Our survey demonstrated a persistent variation in the practice of RSI amongst the anaesthetists in the UK. The 'classical' technique of RSI is now seldom used. Therefore there is a clear need for developing consistent guidelines for the practice of RSI.

Head and neck position is one of the factors which can be associated with difficult videolaryngoscopy and tracheal intubation. This prospective randomised clinical trial compared 'sniffing' and neutral positions using a channelled (KingVision ) and a non-channelled (C-MAC D-blade) videolaryngoscope in 200 adult patients randomly allocated into four groups (KingVision 'sniffing', KingVision neutral, C-MAC 'sniffing' and C-MAC neutral). The primary outcome was the ease of tracheal intubation using the modified intubation difficulty scale (mIDS) score. Laryngoscopy time, intubation time, laryngoscopic view using the percentage of glottic opening (POGO) score and success rate of tracheal intubation were secondary outcomes. The median (IQR [range]) modified difficulty scale scores for the four groups, respectively, were 0 (0-1 [0-3]), 0 (0-1 [0-4]), 1 (0-1 [0-5]) and 0 (0-1 [0-3]; p = 0.384). There was no significant difference in laryngoscopy time (p = 0.020), intubation time (p = 0.272) and success rate (p = 0.968) between the groups. The percentage of glottic opening score was lower for C-MAC neutral group as compared with other three groups (p = 0.01). There was no significant difference in the ease of intubation between the 'sniffing' and the neutral position when using the KingVision and the C-MAC videolaryngoscopes. Therefore, either of the two positions could be used with these types of videolaryngoscopes, if deemed advantageous for the patient.

No abstract

Summary Supraglottic airway devices are commonly used to manage the airway during general anaesthesia. There are sporadic case reports of temporomandibular joint dysfunction and dislocation following supraglottic airway device use. We conducted a prospective observational study of adult patients undergoing elective surgery where a supraglottic airway device was used as the primary airway device. Pre‐operatively, all participants were asked to complete a questionnaire involving 12 points adapted from the Temporomandibular Joint Scale and the Liverpool Oral Rehabilitation Questionnaire. Objective measurements included inter‐incisor distance as well as forward and lateral jaw movements. The primary outcome was the inter‐incisor distance, an accepted measure of temporomandibular joint mobility. Both the questionnaire and measurements were repeated in the postoperative period and we analysed data from 130 participants. Mean (SD) inter‐incisor distance in the pre‐ and postoperative period was 46.5 (7.2) mm and 46.3 (7.5) mm, respectively (p = 0.521) with a difference (95%CI) of 0.2 (−0.5 to 0.9) mm. Mean (SD) forward jaw movement in the pre‐ and postoperative period was 3.6 (2.4) mm and 3.9 (2.4) mm, respectively (p = 0.018). Mean (SD) lateral jaw movement to the right in the pre‐ and postoperative period was 8.9 (4.1) mm and 9.1 (4.0) mm, respectively (p = 0.314). Mean (SD) lateral jaw movement to the left in the pre‐ and postoperative period was 8.8 (4.0) mm and 9.3 (3.6) mm, respectively (p = 0.008). The number of patients who reported jaw clicks or pops before opening their mouth as wide as possible was 28 (21.5%) vs. 12 (9.2%) in the pre‐ and postoperative period, respectively (p < 0.001) with a difference (95%CI) of 12.3% (6.7–17.9%). There was no significant difference in the responses to the other 11 questions or in the number of patients who reported pain in the temporomandibular joint area postoperatively. No clinically significant dysfunction of the temporomandibular joint following the use of supraglottic airway devices in the postoperative period was identified by either patient questionnaires or objective measurements.

THRIVE extends safe apnoea time to 5 min in the 'morbidly obese'. However, this length of safe apnoea time can be achieved using simple nasal cannulae only, at a flow rate of 5 l.min À1 with the patients in a 25°h