{"title":"5 best articles in airway journal since inception","authors":"V. Ramkumar","doi":"10.4103/arwy.arwy_43_22","DOIUrl":"https://doi.org/10.4103/arwy.arwy_43_22","url":null,"abstract":"","PeriodicalId":7848,"journal":{"name":"Airway Pharmacology and Treatment","volume":"15 1","pages":"101 - 102"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87391253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Maintenance of airway patency and oxygenation are the main objectives of face mask ventilation. Preoperative prediction can reduce the incidence of unanticipated difficult mask ventilation (DMV). Aim of Study: The aim of this study was to evaluate the correlation between predictors of DMV and its grading using a risk score. Study Setting and Design: This was an observational study approved by the Institutional Ethics Committee in a tertiary care hospital between 2020 and 2021. Patients and Methods: A total of 110 adult patients scheduled for elective surgery under general anaesthesia were studied. A detailed preoperative airway assessment was done to identify and risk score for seven standard predictors of DMV (male gender, age >55 years, body mass index ≥30 kg/m2, obstructive sleep apnoea [STOP-BANG score], edentulous state, modified Mallampati class and presence of beard). The risk score was correlated with the grading of mask ventilation in the operation theatre performed using the four-point scale as described by Han et al. Results: A statistically significant association was found with standard predictors such as male gender, obstructive sleep apnoea (STOP-BANG score) and the total preoperative risk score with the grading of mask ventilation (P < 0.05 for all). Additional risk factors found statistically significant were interincisor distance, thyromental distance, neck circumference, receding mandible, mandibular jaw protrusion, restricted neck movements, buck teeth and submucosal fibrosis. Conclusion: Prediction of DMV with preoperative risk score can lead to better anticipation of difficult airway management. Appropriate anticipatory airway management could potentially decrease the incidence of failed ventilation and resultant hypoxia.
{"title":"Correlation between predictors of difficult mask ventilation and its grading using a risk score","authors":"Indu Manikonda, S. Aphale","doi":"10.4103/arwy.arwy_16_22","DOIUrl":"https://doi.org/10.4103/arwy.arwy_16_22","url":null,"abstract":"Background: Maintenance of airway patency and oxygenation are the main objectives of face mask ventilation. Preoperative prediction can reduce the incidence of unanticipated difficult mask ventilation (DMV). Aim of Study: The aim of this study was to evaluate the correlation between predictors of DMV and its grading using a risk score. Study Setting and Design: This was an observational study approved by the Institutional Ethics Committee in a tertiary care hospital between 2020 and 2021. Patients and Methods: A total of 110 adult patients scheduled for elective surgery under general anaesthesia were studied. A detailed preoperative airway assessment was done to identify and risk score for seven standard predictors of DMV (male gender, age >55 years, body mass index ≥30 kg/m2, obstructive sleep apnoea [STOP-BANG score], edentulous state, modified Mallampati class and presence of beard). The risk score was correlated with the grading of mask ventilation in the operation theatre performed using the four-point scale as described by Han et al. Results: A statistically significant association was found with standard predictors such as male gender, obstructive sleep apnoea (STOP-BANG score) and the total preoperative risk score with the grading of mask ventilation (P < 0.05 for all). Additional risk factors found statistically significant were interincisor distance, thyromental distance, neck circumference, receding mandible, mandibular jaw protrusion, restricted neck movements, buck teeth and submucosal fibrosis. Conclusion: Prediction of DMV with preoperative risk score can lead to better anticipation of difficult airway management. Appropriate anticipatory airway management could potentially decrease the incidence of failed ventilation and resultant hypoxia.","PeriodicalId":7848,"journal":{"name":"Airway Pharmacology and Treatment","volume":"32 22","pages":"115 - 122"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91436077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Airway management in a burn victim poses special challenges for the anaesthesiologist not only during the acute phase but also after delayed consequences have set in resulting in difficulty in airway management. We report a 5-year-old boy who was admitted to the Department of Paediatrics with biphasic stridor 2 months following inhalational burn injury. He presented with complaints of difficulty in swallowing solid food, hoarseness of voice for the past 1 month and occasional difficulty in breathing for the past 10 days. Laryngoscopy using a #2 Macintosh blade revealed pharyngeal stenosis with grossly distorted airway anatomy. The patient was finally intubated after great difficulty with a 3.5 mm internal diameter endotracheal tube using a fibrescope.
{"title":"Difficult airway following inhalational burn injury in a child","authors":"Renu Wakhloo, Hitesha Gurtoo, Megha Gandotra, Shruti Gupta","doi":"10.4103/arwy.arwy_28_22","DOIUrl":"https://doi.org/10.4103/arwy.arwy_28_22","url":null,"abstract":"Airway management in a burn victim poses special challenges for the anaesthesiologist not only during the acute phase but also after delayed consequences have set in resulting in difficulty in airway management. We report a 5-year-old boy who was admitted to the Department of Paediatrics with biphasic stridor 2 months following inhalational burn injury. He presented with complaints of difficulty in swallowing solid food, hoarseness of voice for the past 1 month and occasional difficulty in breathing for the past 10 days. Laryngoscopy using a #2 Macintosh blade revealed pharyngeal stenosis with grossly distorted airway anatomy. The patient was finally intubated after great difficulty with a 3.5 mm internal diameter endotracheal tube using a fibrescope.","PeriodicalId":7848,"journal":{"name":"Airway Pharmacology and Treatment","volume":"141 1","pages":"133 - 135"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76240238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fibreoptic bronchoscopy-guided intubation (FOBI) is ideal in establishing the airway in patients with anticipated difficult airway before the induction of general anaesthesia. At times, patient factors lead to the need for FOBI in unconventional positions. We encountered a patient with postburn contracture with fixed flexion deformity of the neck who was unable to lie supine. Awake FOBI in sitting position turned out to be the ideal position for our patient.
{"title":"Awake fibreoptic bronchoscopy-guided nasal intubation in a burn patient: Role in sitting position","authors":"Sekar Loganathan, Ajay Singh, N. Naik","doi":"10.4103/arwy.arwy_23_22","DOIUrl":"https://doi.org/10.4103/arwy.arwy_23_22","url":null,"abstract":"Fibreoptic bronchoscopy-guided intubation (FOBI) is ideal in establishing the airway in patients with anticipated difficult airway before the induction of general anaesthesia. At times, patient factors lead to the need for FOBI in unconventional positions. We encountered a patient with postburn contracture with fixed flexion deformity of the neck who was unable to lie supine. Awake FOBI in sitting position turned out to be the ideal position for our patient.","PeriodicalId":7848,"journal":{"name":"Airway Pharmacology and Treatment","volume":"120 1","pages":"123 - 125"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80613121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sugandhi Nemani, S. Mishra, P. Rudingwa, S. Padala, M. Senthilnathan, S. Parida
Background: Ambu® AuraGain™ laryngeal airway is a supraglottic airway device designed to provide better airway protection and airway seal pressures. Aim of Study: To quantify oropharyngeal leak pressures (OPLPs), fibreoptic view, peak airway pressure and ventilation scoring with Ambu® AuraGain™ in children in different head and neck positions such as maximum flexion, maximum extension and lateral rotation. Patients and Methods: Sixty-eight children aged between 1 and 6 years posted for surgery were enrolled. Ambu® AuraGain™ was inserted after the induction of anaesthesia and ventilation was confirmed. OPLP, fibreoptic view, peak airway pressure and ventilation scores were noted in different head and neck positions such as maximum flexion, maximum extension and lateral rotation. Results: The OPLP significantly increased in flexion (P < 0.001) and significantly decreased in extension (P < 0.001) when compared to the neutral position. Airway pressure (Paw) increased significantly in flexion (P < 0.001) and decreased in extension (P = 0.04) when compared to the neutral position. Tidal volume delivery was comparable in all positions. There was a statistically significant decrease in ventilation scoring in the flexed position when compared to the neutral position (P = 0.005). There was a significant worsening of fibreoptic view in flexion when compared to the neutral position (P < 0.001). Fibreoptic view in the lateral position and extension was comparable with the neutral position. Conclusions: Use of Ambu® AuraGain™ laryngeal airway provides the best ventilatory parameters and Paw in children with head in the neutral and lateral position but lower OPLP with head in extension. However, flexing the head results in the worst ventilatory parameters and Paw among the positions studied.
{"title":"Influence of different head and neck positions on oropharyngeal leak pressures and cuff positions with Ambu® AuraGainTM laryngeal airway in children","authors":"Sugandhi Nemani, S. Mishra, P. Rudingwa, S. Padala, M. Senthilnathan, S. Parida","doi":"10.4103/arwy.arwy_36_22","DOIUrl":"https://doi.org/10.4103/arwy.arwy_36_22","url":null,"abstract":"Background: Ambu® AuraGain™ laryngeal airway is a supraglottic airway device designed to provide better airway protection and airway seal pressures. Aim of Study: To quantify oropharyngeal leak pressures (OPLPs), fibreoptic view, peak airway pressure and ventilation scoring with Ambu® AuraGain™ in children in different head and neck positions such as maximum flexion, maximum extension and lateral rotation. Patients and Methods: Sixty-eight children aged between 1 and 6 years posted for surgery were enrolled. Ambu® AuraGain™ was inserted after the induction of anaesthesia and ventilation was confirmed. OPLP, fibreoptic view, peak airway pressure and ventilation scores were noted in different head and neck positions such as maximum flexion, maximum extension and lateral rotation. Results: The OPLP significantly increased in flexion (P < 0.001) and significantly decreased in extension (P < 0.001) when compared to the neutral position. Airway pressure (Paw) increased significantly in flexion (P < 0.001) and decreased in extension (P = 0.04) when compared to the neutral position. Tidal volume delivery was comparable in all positions. There was a statistically significant decrease in ventilation scoring in the flexed position when compared to the neutral position (P = 0.005). There was a significant worsening of fibreoptic view in flexion when compared to the neutral position (P < 0.001). Fibreoptic view in the lateral position and extension was comparable with the neutral position. Conclusions: Use of Ambu® AuraGain™ laryngeal airway provides the best ventilatory parameters and Paw in children with head in the neutral and lateral position but lower OPLP with head in extension. However, flexing the head results in the worst ventilatory parameters and Paw among the positions studied.","PeriodicalId":7848,"journal":{"name":"Airway Pharmacology and Treatment","volume":"6 1","pages":"109 - 114"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80533439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Elayat, Vineeth Krishnan, R. Reddy, Dhaneesh CP, Shynimol George
Flexible videobronchoscopy-guided awake intubation is the standard of care in adult patients with negligible mouth opening presenting for corrective surgeries. Although paediatric and neonatal flexible bronchoscopes are available, they are seldom used for awake intubation due to a lack of cooperation from children. A highly sensitive airway coupled with an increased risk for bronchospasm in children precludes attempts in performing bronchoscopy without any sedation. As a result, elective tracheostomy is often performed in such children with anticipated difficult airways. Our report describes the rationale, procedure and implications of videobronchoscopy-guided nasotracheal intubation under conscious sedation in a 5-year-old child with Treacher Collins syndrome or mandibulofacial dysostosis complicated by obstructive sleep apnoea.
{"title":"Awake bronchoscopy-guided nasotracheal intubation in a child with Treacher Collins syndrome and obstructive sleep apnoea","authors":"A. Elayat, Vineeth Krishnan, R. Reddy, Dhaneesh CP, Shynimol George","doi":"10.4103/arwy.arwy_29_22","DOIUrl":"https://doi.org/10.4103/arwy.arwy_29_22","url":null,"abstract":"Flexible videobronchoscopy-guided awake intubation is the standard of care in adult patients with negligible mouth opening presenting for corrective surgeries. Although paediatric and neonatal flexible bronchoscopes are available, they are seldom used for awake intubation due to a lack of cooperation from children. A highly sensitive airway coupled with an increased risk for bronchospasm in children precludes attempts in performing bronchoscopy without any sedation. As a result, elective tracheostomy is often performed in such children with anticipated difficult airways. Our report describes the rationale, procedure and implications of videobronchoscopy-guided nasotracheal intubation under conscious sedation in a 5-year-old child with Treacher Collins syndrome or mandibulofacial dysostosis complicated by obstructive sleep apnoea.","PeriodicalId":7848,"journal":{"name":"Airway Pharmacology and Treatment","volume":"52 1","pages":"126 - 129"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82314474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: One lung ventilation (OLV) results in a ventilation-perfusion (V/Q) mismatch. Protective lung ventilation (PLV) reduces postoperative pulmonary complications following OLV. However, PLV predisposes to areas of atelectasis in the ventilated lung and worsens the V/Q mismatch. Aim of Study: To evaluate the gradient between arterial carbon dioxide tension (PaCO2) and partial pressure of end-tidal carbon dioxide gas (ETCO2) during OLV using PLV. The second objective was to see if a high gradient could be predicted based on preoperative pulmonary function tests (PFTs), American Society of Anesthesiologists Physical Status (ASA-PS) or intraoperative haemodynamic changes. Patients and Methods: The PaCO2 and ETCO2 during two lung ventilation (TLV) and OLV were noted with patient in the lateral position. The PaCO2-ETCO2 gradients during TLV and OLV were calculated. The mean values of PaCO2, ETCO2 and PaCO2-ETCO2 gradient were compared for OLV and TLV. For gradients above 8 mm Hg, PFT, ASA-PS grade and blood pressure were assessed to identify any clinical association. Results: Sixty patients were enrolled in the study. The mean values of PaCO2 were 38.17 and 44.02 mm Hg during TLV and OLV respectively. The mean values of ETCO2 were 31.31 and 34.53 mm Hg during TLV and OLV respectively. The mean PaCO2-ETCO2 gradient was 6.74 and 9.71 mm Hg during TLV and OLV respectively. These values were significantly lower during TLV than OLV. Conclusion: ETCO2 does not correspond with PaCO2 during OLV using PLV. It is not possible to predict which patients will show a higher PaCO2-ETCO2 gradient. This study could not find any clinical association between the preoperative PFT, ASA-PS grade or intraoperative haemodynamics when PaCO2-ETCO2 gradient was greater than 8 mm Hg.
背景:单肺通气(OLV)导致通气-灌注(V/Q)不匹配。保护性肺通气(PLV)可减少OLV术后肺部并发症。然而，PLV易在通气肺中出现肺不张区域，并使V/Q不匹配恶化。研究目的:用PLV评价OLV时动脉二氧化碳张力(PaCO2)与潮末二氧化碳分压(ETCO2)之间的梯度。第二个目的是观察是否可以根据术前肺功能测试(pft)、美国麻醉医师协会生理状态(ASA-PS)或术中血流动力学变化预测高梯度。患者与方法:采用侧卧位观察两肺通气(TLV)和OLV时PaCO2和ETCO2的变化。计算TLV和OLV期间PaCO2-ETCO2梯度。比较OLV和TLV的PaCO2、ETCO2和PaCO2-ETCO2梯度的平均值。对于高于8毫米汞柱的梯度，评估PFT、ASA-PS等级和血压以确定任何临床关联。结果:60例患者入组研究。TLV和OLV期间PaCO2平均值分别为38.17和44.02 mm Hg。TLV和OLV期间ETCO2均值分别为31.31和34.53 mm Hg。TLV和OLV期间PaCO2-ETCO2平均梯度分别为6.74和9.71 mm Hg。这些值在TLV期间明显低于OLV。结论:使用PLV进行OLV时，ETCO2与PaCO2不对应。无法预测哪些患者PaCO2-ETCO2梯度较高。本研究未发现PaCO2-ETCO2梯度大于8mmhg时术前PFT、ASA-PS分级或术中血流动力学之间有任何临床关联。
{"title":"Influence of protective lung ventilation on arterial-to-end tidal carbon dioxide gradient during one lung ventilation: A prospective observational study","authors":"Shruthi Pendyala, A. Date","doi":"10.4103/arwy.arwy_21_22","DOIUrl":"https://doi.org/10.4103/arwy.arwy_21_22","url":null,"abstract":"Background: One lung ventilation (OLV) results in a ventilation-perfusion (V/Q) mismatch. Protective lung ventilation (PLV) reduces postoperative pulmonary complications following OLV. However, PLV predisposes to areas of atelectasis in the ventilated lung and worsens the V/Q mismatch. Aim of Study: To evaluate the gradient between arterial carbon dioxide tension (PaCO2) and partial pressure of end-tidal carbon dioxide gas (ETCO2) during OLV using PLV. The second objective was to see if a high gradient could be predicted based on preoperative pulmonary function tests (PFTs), American Society of Anesthesiologists Physical Status (ASA-PS) or intraoperative haemodynamic changes. Patients and Methods: The PaCO2 and ETCO2 during two lung ventilation (TLV) and OLV were noted with patient in the lateral position. The PaCO2-ETCO2 gradients during TLV and OLV were calculated. The mean values of PaCO2, ETCO2 and PaCO2-ETCO2 gradient were compared for OLV and TLV. For gradients above 8 mm Hg, PFT, ASA-PS grade and blood pressure were assessed to identify any clinical association. Results: Sixty patients were enrolled in the study. The mean values of PaCO2 were 38.17 and 44.02 mm Hg during TLV and OLV respectively. The mean values of ETCO2 were 31.31 and 34.53 mm Hg during TLV and OLV respectively. The mean PaCO2-ETCO2 gradient was 6.74 and 9.71 mm Hg during TLV and OLV respectively. These values were significantly lower during TLV than OLV. Conclusion: ETCO2 does not correspond with PaCO2 during OLV using PLV. It is not possible to predict which patients will show a higher PaCO2-ETCO2 gradient. This study could not find any clinical association between the preoperative PFT, ASA-PS grade or intraoperative haemodynamics when PaCO2-ETCO2 gradient was greater than 8 mm Hg.","PeriodicalId":7848,"journal":{"name":"Airway Pharmacology and Treatment","volume":"24 1","pages":"103 - 108"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83300471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Unusual difficult airway view in a patient following corrosive poisoning: Videolaryngoscope replaces fibreoptic-guided intubation","authors":"H. Subramanian, K. Govindaraj, M. Senthilnathan","doi":"10.4103/arwy.arwy_35_22","DOIUrl":"https://doi.org/10.4103/arwy.arwy_35_22","url":null,"abstract":"","PeriodicalId":7848,"journal":{"name":"Airway Pharmacology and Treatment","volume":"63 1","pages":"138 - 139"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73505275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Anaesthetic management of transoral endoscopic thyroidectomy via vestibular approach","authors":"S. Rajan, Roniya Roy, N. Sasikumar, J. Paul","doi":"10.4103/arwy.arwy_33_22","DOIUrl":"https://doi.org/10.4103/arwy.arwy_33_22","url":null,"abstract":"","PeriodicalId":7848,"journal":{"name":"Airway Pharmacology and Treatment","volume":"46 1","pages":"136 - 137"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75148571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Intraoperative motor evoked potentials are being increasingly used in surgeries for the removal of spinal tumours. However, this useful monitoring is accompanied by risks such as bite injury to the tongue and oral mucosal soft tissues due to clenching of the teeth and jaws as the patient may not be completely under the effect of neuromuscular blocking agents, resulting in bleeding in the oropharynx. To prevent these complications, we conceptualised and utilised a boxer's mouthguard as a preventive protection during cervical intramedullary tumour excision surgery. Such mouthguards are routinely used in contact sports such as boxing but their clinical application in neuroanaesthesia has not been described. This use is a novel, economical, convenient, standardised and easy way of bite protection and preventing intraoperative tongue, soft-tissue injuries and airway complications.
{"title":"Boxer's mouthguard to facilitate motor evoked potential monitoring during cervical intramedullary tumour excision: Protect and prevent rather than repair and repent!","authors":"Unmesh Bedekar, J. Monteiro","doi":"10.4103/arwy.arwy_37_22","DOIUrl":"https://doi.org/10.4103/arwy.arwy_37_22","url":null,"abstract":"Intraoperative motor evoked potentials are being increasingly used in surgeries for the removal of spinal tumours. However, this useful monitoring is accompanied by risks such as bite injury to the tongue and oral mucosal soft tissues due to clenching of the teeth and jaws as the patient may not be completely under the effect of neuromuscular blocking agents, resulting in bleeding in the oropharynx. To prevent these complications, we conceptualised and utilised a boxer's mouthguard as a preventive protection during cervical intramedullary tumour excision surgery. Such mouthguards are routinely used in contact sports such as boxing but their clinical application in neuroanaesthesia has not been described. This use is a novel, economical, convenient, standardised and easy way of bite protection and preventing intraoperative tongue, soft-tissue injuries and airway complications.","PeriodicalId":7848,"journal":{"name":"Airway Pharmacology and Treatment","volume":"75 1","pages":"130 - 132"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85509803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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