Videolaryngoscopy: a help or a hindrance?

Airway management is fundamental to anaesthesia, and technology may help with the safety of this procedure. Videolaryngoscopy is a developing area, which is becoming commonplace in anaesthesia practice.

Nalbuphine versus dexmedetomidine for attenuation of haemodynamic response to laryngoscopy and intubation: A randomised double blind comparative study

Laryngoscopy and intubation are noxious stimuli which result in marked sympathetic response. However, literature search did not reveal any study comparing nalbuphine and dexmedetomidine for attenuation of haemodynamic response to laryngoscopy and intubation. After Institutional Ethical Committee approval and written informed consent, 80 ASA I and II patients were randomised in two groups of 40 each. Group N received 0.2 mg/kg of nalbuphine; group D received 1 µg/kg dexmedetomidine over a period of 10 min. Anaesthesia was induced as per standard general anaesthesia practice. Haemodynamic parameters [Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), & Mean Arterial Pressure (MAP)] were recorded at baseline, 0, 1, 3, 5, 10, and 15 min following intubation. Patients were also observed for any side effects of the study drugs.There was a significant decrease (p<0.001) in mean HR in group D compared to group N, after administration of drug and 1 min after intubation. Both group N and group D showed no significant increase in mean HR at any time point compared to baseline values. There was no significant increase in mean SBP at any time interval in both the groups when compared to baseline. There was a significant increase (p<0.001) in mean DBP and MAP at the time of intubation in group N whereas no significant increase in mean DBP, and MAP was observed in group D at any time point. Dexmedetomidine was found to be more effective in attenuating haemodynamic response to laryngoscopy and intubation as compared to nalbuphine.

A Comparative Study of Intubation Performance between Channelled vs. Non-Channelled Blade of King Vision Video Laryngoscope in Orotracheal Intubation

BACKGROUND Video laryngoscope is an important tool for orotracheal intubation in anaesthesia practice particularly in difficult airways. It provides an indirect view of glottis without the need of alignment of oropharyngeal-laryngeal axis. We compared the intubation characteristics of channelled versus non-channelled blades of King VisionTM Video Laryngoscope. METHODS In this study 60 patients were randomly allocated to two groups; group C were intubated with channelled and group NC with non-channelled blade of King Vision. We measured time for glottis visualisation and intubation time using both blades. Percentage of glottis opening (POGO), insertion attempts, intubation attempts, and ease of intubation were also assessed. RESULTS The time for glottis visualisation was 8.5 ± 3 seconds for group C and 7 ± 2 seconds for group NC. Intubation time was 24 ± 8.5 seconds for group C and 44 ± 5 seconds for NC. There was no statistical difference in POGO, insertion attempts, intubation attempts and ease of intubation between the two groups. CONCLUSIONS We concluded that the time for glottis recognition is longer but intubation time is shorter when using King Vision video laryngoscope channelled blade as compared to non-channelled blade. KEYWORDS Video Laryngoscope, King Vision, Channelled, Non-Channelled

Efficacy of Oral Gabapentin for Attenuation of Haemodynamic Responses to Laryngoscopy & Endotracheal Intubation

BACKGROUND Laryngoscopy and endotracheal intubation are basic skills to be acquired by an anaesthesiologist. For many years, laryngoscopy has been used as a conventional way to facilitate endotracheal intubation. These are the most critical events because, they provoke a marked rise in sympathoadrenal response as hypertension and tachycardia. There is an absolute need to decrease these haemodynamic responses, for which various drugs were used, with varying degrees of success. Gabapentin, initially used as an anticonvulsant has extended its role into anaesthesia practice with its multimodal effects. This study was conducted to evaluate the efficacy of oral gabapentin 800 mg in attenuation of haemodynamic responses to laryngoscopy and endotracheal intubation. METHODS After obtaining institutional ethical clearance, a prospective randomised comparative study was undertaken. Written and informed consent was obtained from 80 patients belonging to American Society of Anaesthesiologists (ASA) class I & II scheduled for various elective surgeries under general anaesthesia. They were divided into two groups of 40 each using computer generated random number table. Group G received oral gabapentin 800 mg and group C received empty capsules with sips of water, 2 hours prior to induction. Haemodynamic parameters – heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) were noted and rate pressure product (RPP) was calculated at baseline, at laryngoscopy and then at 1, 3, 5, 10 & 15 minutes after laryngoscopy and endotracheal intubation. RESULTS In Group G there was significant attenuation of HR, SBP, DBP, MAP at 1, 3 and 5 minutes after laryngoscopy and endotracheal intubation as compared to Group C. Hence, in Group G there was significant attenuation of RPP at 1 minute (12673.60 ± 1691.25, 11769.08 ± 1146.02, P = 0.01), 3 minutes (12546.85 ± 1123.78, 11759.98 ± 1358.02, P = 0.01) and 5 minutes (12411.68 ± 1270.04, 11537.03 ± 1230.06, P = 0.002) after laryngoscopy and endotracheal intubation as compared to Group C. No statistical difference was seen at 10 and 15 minutes. CONCLUSIONS Oral gabapentin 800 mg given preoperatively can attenuate haemodynamic responses to laryngoscopy and endotracheal intubation without significant side effects. KEY WORDS Oral Gabapentin, Laryngoscopy, Endotracheal Intubation, Haemodynamic Changes, Attenuation, Pressor Responses

Analysis of anaesthesia services to calculate national need and supply of anaesthetics in Switzerland during the COVID-19 pandemic

Background In Switzerland, details of current anaesthesia practice are unknown. However, they are urgently needed to manage anaesthesia drug supply in times of drug shortages due to the pandemic. Methods We surveyed all Swiss anaesthesia institutions in April 2020 to determine their annual anaesthesia activity. Together with a detailed analysis on anaesthetic drug use of a large, representative Swiss anaesthesia index institution, calculations and projections for the annual need of anaesthetics in Switzerland were made. Only those drugs have been analysed that are either being used very frequently or that have been classified critical with regard to their supply by the pharmacy of the index institution or the Swiss Federal Office of Public Health. Results The response rate to our questionnaire was 98%. Out of the present 188 Swiss anaesthesia institutions, 185 responded. In Switzerland, the annual number of anaesthesias was 1’071’054 (12’445 per 100’000 inhabitants) with a mean anaesthesia time of 2.03 hours. Teaching hospitals (n = 54) performed more than half (n = 572’231) and non-teaching hospitals (n = 103) provided almost half of all anaesthesias (n = 412’531). Thereby, private hospitals conducted a total of 290’690 anaesthesias. Finally, office-based anaesthesia institutions with mainly outpatients (n = 31) administered 86’292 anaesthesias. Regarding type of anaesthesia provided, two thirds were general anaesthesias (42% total intravenous, 17% inhalation, 8% combined), 20% regional and 12% monitored anaesthesia care. Projecting for example the annual need for propofol in anaesthesia, Switzerland requires 48’573 L of propofol 1% which corresponds to 5’644 L propofol 1% per 100’000 inhabitants every year. Conclusions To actively manage anaesthesia drug supply in the context of the current pandemic, it is mandatory to have a detailed understanding of the number and types of anaesthesias provided. On this basis, the Swiss annual consumption of anaesthetics could be projected and the replenishment organized.

Cricoid pressure controversies

Rapid sequence induction (RSI) is a common technique used in clinical anaesthesia to prevent pulmonary aspiration of gastric contents. Sellick introduced this in 1961. However, scientific validation to show the advantage of this technique in preventing aspiration is limited in literature. Numerous researches have shown that cricoid pressure (CP) application might have no benefit in preventing aspiration. Additionally this could lead to problems in securing the airway. Proper teaching and regular training sessions of this technique are mandatory in routine anaesthesia practice.