scholarly journals Recovery Status in Children after General Anaesthesia: Role of Pre-emptive Local Anaesthetic Infiltration

2009 ◽  
pp. 38-44
Author(s):  
Md Maqsud Isa ◽  
Rubina Yasmin ◽  
Nur Syeeda ◽  
Suraiya Enam ◽  
Md Manowarul Isiam ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
General Anaesthesia ◽  
Local Anaesthetic ◽  
Local Infiltration ◽  
Group I ◽  
Mean Pressure ◽  
Recovery Status ◽  
Group Ii ◽  
Operative Recovery ◽  
Group 1

This prospective clinical study was carried out in the dept. of Anaesthesia, Analgesia and Intensive Care Medicine, BSMMU. Dhaka during the period of January 04 to September 04. The study was done to emphasize the importance of giving analgesics preemptively instead of waiting for the child to complain or express their pain and to improve post operative recovery status and associated response by reducing the immediate post operative pain with simple local anaesthetic infiltration. The children scheduled for elective herniotomy operation through a hernial incision under general anaesthesia were recruited in this study. Immediate recovery status in children was compared with preemptive (group-1 and without preemptive (group-II) local infiltration of 0.25% bupivacaine in herniotomy operation. No. of patients was 20 in each group. Pulse, systolic, diastolic and mean pressure, oxygen saturation, pain (scored by TPPPS), anaesthetic recovery (scored by steward recovery system) and mental status if the children were observed postoperatively at different time interval up to one hour. Pulse, systolic, diastolic, mean pressure were stable in group-1 then group-II. Oxygen saturation in both the groups were in clinically acceptable range but in group-11 5 mins after extubation fall more than that of group- l and statistically significant. Pain score (TPPPS) in group-1 was lower all the time period but in group-II the score was high, all the children required rescue pethidine within 10 mins after extubation, mean dose reqd, in group-II was 23.6+3.6mg. Steward recovery score in both group was not significant at early period but after 10 mins. P value become significant The mental state of group-I was calm & quite only 3 were excited, on the other hand in group-11 all children were excited & irritable and required rescue pethidine. So preemptive local infiltration of 0.25 bupivacaine improved the recovery status in children by reducing the immediate postoperative pain and there by decrease in postoperative morbidity. Journal of BSA, Vol. 18, No. 1 & 2, 2005 p.38-44

scholarly journals Efficacy of nebulised L-adrenaline with 3% hypertonic saline versus normal saline in bronchiolitis

2016 ◽  
Vol 7 (1) ◽  
pp. 15
Author(s):  
Shabnam Sharmin ◽  
Laila Helaly ◽  
Zakir Hossain Sarker ◽  
Ruhul Amin ◽  
Shafi Ahmed ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Respiratory Rate ◽  
Hypertonic Saline ◽  
Normal Saline ◽  
Severity Score ◽  
Saline Group ◽  
Clinical Severity ◽  
Clinical Severity Score ◽  
Group I ◽  
Group Ii

<p><strong>Background:</strong> Bronchiolitis is one of the most common respiratory diseases requiring hospitalization. Nebulized epineph­rine and salbutamol therapy has been used in different centres with varying results. <strong></strong></p><p><strong>Objective:</strong> The objective of the study was to compare the efficacy of nebulised adrenaline diluted with 3% hypertonic saline with nebulised adrenaline diluted with normal saline in bronchiolitis. <strong></strong></p><p><strong>Methods:</strong> Fifty three infants and young children with bronchiolitis, age ranging from 2 months to 2 years, presenting in the emergency department of Manikganj Sadar Hospital were enrolled in the study. After initial evaluation, patients were randomized to receive either nebulized adrenaline I .5 ml ( 1.5 mg) diluted with 2 ml of3% hypertonic saline (group I) ornebulised adrenaline 1.5 ml (1.5 mg) diluted with 2 ml of normal saline (group II). Patients were evaluated again 30 minutes after nebulization. <strong></strong></p><p><strong>Results:</strong> Twenty eight patients in the group I (hypertonic saline) and twenty five in groupII (normal saline) were included in the study. After nebulization, mean respiratory rate decreased from 63.7 to 48.1 (p&lt;.01), mean clinical severity score decreased from 8.5 to 3.5 (p&lt;.01) and mean oxygen satw·ation increased 94.7% to 96.9% (p&lt;.01) in group I. In group II, mean respiratory rate decreased from 62.4 to 47.4 (p&lt;.01), mean clinical severity score decreased from 7.2 to 4.1 (p&lt;.01) and mean oxygen saturation increased from 94. 7% to 96. 7% (p&lt;.01). Mean respiratory rate decreased by 16 in group I versus 14.8 (p&gt;.05) in group 11, mean clinical severity score decreased by 4.6 in group versus 3 (p&lt;.05) in group, and mean oxygen saturation increased by 2.2% and 1.9% in group and group respectively. Difference in reduction in clinical severity score was statistically significant , though the changes in respiratory rate and oxygen saturation were not statistically significant. <strong></strong></p><p><strong>Conclusion:</strong> The study concluded that both nebulised adrenaline diluted with 3% hypertonic saline and nebulised adrenaline with normal saline are effective in improving respiratory rate, clinical severity score and oxygen saturation in infants with bronchiolitis; and nebulised adrenaline with hypertonic saline is more effective than nebulised adrenaline with normal saline in improving clinical severity score in bronchiolitis.</p>

Evolving Solutions in the Surgical Treatment of Isolated Pulmonary Valve Stenosis

2021 ◽  
Author(s):  
Sonia B. Albanese Albanese
Keyword(s):  
Surgical Treatment ◽  
Pressure Gradient ◽  
Pulmonary Valve ◽  
Balloon Valvuloplasty ◽  
Pulmonary Valve Stenosis ◽  
Group I ◽  
Mean Pressure ◽  
Valve Function ◽  
Group Ii

Background: Surgical treatment of isolated pulmonary valve stenosis in infants and children has evolved over the years, shifting from the original exclusive aim at lowering right ventricle pressure to the current concomitant focus on preserving pulmonary valve function. In our study, we sought to analyze the effect of such evolving philosophy on long-term results. Methods: All consecutive patients treated in our center between July 1983 and March 2019 were included. Patients were categorized into 2 groups based on the introduction into treatment practice of sparing valve techniques (1995). Actuarial survival, freedom from reintervention on the right outflow tract, transvalvular mean pressure gradient decrease, and pulmonary valve function at follow-up were analyzed. Results: One hundred twenty-three patients operated before (Group I, n=81) or since (Group II, n=42) 1995 were enrolled in the study. Mean age and weight were 3.0 ± 0.36 years and 16.6 ± 1.7kg, respectively. Early mortality occurred exclusively in 3 patients of Group 1. Transvalvular mean pressure gradient decreased in the entire patient population (from 63.28 ± 12.9mmHg to 16.46 ± 7.9mmHg). At a mean follow-up interval of 4.9 ± 33 years, freedom from death was comparable, but freedom from right ventricular outflow tract reintervention was significantly greater in Group II. Although the transvalvular gradient remained stable over time in non-reoperated survivors (mean value of 16.46 ± 7.9mmHg), pulmonary valve function on 2D-Echo showed severe incompetence in 2 patients of Group I and just mild to moderate incompetence in 20 patients of Group II, with a significantly negative effect of unsuccessful preoperative pulmonary balloon valvuloplasty (14/20 vs 6/20, p=0.025) in the latter. Conclusion: Current pulmonary valve sparing techniques are associated with better results, particularly in terms of freedom from re-interventions and pulmonary valve function at follow-up. Balloon valvuloplasty prior to surgery may worsen operative results, promoting pulmonary insufficiency and therefore should probably be avoided in all patients in whom anatomical characteristics predict failure of percutaneous therapy.

Right-To-Left Shunts (Extra-Cardiac Arterial-Venous Malformations) Are Highly Common In Adults With Sickle Cell Disease

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1004-1004
Author(s):  
Nathan Langer ◽  
MaryAnn O'Riordan ◽  
Santosh K. Rao ◽  
Jane A. Little ◽  
Robert Schilz
Keyword(s):  
Sickle Cell Disease ◽  
General Population ◽  
Oxygen Saturation ◽  
Sickle Cell ◽  
Morbidity And Mortality ◽  
Acute Chest Syndrome ◽  
Venous Malformations ◽  
Cell Disease ◽  
Group I ◽  
Group Ii

Abstract Introduction Cardiopulmonary complications are a major cause of morbidity and mortality in sickle cell disease (SCD) as shown by worse prognosis in patients who have experienced acute chest syndrome or who have an elevated tricuspid regurgitant jet velocity (TRV) on echocardiogram at clinical baseline. Here we describe an unexpected and novel cardio-pulmonary complication in HbSS, right-to-left shunting through extra-cardiac arterial-venous malformations (AVMs), which may contribute to pathophysiology. Extracardiac AVMs are rare in the general population, with an estimated incidence of 1/5000. Of 2111 shunt evaluation echocardiograms performed at our institution over 12 months only 81 (3.8%) of individual studies were positive. Methods We evaluated 36 HbSS patients who presented with subjective dyspnea or hypoxia with clinical exam and with echocardiogram utilizing agitated saline to assess for vascular right-to-left shunts. We compared this group with the remaining 81 HbSS patients in our database. 19 of 36 symptomatic patients were found to have an extracardiac right-to-left shunt. We then compared these 19 patients with the 17 symptomatic HbSS patients who did not have a shunt. 10 HbSC and 5 S-beta-thalassemia patients were also studied and did not have a right-to-left shunt; only HbSS are included in comparative analyses. Results Patients with symptoms did not differ in age (32.7±10.3 years vs 31.7±11.7 years) from patients who did not present with hypoxia or subjective dyspnea (n=81). Symptomatic patients were more likely to have macroalbuminuria (>300 mg/g albumin-to-creatinine, 9/36 vs 8/63 evaluable, p=0.05), more likely to have a TRV ≥3 meters/second (9/36 vs 11/74 evaluable, p=0.09), and were more hypoxic at rest (96 ±5% vs 98±2% oxygen saturation, p=0.07). We found delayed left-sided bubble visualization in 19/36 symptomatic HbSS subjects (53%) consistent with extra-cardiac AVMs. HbSS subjects with (n=19, Group I) or without (n=17, Group II) a positive bubble study were clinically and demographically similar (age, gender, WBC, total Hgb, HgbF%, LDH, eGFR, proportion with macroalbuminuria, baseline oxygen saturation, and elevated TRV). However, group I patients had a higher reticulocyte count (15.4±5.5% vs 9.8±6.7% p<0.005). Of Group I patients, 42.1% had history of acute chest while 70.6% of Group II had such history (p=0.09). Group I patients were less likely to be on hydroxyurea (52.78% vs 47.22% p<0.05). Conclusion Extra-cardiac AVMs are observed in 16% of all subjects with HbSS, compared with 3.8% of general medical patients at a tertiary center undergoing shunt evaluation and .02% in the general population. In HbSS, symptomatic subjects are more likely to have evidence for vasculopathy (macroalbuminuria, elevated TRV) and hypoxia; one-half of these symptomatic patients have extracardiac AVMs. We speculate that this finding is unlikely to be clinically silent, and a bubble-echocardiogram may be an important additional clinical evaluation for symptomatic dyspnea or hypoxia. The impact of this novel clinical finding on morbidity and mortality in this disease remains under investigation. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Elevated jugular venous oxygen saturation after severe head injury

2001 ◽  
Vol 11 (4) ◽  
pp. 9-15 ◽  
Author(s):  
Manuela Cormio ◽  
Alex B. Valadka ◽  
Claudia S. Robertson
Keyword(s):  
Head Injury ◽  
Oxygen Saturation ◽  
Severe Head Injury ◽  
Vegetative State ◽  
Persistent Vegetative State ◽  
Lactate Production ◽  
Jugular Venous Oxygen Saturation ◽  
Group I ◽  
Venous Oxygen Saturation ◽  
Group Ii

Object The aim of this study was to investigate the incidence of elevated (≥ 75%) jugular venous oxygen saturation (SjvO2) and its relationship to cerebral hemodynamic and metabolic parameters and to outcome after severe head injury. Methods Data from 450 severely head injured patients admitted to the Neurosurgical Intensive Care Unit of Ben Taub General Hospital were analyzed retrospectively. The SjvO2 was measured in blood obtained from indwelling jugular bulb catheters. Patients were classified into the following categories: high (Group I), normal (Group II), or low SjvO2 (Group III) if their mean SjvO2 over the duration of monitoring was 75% or higher, 74 to 56%, or 55% or lower, respectively. A high SjvO2 occurred in 19.1% of patients. There was no consistent relationship between SjvO2 and simultaneous cerebral blood flow (CBF) or cerebral perfusion pressure measurements. Compared with Groups II and III, the patients in Group I had a significantly higher CBF and lower cerebral metabolic rate of oxygen (CMRO2). In Group I, the out- comes were death or persistent vegetative state in 48.8% of patients and severe disability in 25.6%. These outcomes were significantly worse than for patients in Group II. Within Group I, the patients with a poor neurological outcome were older and more likely to have suffered a focal head injury; they demonstrated a lower CMRO2 and a greater rate of cerebral lactate production than the patients who attained a favorable outcome. Conclusions Posttraumatic elevation of SjvO2 is common but cannot be automatically equated with hyperemia. Instead, elevated SjvO2 is a heterogeneous condition that is associated with poor outcome after head injury and may carry important implications for the management of comatose patients.

scholarly journals CHEMICAL CHARACTERIZATION OF GLYCOPEPTIDES FROM HUMAN γM-GLOBULINS

1968 ◽  
Vol 128 (4) ◽  
pp. 699-713 ◽  
Author(s):  
Joseph M. Davie ◽  
C. Kirk Osterland
Keyword(s):  
Molecular Weight ◽  
Sialic Acid ◽  
Gel Filtration ◽  
Chemical Characterization ◽  
Carbohydrate Composition ◽  
Total Percentage ◽  
Group I ◽  
Group Ii ◽  
Group 1

A survey of human pathological macroglobulins revealed that γM can be divided into at least two groups on the basis of carbohydrate composition. Differences between the two groups exist in the total percentage of carbohydrate (10.69 ± 1.49% for group 1, 7.71 ± 0.65% for group II) which is attributable to variation in hexose content. Glycopeptides from macroglobulins of each group were purified from pronase digests and characterized chemically. Macroglobulins from each group contain three types of oligosaccharides. Glycopeptide I for each group consisted of mannose, galactose, and NAG with a ratio of 3:2:1 for group I and a ratio of 2:1:2 for group II. Glycopeptide II consisted of mannose, galactose, and NAG (9:1:2) for group I, and mannose, fucose, galactose, and NAG (2:1:3:2) for group II. Glycopeptide III in both groups consisted of mannose, fucose, galactose, NAG, and sialic acid with a ratio of 6:2.5:2.5:5.5:2 for group I and a ratio of 5:1:1:6:1 for group II. Molecular weight estimations by gel filtration indicates that there are 10 glycopeptides I and II and 20 units of glycopeptide III per molecule of γM.

scholarly journals Rationale of specialized medical care for patients with chronic heart failure in the Russian Federation

2020 ◽  
Vol 1 (3) ◽  
pp. 44-53
Author(s):  
I. V. Fomin ◽  
N. G. Vinogradova
Keyword(s):  
Heart Failure ◽  
Medical Care ◽  
Clinical Severity ◽  
Adherence To Treatment ◽  
Group I ◽  
Patients With Heart Failure ◽  
Group Ii ◽  
Overall Mortality ◽  
Group 1

Objectives: to determine the causes of ineffective observation and poor prognosis in patients undergoing ADHF, in real clinical practice and to consider the basics of the formation of specialized medical care for patients with heart failure (HF).Materials and methods: the study was conducted based on the City Center for the treatment of heart failure (center HF), N. Novgorod. The study consistently included 942 patients with heart failure (HF) at the age of 18 years and older who underwent ADHF and received inpatient treatment in center HF between March 4, 2016 and March 3, 2017. Based on the decisions of patients to continue outpatient monitoring in center HF, two groups of patients were distinguished: patients who continued to be monitored in center HF (group I, n = 510) and patients who continued to be monitored in outpatient clinics at the place of residence (group II, n = 432). The assessment of adherence to treatment, overall mortality, survival and re-admission to a depth of two years of observation was carried out. Statistical data processing was performed using Statistica 7.0 for Windows and the software package R.Results: all patients in the study groups had high comorbidity. Group 2 patients turned out to be statistically significantly older, more often had III functional class (FC) HF, lower the baseline test score of 6-minute walk, and higher the baseline clinical assessment scale. After 2 years of follow-up in group II, there was a significant deterioration in adherence to basic therapy of HF compared with group I. According to the results of multifactorial proportional risk Cox models, it was shown that observation of patients in the group 1 is an independent factor increasing the risk of overall mortality by 2.8 times by the end of the second year of observation. Survival after two years of follow-up was: in group I — 89.8 %, and in group II — 70.1 % of patients (OR = 0.3, 95 % CI 0.2 – 0.4; p1/2 < 0.001). After two years of follow-up, the proportion of re-hospitalized patients in group II was greater (78.0 % of patients) versus group 1 (50.6 % of patients, OR = 3.5, 95 % CI 2.6 – 4.6; p1/2 <0.001). The independent risk of re-hospitalization according to multinominal logit regression was 3.4 times higher in group II and 2.4 times for III – IV FC HF. Conclusions: the inclusion of patients with HF in the system of specialized medical care improves adherence to treatment, prognosis of life and reduces the risk of repeated hospitalizations. Patients of an older age and with an initially greater clinical severity refused specialized supervision in center HF.

scholarly journals Mini-thoracotomy versus Full Sternotomy Techniques in Mitral Valve Surgery: Blood Loss, Wound infections, Post-operative Recovery, Morbidity and Mortality Investigation

2021 ◽  
pp. 21
Author(s):  
Keyword(s):  
Mitral Valve ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Wound Infections ◽  
Operative Outcomes ◽  
Group I ◽  
Group Ii ◽  
Operative Recovery

Background: Mitral valve surgery is routinely performed through a Median full sternotomy (MFS) with excellent long term outcomes. Minimally invasive mitral (MIMVS) valve surgery is also a surgical approach that improves operative outcomes. In this study we report early post-operative outcomes in minimally invasive mitral valve surgery compared with MFS access with reference to Blood Loss, Wound infections, post-operative Recovery, Morbidity, Mortality and others variables. Patient and Methods: This study was a prospective data collection from 52 consecutive patients who underwent isolated mitral valve surgery at our institution from November 2017 to October 2019. Population study was divided to two groups, MIMVS (group I n= 26) and MFS (group II n=26). Pre-operative planning were performed so that to obtain similar characteristics. Intra and post-operative data were analysed. Results: The baselines characteristics were similar in both groups. Of the 26 patients in group I, 23 (88.46%) underwent mitral valve replacement and 3 a mitral valve repair. All the patients in group II underwent mitral valve replacement. There was no difference in term of mortality and morbidity. MIMVS was associated with longer CPB time (mean 161.9 vs 89.8 mins, P =.025) but similar ACC (99 mins vs 64 P=.468) time. MIMVS Patients had likely lower incidence of red blood cells transfusion (12.2% vs 34.7%,), post-operative haemoglobin was similar before transfusion. Haemorrhage complications were more likely in the group II (26.08 vs 7.7%); requiring inotropic support was found to be higher in the group II (54.5 vs 19%). In addition, patients in the MIMVS group had a shorter mechanical ventilation time (1.6 [1-6] vs 3.6 [2-8] hours; P <.01), shorter ICU stay 1.36 [1-6] vs 3.6 [2-8] days, p<.01. Length of hospital stay and chest tube stay were found to be shorter, respectively 6.9 [6-16] vs 7, 7 [7-13] and (1.38 [1-2] days vs 2.64 [2-4], P <.01). Wound infections were not found in both groups. Conclusion: Although the controversy interest of minimally invasive mitral valve surgery, it may be associated with less blood loss, faster post-operative recovery but increases operation time.

scholarly journals Comparison of tolterodine and Solifancine in treatment of female with overactive bladder

2021 ◽  
Vol 10 (6) ◽  
pp. 2138
Author(s):  
Nermeen Mohamed Hefila ◽  
Tamer Mamdouh And el dayem ◽  
Hisham Adel Elfazari
Keyword(s):  
Overactive Bladder ◽  
Maternity Hospital ◽  
P Value ◽  
Detrusor Muscle ◽  
Urinary Urgency ◽  
Urinary Frequency ◽  
Group I ◽  
Significant Difference ◽  
Group Ii ◽  
Group 1

Background: OAB (overactive bladder) is primarily a neuromuscular problem in which the detrusor muscle contracts inappropriately during bladder filling (i.e., storage phase). These contractions often occur regardless of the amount of urine in the bladder. The aim of this work is to study the effect of Solifenacin in comparison to Tolterodine in treatment of females with idiopathic over active bladder.Methods: This study included 50 patients who presented between March 2020 and February2021 to the outpatients clinic at El-Shatby maternity Hospital, Alexandria university. The patients were complaining of urinary urgency usually with urinary frequency, nocturia with or without urge incontinence. All cases were divided in two groups one of them receive Solifenacin5mg twice daily and the otherreceiveTolterodine2mg twice daily.Results: Both groups showed significant decrease in frequency number per day with p value <0.001ingroup I with Solifenacin which mean statistically significant difference between two groups. When the percentage of symptoms severity were compared between both groups, group 1 showed 53% reduction in symptoms severity while group II showed 6.67% reduction which cleared significant difference statistically in group I (p=0.001). The percentage of reduction of severity of symptoms was compared between the two groups, it showed about 60%reduction in symptoms severity in group 1while in group II only 9.7% reduction. This was statistically significant with (p<0.001) in group I with Solifenacin.Conclusions: This study suggests that Solifenacin10mg/day is more effective than Tolterodine4mg/day in reducing OAB incontinence episodes.

Spirulina platensis enhances immune status, inflammatory and oxidative markers of HIV patients on antiretroviral therapy in Cameroon

2020 ◽  
Author(s):  
Vicky Jocelyne Ama Moor ◽  
Pieme Constant Anatole ◽  
Jan René Nkeck ◽  
Prosper Cabral Biapa Nya ◽  
Georges Ikomey Mondinde ◽  
...  
Keyword(s):  
Viral Load ◽  
Antiretroviral Therapy ◽  
Spirulina Platensis ◽  
Immune Status ◽  
Lipid Lowering ◽  
Hiv Patients ◽  
Oxidative Markers ◽  
Group I ◽  
Group Ii ◽  
Group 1

Abstract Background Spirulina platensis is traditionally used as a food supplement with a potential strengthening of the immune system, inhibition of the replication of some viruses, and lipid-lowering effect. The aim of this study was to determine its effect on the inflammatory, immunological, and oxidative status of HIV patients on antiretroviral therapy (ART). Methods We performed a study on 62 HIV patients on ART (Tenofovir-Lamivudine-Efavirenz) divided into 2 groups. Group I, supplemented with 10 grams of Spirulina platensis daily, and group II only ART. Participants were paired on ART duration and followed-up for 6 months from December 2015 to June 2016 at the HIV care unit of the Yaounde Central Hospital and the Cité-Verte Hospital, Yaounde. Each group was sampled for CD4-count, viral load, serum levels of interleukins 6 and 8, TNFα and oxidative markers (malondialdehyde, FRAP, catalase, total peroxides, superoxide dismutase, glutathione peroxidase, reduced glutathione) at the beginning (T0) and the end of the trial (T1). Ethical clearance was obtained from the Cameroon National Ethics Committee for Human Health and Research (Ref 2016/01/699/CE/CNERSH/SP). Statistical analysis was performed using the software SPSS 21.0. The threshold of significance was set at 0.05. Results Mean ages of participants were 35 ± 8 and 37 ± 7 respectively for group I and II. We observed a significant decrease in viral load in patients receiving spirulina comparing at T0 and T1 (p = 0.001), not observed for participants in group II (p>0.05). CD4-counts were unchanged. There was a significant reduction of TNFα levels in group 1. The levels of pro-oxidative markers were significantly reduced in group 1 while increased in the other group. Antioxidant levels significantly increased in both groups. Conclusion Daily supplementation of Spirulina platensis could improve the immune status of HIV patients on ART, and decrease inflammatory and pro-oxidant levels.

Comparison between Sniffing Position and 25 Degree Backup Position in View of Glottis During Direct Laryngoscopy and Intubation - A Study from Mangalore, Karnataka

2021 ◽  
Vol 8 (41) ◽  
pp. 3573-3577
Author(s):  
AKhil Rao U.K. ◽  
Athira Soman ◽  
Anuradha Yadav ◽  
Yashwant R. ◽  
Sucheth Sharat
Keyword(s):  
General Anaesthesia ◽  
Endotracheal Intubation ◽  
Direct Laryngoscopy ◽  
Elective Surgery ◽  
Controlled Trial ◽  
Randomized Study ◽  
Group I ◽  
Head Positioning ◽  
Difficulty Scale ◽  
Group Ii

BACKGROUND Endotracheal intubation for the purpose of providing anaesthesia was first described by William Mc Ewan. Jackson1 stressed the importance of anterior flexion of the lower cervical spine, in addition to obvious extension of the atlanto-occipital joint. Sniffing position has been commonly advocated as a standard head positioning for direct laryngoscopy which is achieved by flexion of the neck on chest and extension of the head at the atlanto-occipital joint. Present study was designed to evaluate the glottis view and ease of intubation achieved with direct laryngoscopy in the sniffing position with that of 25 degree backup position in a study group of 100 patients divided in 2 groups of 50 each. METHODS This study is a controlled comparative study. Controlled trial in 50 consecutive patients in each group [Group I and Group II] was conducted on patients who underwent elective surgery under general anaesthesia. Inclusion Criteria - General anaesthesia with endotracheal intubation, Aged 18 to 60 years, American society of Anaesthesiologists (ASA) grades I and II. Exclusion Criteria - Patients with body mass index more than 30 kg/m2. 1. Bucked teeth. 2. Restricted neck movement. 3. Inter-incisor gap less than 35 mm. 4. Thyro-mental distance less than 6 mm. 5. Patients with risk of regurgitation and aspiration. 6. Pharyngeal pathology. 7. Limitation of anterior and posterior movement of mandible 8. Pregnant patients Groups wereGroup I – Sniffing position Group II– 25 degree back up position RESULTS The glottis visualization was assessed by Cormack Lehane grading which revealed that glottis view was better in 25 degree backup position than sniffing position. CONCLUSIONS In our prospective randomized study in a series of 50 patients undergoing general anaesthesia in SIMS & RC, intubation difficulty scale (IDS) score was better in 25 degree backup position than sniffing position. It implies glottis view is better in 25 degree backup position than sniffing position. KEYWORDS Sniffing Position, 25 Degree Backup Position, Laryngoscopy

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