Pub Date : 2022-01-01DOI: 10.4103/2665-9425.342633
{"title":"13TH NATIONAL AIRWAY CONFERENCE","authors":"","doi":"10.4103/2665-9425.342633","DOIUrl":"https://doi.org/10.4103/2665-9425.342633","url":null,"abstract":"","PeriodicalId":7848,"journal":{"name":"Airway Pharmacology and Treatment","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85913984","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}
Head-and-neck tumours are associated with a difficult airway due to the involvement of airway structures and infiltration into surrounding tissues. In clinical practice, awake tracheal intubation (ATI) is mainly performed with a fibreoptic bronchoscope. Videolaryngoscope-guided ATI has been proven to be equally effective in terms of patient comfort, safety profile and success rate. It also takes lesser time as compared to fibreoptic bronchoscopy provided adequate airway topicalisation is done and sedation carefully titrated with a suitable sedative. Formulating a good plan with team members, psychological preparation of the patient and choosing the right technique facilitated successful ATI in our patient with an anticipated difficult airway.
{"title":"Videolaryngoscope-guided awake tracheal intubation in a patient with invasive medullary thyroid carcinoma causing subglottic airway obstruction","authors":"Ram Singh, M. Baruah, B. Ratre, Vinod Kumar","doi":"10.4103/arwy.arwy_50_21","DOIUrl":"https://doi.org/10.4103/arwy.arwy_50_21","url":null,"abstract":"Head-and-neck tumours are associated with a difficult airway due to the involvement of airway structures and infiltration into surrounding tissues. In clinical practice, awake tracheal intubation (ATI) is mainly performed with a fibreoptic bronchoscope. Videolaryngoscope-guided ATI has been proven to be equally effective in terms of patient comfort, safety profile and success rate. It also takes lesser time as compared to fibreoptic bronchoscopy provided adequate airway topicalisation is done and sedation carefully titrated with a suitable sedative. Formulating a good plan with team members, psychological preparation of the patient and choosing the right technique facilitated successful ATI in our patient with an anticipated difficult airway.","PeriodicalId":7848,"journal":{"name":"Airway Pharmacology and Treatment","volume":"58 1","pages":"36 - 39"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79223466","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 an independent anaesthetic practice, often with limited resources, is always challenging. Comprehensive situational awareness, detailed airway evaluation, strategic planning and efficient execution of the plan are essential components of care. Equally important is the willingness to back out if the situation demands. Although the placement of a definitive airway device is necessary for the safe conduct of anaesthesia, prevention of hypoxia and secondary insults takes priority at times of crisis and all attempts should be channelled to achieve this at all costs. The practicing anaesthesiologist must always be prepared with an airway kit for dealing with emergencies and also train support staff in managing a difficult or failed airway.
{"title":"Strategic airway management in an independent anaesthetic practice – Hurdles and possible solutions","authors":"S. Airody, A. Bangera","doi":"10.4103/arwy.arwy_54_21","DOIUrl":"https://doi.org/10.4103/arwy.arwy_54_21","url":null,"abstract":"Airway management in an independent anaesthetic practice, often with limited resources, is always challenging. Comprehensive situational awareness, detailed airway evaluation, strategic planning and efficient execution of the plan are essential components of care. Equally important is the willingness to back out if the situation demands. Although the placement of a definitive airway device is necessary for the safe conduct of anaesthesia, prevention of hypoxia and secondary insults takes priority at times of crisis and all attempts should be channelled to achieve this at all costs. The practicing anaesthesiologist must always be prepared with an airway kit for dealing with emergencies and also train support staff in managing a difficult or failed airway.","PeriodicalId":7848,"journal":{"name":"Airway Pharmacology and Treatment","volume":"35 1","pages":"9 - 12"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77073027","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}
Objective: Assessment and evaluation of changes in modified Mallampati class (MMC) in patients undergoing percutaneous nephrolithotomy (PCNL) in the prone position. Patients and Methods: Seventy-one patients undergoing PCNL in prone position who satisfied inclusion criteria were studied and their MMC was assessed preoperatively. The MMC was assessed immediately after surgery and 6 h, 12 h and 24 h postoperatively. The number of attempts for successful intubation, duration of surgery, the quantity of intraoperative fluids and irrigation fluids used, and blood loss was recorded to identify any significant correlation with changes in MMC. Results: MMC changed in 17 patients (23.9%) with the grade increasing by one in all the patients. Among the 17 patients who showed a change in MMC, 8 patients returned to baseline within 6 h, 6 patients at 12 h and the remaining 3 patients at 24 h. Conclusion: MMC worsened by one grade in almost one-quarter of the patients undergoing PCNL in the prone position. This change in MMC had no clinically significant correlation with the number of attempts for successful intubation, duration of surgery, quantity of intraoperative fluids and irrigation fluids used, and blood loss.
{"title":"Changes in modified Mallampati class in patients undergoing percutaneous nephrolithotomy in prone position – A prospective observational study","authors":"Priyanka Mishra, B. Gupta, P. Chandra, Ajit Kumar","doi":"10.4103/arwy.arwy_43_21","DOIUrl":"https://doi.org/10.4103/arwy.arwy_43_21","url":null,"abstract":"Objective: Assessment and evaluation of changes in modified Mallampati class (MMC) in patients undergoing percutaneous nephrolithotomy (PCNL) in the prone position. Patients and Methods: Seventy-one patients undergoing PCNL in prone position who satisfied inclusion criteria were studied and their MMC was assessed preoperatively. The MMC was assessed immediately after surgery and 6 h, 12 h and 24 h postoperatively. The number of attempts for successful intubation, duration of surgery, the quantity of intraoperative fluids and irrigation fluids used, and blood loss was recorded to identify any significant correlation with changes in MMC. Results: MMC changed in 17 patients (23.9%) with the grade increasing by one in all the patients. Among the 17 patients who showed a change in MMC, 8 patients returned to baseline within 6 h, 6 patients at 12 h and the remaining 3 patients at 24 h. Conclusion: MMC worsened by one grade in almost one-quarter of the patients undergoing PCNL in the prone position. This change in MMC had no clinically significant correlation with the number of attempts for successful intubation, duration of surgery, quantity of intraoperative fluids and irrigation fluids used, and blood loss.","PeriodicalId":7848,"journal":{"name":"Airway Pharmacology and Treatment","volume":"3 1","pages":"13 - 18"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87166132","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}
K. Sathe, Hrishikesh P. Kale, H. Wagh, B. Branstetter
Introduction: A question often asked in the anaesthetic room is 'What size endotracheal tube (ETT) should be used for this patient?' In the recent past, it has become common for anaesthesiologists to use ETTs 1–2 mm smaller than the expected tracheal size. However, it is difficult to gauge the appropriate size of ETT in obese patients. Aim: This study aimed to establish the baseline dimensions of the normal adult trachea and determine whether body mass index (BMI) affects cervical tracheal size. Patients and Methods: A total of 179 patients were included in the study. All imaging was performed on a 64-slice Lightspeed scanner (GE Healthcare) using collimation of 1.25 mm or 2.5 mm. Two axial levels were identified: the first tracheal ring and the most superior segment of the substernal trachea (i.e., the thoracic inlet). The diameter of the trachea in the anteroposterior (AP) and transverse (Trans) dimensions, as well as the cross-sectional area (using freehand region of interest tool) were measured at both the identified levels. The BMI was calculated from weight and height or taken directly from the clinical notes when available. To test the null hypothesis of no association between BMI and tracheal size, Pearson correlation coefficients along with 95% confidence interval were computed. Results: No trends or statistically significant associations were found between BMI and tracheal size on computerised tomography using AP, transverse and cross-sectional area measurements. Conclusion: Our study suggests that there is no link between BMI and tracheal size.
{"title":"Correlation of tracheal size with body mass index – Retrospective computerised tomographic evaluation","authors":"K. Sathe, Hrishikesh P. Kale, H. Wagh, B. Branstetter","doi":"10.4103/arwy.arwy_55_21","DOIUrl":"https://doi.org/10.4103/arwy.arwy_55_21","url":null,"abstract":"Introduction: A question often asked in the anaesthetic room is 'What size endotracheal tube (ETT) should be used for this patient?' In the recent past, it has become common for anaesthesiologists to use ETTs 1–2 mm smaller than the expected tracheal size. However, it is difficult to gauge the appropriate size of ETT in obese patients. Aim: This study aimed to establish the baseline dimensions of the normal adult trachea and determine whether body mass index (BMI) affects cervical tracheal size. Patients and Methods: A total of 179 patients were included in the study. All imaging was performed on a 64-slice Lightspeed scanner (GE Healthcare) using collimation of 1.25 mm or 2.5 mm. Two axial levels were identified: the first tracheal ring and the most superior segment of the substernal trachea (i.e., the thoracic inlet). The diameter of the trachea in the anteroposterior (AP) and transverse (Trans) dimensions, as well as the cross-sectional area (using freehand region of interest tool) were measured at both the identified levels. The BMI was calculated from weight and height or taken directly from the clinical notes when available. To test the null hypothesis of no association between BMI and tracheal size, Pearson correlation coefficients along with 95% confidence interval were computed. Results: No trends or statistically significant associations were found between BMI and tracheal size on computerised tomography using AP, transverse and cross-sectional area measurements. Conclusion: Our study suggests that there is no link between BMI and tracheal size.","PeriodicalId":7848,"journal":{"name":"Airway Pharmacology and Treatment","volume":"1 1","pages":"25 - 29"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82988530","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}
Beckwith-Wiedemann syndrome (BWS) is a complex overgrowth syndrome. Affected children require surgeries for various reasons such as correction of macroglossia, abdominal wall defects, cleft palate or neoplasms. Anaesthesiologists often face problems in the form of a difficult airway, associated congenital heart disease causing haemodynamic compromise and hypoglycaemia, especially during the neonatal period. We discuss the management of a child with BWS scheduled to undergo tongue reduction surgery for macroglossia.
{"title":"Anaesthetic management of a child with Beckwith-Wiedemann syndrome posted for tongue reduction surgery - A case report and review of literature","authors":"Reena, A. Jayanthi, A. Rath, V. Mishra, A. Vikram","doi":"10.4103/arwy.arwy_62_21","DOIUrl":"https://doi.org/10.4103/arwy.arwy_62_21","url":null,"abstract":"Beckwith-Wiedemann syndrome (BWS) is a complex overgrowth syndrome. Affected children require surgeries for various reasons such as correction of macroglossia, abdominal wall defects, cleft palate or neoplasms. Anaesthesiologists often face problems in the form of a difficult airway, associated congenital heart disease causing haemodynamic compromise and hypoglycaemia, especially during the neonatal period. We discuss the management of a child with BWS scheduled to undergo tongue reduction surgery for macroglossia.","PeriodicalId":7848,"journal":{"name":"Airway Pharmacology and Treatment","volume":"38 1","pages":"45 - 49"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87351270","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}
H. Kapoor, Mohan Terdal, S. Badhwar, Faizan Rahmani
Rhino-orbito-cerebral mucormycosis is a serious infection that can complicate the course of coronavirus disease 2019 (COVID-19). Surgical debridement of infected/necrotic tissue along with antifungal co-medication constitutes the mainstay of treatment. Amphotericin B can produce electrolyte imbalance and nephrotoxicity. The lungs and other organs can be affected to various extents by COVID-19 infection. Both mask ventilation and intubation can be difficult in these patients. Meticulous preoperative evaluation and optimisation, followed by a carefully planned anaesthetic aimed at maintaining haemodynamic stability, often spells success.
{"title":"Anaesthetic considerations in rhino-orbito-cerebral mucormycosis","authors":"H. Kapoor, Mohan Terdal, S. Badhwar, Faizan Rahmani","doi":"10.4103/arwy.arwy_56_21","DOIUrl":"https://doi.org/10.4103/arwy.arwy_56_21","url":null,"abstract":"Rhino-orbito-cerebral mucormycosis is a serious infection that can complicate the course of coronavirus disease 2019 (COVID-19). Surgical debridement of infected/necrotic tissue along with antifungal co-medication constitutes the mainstay of treatment. Amphotericin B can produce electrolyte imbalance and nephrotoxicity. The lungs and other organs can be affected to various extents by COVID-19 infection. Both mask ventilation and intubation can be difficult in these patients. Meticulous preoperative evaluation and optimisation, followed by a carefully planned anaesthetic aimed at maintaining haemodynamic stability, often spells success.","PeriodicalId":7848,"journal":{"name":"Airway Pharmacology and Treatment","volume":"108 1","pages":"4 - 8"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81725368","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}
Suparna Mitra, Debashis Debroy, Joy L. Mitra, Jyotsna Goswami
Gnana laryngeal airway (GLA) is a supraglottic airway device with capability of hypopharyngeal suctioning for removing oral secretions. It is easy to insert and is an effective means of airway management. We present a case series of 32 patients in whom GLA was used as a primary device to manage the airway after induction of general anaesthesia for breast surgeries, intracavitary application of brachytherapy and cystoscopy. The GLA was found to be easy to insert in a short time.
{"title":"Gnana laryngeal airway device – A case series of our experience at a tertiary care cancer hospital","authors":"Suparna Mitra, Debashis Debroy, Joy L. Mitra, Jyotsna Goswami","doi":"10.4103/arwy.arwy_4_22","DOIUrl":"https://doi.org/10.4103/arwy.arwy_4_22","url":null,"abstract":"Gnana laryngeal airway (GLA) is a supraglottic airway device with capability of hypopharyngeal suctioning for removing oral secretions. It is easy to insert and is an effective means of airway management. We present a case series of 32 patients in whom GLA was used as a primary device to manage the airway after induction of general anaesthesia for breast surgeries, intracavitary application of brachytherapy and cystoscopy. The GLA was found to be easy to insert in a short time.","PeriodicalId":7848,"journal":{"name":"Airway Pharmacology and Treatment","volume":"64 1","pages":"57 - 60"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85856137","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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