANCE RATIO AND EASE OF LARYNGOSCOPY

2019 ◽  
Vol 3 (11) ◽  
Author(s):  
Dr. Vishal Koundal ◽  
Dr. Mahesh Kumar
Keyword(s):  
Tracheal Intubation ◽  
General Anesthesia ◽  
Endotracheal Intubation ◽  
Direct Laryngoscopy ◽  
Himachal Pradesh ◽  
Morbidity And Mortality ◽  
Distance Ratio ◽  
Keywords Ultrasound ◽  
The Mean ◽  
Grade 3

Background: Difficult and failed tracheal intubation after direct laryngoscopy is a dreaded complication of general anesthesia as it is associated with serious morbidity and mortality. Methods: Prospective Observational conducted at Department of Anesthesiology, Dr. RPGMC Kangra at Tanda, Himachal Pradesh. Results: In the present study, the mean hyomental distance ratio was (mean±SD:1.1.±.127 and 1.04±.018) in predicting CL grade 3 and 4 respectively (P=0.010) and 1.12±.033, 1.11±.035 in grade 1 and 2 respectively. Conclusion: Ultrasound is better and fast in confirming endotracheal intubation. Keywords: Ultrasound, endotracheal intubation, direct laryngoscopy.

scholarly journals TO STUDY THE CORRELATION BETWEEN SONOGRAPHIC MODIFICATION OF CORMACK LEHANE SCORING WITH ACTUAL CL GRADING DURING DIRECT LARYNGOSCOPY

2019 ◽  
Vol 3 (11) ◽  
Author(s):  
Dr. Vishal Koundal
Keyword(s):  
Difficult Airway ◽  
Endotracheal Intubation ◽  
Clinical Assessment ◽  
Direct Laryngoscopy ◽  
Himachal Pradesh ◽  
Keywords Ultrasound ◽  
Airway Assessment ◽  
Lehane Grade ◽  
Significant Difference ◽  
Grade 3

Background: Airway assessment is an essential aspect of preanaesthetic assessment. Presently, prediction of difficult airway is based on clinical assessment of airway. Methods:  Prospective Observational conducted at Department of Anesthesiology, Dr. RPGMC Kangra at Tanda, Himachal Pradesh. Results:  It was observed that 44% patients (n=88) were in grade 2 followed by 27 % (n=54) in grade 1, grade 3 was observed in 24.5% patients (n=49) whereas Cormack Lehane grade 4 was seen in 4.5% patients (n=9) Conclusion: The thyromental distance was more than 6.5 cm in the majority of patients (87.5%) while 12.5% had a thyromental distance less than 6.5 cm. There was a significant difference in Thyromental distance between different Cormack Lehane grades (P=0.001) Keywords: Ultrasound, endotracheal intubation, direct laryngoscopy

A COMPARISON OF EFFECT OF NEBULISED KETAMINE AND NEBULISED MAGNESIUM SULPHATE IN REDUCTION OF INCIDENCE AND SEVERITY OF POSTOPERATIVE SORE THROAT - A PROSPECTIVE RANDOMIZED DOUBLE BLINDED STUDY

2021 ◽  
pp. 38-40
Author(s):  
M. Selvi Annie Geeta ◽  
M. Ramesh Ram
Keyword(s):  
Tracheal Intubation ◽  
General Anesthesia ◽  
Sore Throat ◽  
Magnesium Sulphate ◽  
Success Rates ◽  
Postoperative Sore Throat ◽  
It Effectiveness ◽  
Duration Of Surgery ◽  
The Mean ◽  
Group B

Introduction: Postoperative sore throat (POST) is a common occurrence following general anesthesia with endotracheal intubation. The incidence of POST is estimated to be 21%-65% in various studies. Irritation and inammation of the air way are considered to be the cause of POST. Although considered a minor and self limiting complication, it may cause a signicant patient morbidity, dissatisfaction and increased the length of duration of hospital stay. Various pharmacological and non pharmacological methods have been tried to decrease POST with varying success rates. Among the interventions, the use of ketamine gargle or lozenges has highest success rates, but the problem with this is the bitter taste of the drug and the risk of aspiration, so aerosol route of drug administration gained popularity among the anesthesiologists with good acceptance from the patients. It is known that N-methyl-D-aspartate (NMDA) receptors have a role in nociception and inammation. Hence, this study is aimed at using the aerosol route of magnesium sulphate and ketamine and to nd it effectiveness in preventing POST. Aim Of The Study: To evaluate the effect of nebulized ketamine and nebulized magnesium sulphate for attenuation of postoperative sore throat in patients undergoing surgeries under general anesthesia with tracheal intubation. Materials And Methods: This study was done in the Department of Anesthesiology in collaboration with the Department of Surgery in Kanyakumari Government Medical College from January 2019 to December 2019. Patient planned for surgery under general anesthesia except head, neck & ENT surgeries were selected and randomized into two groups (35 each). Each group received nebulisation for 15 min before induction of general anaesthesia. Group M: Nebulization with 500mg magnesium sulphate in 5ml NS. Group K: Nebulization with 50mg ketamine in 5ml NS. The Parameters related to the study such as duration of laryngoscopy, time taken to intubate, duration of surgery, number of attempts to intubate were recorded. Incidence and severity of sore throat were assessed by four point scale. Incidence of sore throat is assessed for 24 hours. Complication were recorded. Results: We found that the demographic parameters were comparable and statistically insignicant. The mean duration of laryngoscopy difference between the two groups Group M - 24.54± 1.12 seconds and Group K - 24.49 ±1.15 seconds was not statistically signicant P= 0.834 (P>0.05). The mean time taken to intubate in Group M - 27.54± 1.12 seconds and Group K - 27.54± 1.12 seconds was not statistically signicant with P=1.000 respectively (P>0.05). The mean duration of surgery in Group M - 90.71±15.67 minutes and the Group K - 88.20 ±16.53 minutes between the two groups was not statistically signicant P= 0.516 (P>0.05). The mean difference of number of attempts taken to intubate between the two groups was statistically insignicant P=0.771 (P>0.05). The overall incidence of sore throat in Group M was 91% and in Group B was 34%. The severity of sore throat between Group M and Group K is statistically signicant at 2, 4, 6 hrs at grade 1 and grade 2. Conclusion: On the basis of our result, we can suggest that the use of perioperative ketamine nebulization when compared magnesium sulphate nebulization reduces the incidence and severity of post-operative sore throat at 4th and 6th hour during postoperative period in patients who had received general anesthesia with tracheal intubation.

Prolonged Intubation Injuries of the Larynx: Endoscopic Diagnosis, Classification, And Treatment

2018 ◽  
Vol 127 (8) ◽  
pp. 492-507 ◽  
Author(s):  
Bruce Benjamin
Keyword(s):  
General Anesthesia ◽  
Endotracheal Intubation ◽  
Granulation Tissue ◽  
Direct Laryngoscopy ◽  
Prolonged Intubation ◽  
Laryngeal Trauma ◽  
Flow Charts ◽  
Diagnosis Classification ◽  
Classification And Treatment

Laryngeal trauma from prolonged endotracheal intubation occurs in patients of all ages. Most changes are superficial and heal quickly. Injuries that are found consistently during intubation include nonspecific changes, edema, granulation tissue, ulceration, and othermiscellaneous injuries. In thispapersignificant, severe, and lasting trauma of the larynx has been classified on thebasis of theknown factors in pathogenesis, observations made atendoscopy, and photographic documentation. This classification has required introduction of new descriptive terminology: “tongues of granulation tissue,” “ulcerated troughs,” “healed furrows,” and “healed fibrous nodule.” During intubation the degree of injury can be precisely assessed under general anesthesia by using telescopes for image magnification, thus assisting adecision whether to continue intubation orperform tracheotomy to minimize long-term morbidity. Changes that are found after extubation result from granulation tissue, ulceration, ora combination of both and have been illustrated on flow charts; a knowledge and understanding of these sequelae allows them to be identified by both indirect and direct laryngoscopy so that treatment can be planned.

scholarly journals A Case Report of Female Patient with Laryngeal Granuloma

2017 ◽  
Vol 18 (2) ◽  
pp. 175-177
Author(s):  
Sladjana Simovic ◽  
Tatjana Sarenac Vulovic ◽  
Jasmina Stojanovic ◽  
Sandra Zivanovic ◽  
Mladen Koravovic
Keyword(s):  
Early Childhood ◽  
Case Report ◽  
Tracheal Intubation ◽  
General Anesthesia ◽  
Female Patient ◽  
Direct Laryngoscopy ◽  
Potential Complication ◽  
Patient Case ◽  
Vocal Cords ◽  
Laryngeal Granuloma

AbstractThe aim of this case report is to present the laryngeal granuloma in 23 year old female patient. Case outline: The 23 year old female was admitted for examination, because of long lasting, progressive hoarseness. In anamnesis, we found that she has undergone general anesthesia for 8 times, in the early childhood. We performing direct laryngoscopy with complete otorhinolaryngologic examination, rigid endovideostroboscopy and the large granuloma of the larynx was found. Conclusions: Laryngeal granuloma of vocal cords affected mainly men, except for cases associated with laryngeal intubation. We should keep in mind that postintubation laryngeal granuloma might develop after tracheal intubation, so care must be taken to avoid the potential complication.

scholarly journals Examination of Demographic Characteristics of Drug and Corrosive Poisonings, Morbidity and Mortality in Children in terms of Emergency Department and Pediatric Surgery

2020 ◽  
Author(s):  
Cengiz Güney ◽  
Abuzer Coskun
Keyword(s):  
Emergency Department ◽  
Rapid Diagnosis ◽  
Morbidity And Mortality ◽  
Diagnosis And Treatment ◽  
Accidental Poisoning ◽  
Pharmacological Agents ◽  
Under Five ◽  
Common Causes ◽  
The Mean ◽  
Grade 3

Background: Poisoning constitutes an important part of morbidity and mortality among environmental emergencies that can be prevented, frequent in childhood, requiring rapid diagnosis and treatment. This study aimed was to examine the epidemiological, clinical and therapeutic characteristics of drug and corrosive poisonings in terms of children. Materials and Methods: Between January 2010 and December 2018, 1678 patients between the ages of 1-16 who applied to the emergency department with drug and corrosive poisoning were included in the study. The patients were divided into three groups as 1-5, 6-11 and over 12 years of age, and the substances with known pharmacological agents were divided into 10 groups. The Zargar Classification (7) was used to determine the degree of damage caused by corrosive substances in the esophagus. Results: The mean age of the patients was 8.32 ± 3.23 years (1-15 years). The girl/boy ratio of the cases was 1.18 / 1 and 54.3% were girls. 18.9% of the cases were under five years of age, 61% were between 6-11 years and 20% were older than 12 years. 94.6% of the patients were poisoned by drugs and 5.4% of them were poisoned due to non-drug reasons. Accidental poisoning was most commonly seen in children aged 6-11 and suicides were seen in children older than 12 years. It was found that 62.2% of the poisonings were accidental and 37.8% were suicidal. The most common causes of poisoning were analgesics and paracetamol exposure as a pharmacological agent. Mortality was found to be most common in 1-5 years age group and accidental poisonings. Accidental poisoning was common in girls and suicidal poisoning was common in boys. Grade 3 damage was found endoscopically in all of the mortalities due to corrosive substances. Conclusion: It was found that accidental poisoning was observed in children under five years of age, suicides were observed in children older than 12 years and the most important cause of mortality was due to corrosive substances. Cause-specific rapid diagnosis and treatment will contribute to the reduction of morbidity and mortality.

scholarly journals EXPERIENCE OF VIDEO LARYNGOSCOPY DURING TRACHEAL INTUBATION FOR EMERGENCY INDICATIONS IN THE PRACTICE OF AN ANESTHESIOLOGIST AND RESUSCITATOR

2020 ◽  
Vol 21 (3) ◽  
pp. 33-38
Author(s):  
V. V. Vasilev
Keyword(s):  
Tracheal Intubation ◽  
Difficult Intubation ◽  
Direct Laryngoscopy ◽  
Successful Intubation ◽  
Failed Intubation ◽  
Advantages And Disadvantages ◽  
Lehane Grade ◽  
Grade Ii ◽  
The Mean ◽  
Technical Solutions

Objectives. To assess the advantages and disadvantages of videolaryngoscopy as one of methods of tracheal intubation which is being widely used as an alternative to direct laryngoscopy in anesthesiologist’s practice.Material and methods. Over 100 of tracheal intubations were conducted with the use of videolaryngoscope, along with a routine use of the direct laryngoscopy. The results of 48 intubations are discussed. 4 clinical cases are presented in this article.Results. Cormack-Lehane grade I view was obtained in 39 cases (81,3%), Cormack-Lehane grade II - in 9 patients (18,8%). First attempt intubation was performed in 43 cases (89,6%), in 4 cases intubation was successful after second attempt (8,3%), failed intubation was in 1 case (2,1%). The mean duration of successful intubation was 36,9 sec. Certain difficulties occured during intubation related with the advancement of the endotracheal tube. Technical solutions are given for some of intraprocedural conditions.Conclusions. Videolaryngoscopy is a safe and effective method of tracheal intubation. Although this method is not lacking in disadvantages it has a number of advantages, main of which is the improved larynx visualization. In our opinion, this method can not completely replace direct laryngoscopy in anesthesiolodist’s practice, but may serve as an adjuvant in case of difficult intubation.

scholarly journals Comparison of the hemodynamic response of dexmedetomidine versus additional intravenous lidocaine with propofol during tracheal intubation: a randomized controlled study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rattaphol Seangrung ◽  
Koravee Pasutharnchat ◽  
Subundit Injampa ◽  
Sirima Kumdang ◽  
Rojnarin Komonhirun
Keyword(s):  
Blood Pressure ◽  
Adverse Effects ◽  
Tracheal Intubation ◽  
Endotracheal Intubation ◽  
Hemodynamic Response ◽  
Controlled Study ◽  
Time Points ◽  
Randomized Controlled ◽  
The Mean ◽  
Group D

Abstract Background Laryngoscopy and tracheal intubation are strong stimuli that cause a reflex increase in blood pressure (BP), heart rate (HR), and serum catecholamine level. These can lead to myocardial infarction or cerebrovascular accidents. The purpose of this study is to compare the efficacy of dexmedetomidine and lidocaine combined with propofol in attenuating the hemodynamic response following laryngoscopy and endotracheal intubation. Methods This study was a randomized controlled study and adhered to the CONSORT guidelines. One-hundred and six patients undergoing elective general anesthesia with endotracheal intubation were divided randomly into two groups. Group D received dexmedetomidine (1 μg kg− 1) before induction. Group LP received lidocaine (1.5 mg kg− 1) before induction with additional propofol (0.5 mg kg− 1) before laryngoscopy. The primary endpoint was hemodynamic including systolic (S) BP, diastolic (D) BP, mean arterial blood pressure (MAP) and HR measured before and after induction and ≤ 10 min after intubation. Secondary outcome was complications/adverse effects. Results After induction, the mean SBP, DBP, MAP and HR decreased significantly from baseline in both groups except for mean HR in group LP at 1 min. Differences in mean values of SBP, DBP, and MAP were significantly lower in group D after intubation at 4–10 min (P <  0.05). Group LP had a non-inferior effect in blunting BP at all time points except 1 and 2 min after induction, and 2 min after intubation. The mean difference in HR in group D was significantly lower than that in group LP at all time points (P <  0.001). Group D had significantly more episodes of bradycardia (18.87% vs. 0%, P = 0.001) and hypotension (52.83% vs. 15.09%, P < 0.001) than did group LP. Conclusion Lidocaine (1.5 mg kg− 1) with additional propofol (0.5 mg kg− 1) had a non-inferior effect compared with dexmedetomidine (1 μg kg− 1) in attenuating the hemodynamic response following laryngoscopy and endotracheal intubation, and had fewer adverse effects. Trial registration Thai Clinical Trial Registry, (TRTC20190206002). Retrospectively registered 4 February 2019.

Prolonged Intubation Injuries of the Larynx: Endoscopic Diagnosis, Classification, and Treatment

1993 ◽  
Vol 102 (4_suppl) ◽  
pp. 1-16 ◽  
Author(s):  
Bruce Benjamin
Keyword(s):  
General Anesthesia ◽  
Endotracheal Intubation ◽  
Granulation Tissue ◽  
Direct Laryngoscopy ◽  
Prolonged Intubation ◽  
Laryngeal Trauma ◽  
Flow Charts ◽  
Diagnosis Classification ◽  
Classification And Treatment

Laryngeal trauma from prolonged endotracheal intubation occurs in patients of all ages. Most changes are superficial and heal quickly. Injuries that are found consistently during intubation include nonspecific changes, edema, granulation tissue, ulceration, and other miscellaneous injuries. In this paper significant, severe, and lasting trauma of the larynx has been classified on the basis of the known factors in pathogenesis, observations made at endoscopy, and photographic documentation. This classification has required introduction of new descriptive terminology: “tongues of granulation tissue,” “ulcerated troughs,” “healed furrows,” and “healed fibrous nodule.” During intubation the degree of injury can be precisely assessed under general anesthesia by using telescopes for image magnification, thus assisting a decision whether to continue intubation or perform tracheotomy to minimize long-term morbidity. Changes that are found after extubation result from granulation tissue, ulceration, or a combination of both and have been illustrated on flow charts; a knowledge and understanding of these sequelae allows them to be identified by both indirect and direct laryngoscopy so that treatment can be planned.

REFLEX CIRCULATORY RESPONSES TO DIRECT LARYNGOSCOPY AND TRACHEAL INTUBATION PERFORMED DURING GENERAL ANESTHESIA

1951 ◽  
Vol 12 (5) ◽  
pp. 556-566 ◽  
Author(s):  
B. D. KING ◽  
L. C. HARRIS ◽  
F. E. GREIFENSTEIN ◽  
J. D. ELDER ◽  
R. D. DRIPPS
Keyword(s):  
Tracheal Intubation ◽  
General Anesthesia ◽  
Direct Laryngoscopy

scholarly journals Criteria for Estimating Likelihood of Difficulty of Endotracheal Intubation with the Macintosh Laryngoscope

1988 ◽  
Vol 16 (3) ◽  
pp. 329-337 ◽  
Author(s):  
C. P. Bellhouse ◽  
C. Doré
Keyword(s):  
Discriminant Analysis ◽  
Tracheal Intubation ◽  
Endotracheal Intubation ◽  
Clinical Evaluation ◽  
Difficult Intubation ◽  
Direct Laryngoscopy ◽  
Macintosh Laryngoscope ◽  
Stepwise Discriminant Analysis ◽  
X Ray

Many anatomical factors in difficult intubation at direct laryngoscopy have been evaluated. Lateral radiographs were taken of nineteen patients in whom tracheal intubation proved particularly difficult, and fourteen patients whose intubation was reasonably straightforward. Stepwise discriminant analysis was used to select the best measurements for distinguishing between the difficult and straightforward groups. The variables which together are most reliable in predicting likely difficulty in intubation are reduced atlanto-occipital extension, reduced mandibular space, and lastly, increased antero-posterior thickness of the tongue. A formula and graph have been derived to relate these variables with likelihood of difficulty, and a method has been described of applying this information at the bedside, without using X-ray examination, to estimate the likelihood of difficulty in intubating a new patient. Eighteen months’ experience of the application of this clinical evaluation have so far found it reliable.

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