Background and Aims:Ultrasonography has emerged as a novel, portable, non-invasive tool encouraging airway assessment and procedural interventions. This study assesses the feasibility of ultrasound for block of internal branch of superior laryngeal nerve (ibSLN) block during upper airway anaesthesia to aid awake fibre-optic intubation.Methods:Forty American Society of Anesthesiologists’ physical status I–II patients, aged 18–60 years, deemed to have a difficult airway (modified Mallampati class III–IV or inter-incisor distance <2.5 cm) and planned for awake fibre-optic intubation were randomised to either landmark group (L, n = 20) or ultrasound group (U, n = 20). All patients received nebulised 4% lignocaine (3 mL) and transtracheal injection 3 mL 2% lignocaine. Group L received landmark-guided bilateral ibSLN block with 1 mL 2% lignocaine. Group U received bilateral ibSLN block with 1 mL 2% lignocaine using a high-frequency ultrasound transducer to define the SLN space. The primary objective was assessment of quality of airway anaesthesia. Secondary objectives were time for intubation, haemodynamic parameters and patient perception of discomfort during procedure.Results:The quality of anaesthesia was significantly better in Group U than in Group L (P < 0.001). The mean time for intubation was shorter in Group U (71.05 ± 9.57 s) compared to Group L (109.05 ± 30.09 s, P < 0.001). Heart rate, mean arterial pressure and patient perception of discomfort were significantly increased in Group L.Conclusion:Ultrasound for ibSLN block as a part of preparation for awake fibre-optic intubation improves quality of airway anaesthesia and patient tolerance.

IntrOductIOnLaryngoscopy and tracheal intubation can cause tachycardia, hypertension, dysarrhythmias, perioperative myocardial ischaemia, acute heart failure, and cerebrovascular accidents in susceptible individuals [1] .These responses are due to intense sympathetic discharge caused by stimulation of upper respiratory tract, evidenced by rise in catecholamine's. Various drugs and techniques like, topical and IV Lignocaine, deepening level of anaesthesia, adrenergic blockers, vasodilators like, alpha blockers, and opioids have been used [1]. Fentanyl, a synthetic opioid which attenuates the cardiovascular response by its action on opioid receptors, effects on cardiovascular system, preventing the increase in plasma concentrations of catecholamines and decreasing the central sympathetic vasoregulatory outflow. We conducted a randomized double blind controlled study to determine the effective dose of fentanyl to attenuate the cardiovascular effects of laryngoscopy and tracheal intubation. MAterIAls And MethOdsWe conducted a randomized double blind controlled study on 50 ASA physical status I and II patients, aged between 20-60 years, scheduled for elective surgery requiring general anaesthesia. Institutional ethical committee approval and informed consent was obtained. Patients with history of hypertension, angina, coronary artery disease, recent myocardial infarction, congestive cardiac failure, heart blocks, cardiac pace maker, chronic obstructive pulmonary disease, pregnant and nursing women, anticipated difficult airway and patients on treatment with anti-hypertensive and anti arrhythmic drugs were excluded from study. All the patients were randomly allocated in a double blind fashion and using a sealed envelope technique to one of the two groups, fentanyl 3µg/ kg (group A), fentanyl 5µg/kg (group B) each containing 25 patients. All the patients were premedicated with Inj.glycopyrrolate 0.2 mg intramuscularly and midazolam 0.05mg/kg IM, 30 min prior to

Background and Aims:The study aimed at comparing the performance of the novel optical Airtraq™ laryngoscope with the McCoy™ and conventional Macintosh laryngoscopes for ease of endotracheal intubation in patients with neck immobilisation using manual inline axial cervical spine stabilisation (MIAS) technique.Methods:Ninety consenting American Society of Anaesthesiologist's physical status I–II patients, aged 18–60 years, scheduled for various surgeries requiring tracheal intubation were randomly assigned into three groups of thirty each to undergo intubation with Macintosh, Airtraq™, or McCoy™ laryngoscope with neck immobilisation by MIAS technique. The ease of intubation based on Intubation difficulty scale (IDS) score, Cormack-Lehane grade of glottic view, optimisation manoeuvres and impact on haemodynamic parameters were recorded. Statistical analysis was performed with ANOVA and Bonferroni correction for post hoc tests.Results:All patients in three groups had a comparable demographic profile and were successfully intubated. The Airtraq™ laryngoscope significantly reduced the IDS (mean − 0.43 ± 0.81) as compared with both McCoy™ (mean − 1.63 ± 1.49, P = 0.001) and Macintosh laryngoscope (mean −2.23 ± 1.92, P < 0.001) and improved the Cormack-Lehane glottic view (77% grade 1 view and no patients with grade 3 or 4 view). There were less haemodynamic variations during laryngoscopy with the Airtraq™ compared to the Macintosh laryngoscope, but there was not between the Airtraq™ and McCoy™ laryngoscope groups.Conclusion:In patients undergoing endotracheal intubation with cervical immobilisation, Airtraq™ laryngoscope was superior to the McCoy™ and Macintosh laryngoscopes, with greater ease of intubation and lower impact on haemodynamic variables.

Background and Aims: Hemidiaphragmatic paresis occurs in almost all patients undergoing interscalene block for proximal upper limb surgeries. This study tested hypothesis that ultrasound-guided extrafascial approach of interscalene block under nerve stimulator guidance reduces incidence of hemidiaphragmatic paresis in comparison to intrafascial approach by achieving same degree of anaesthesia and analgesia. Methods: Sixty patients undergoing proximal upper limb surgeries were randomised to receive an ultrasound-guided interscalene brachial plexus block (ISB) with the aid of nerve stimulator for surgical anaesthesia and analgesia using 20 mL 0.5% ropivacaine by extrafascial (Group E) or intrafascial (Group I) approach. The incidence of hemidiaphragmatic paresis was measured by M-mode ultrasound before and 30 min after the procedure. Secondary outcomes such as respiratory functions (forced vital capacity, forced expiratory volume in 1 s and peak expiratory flow rate) were measured, and complications were recorded and compared. The statistics was obtained using SPSS Version 19. Levene's test and paired and unpaired t -test were used. P value <0.05 was considered significant. Results: The incidence of hemidiaphragmatic paresis was 17% and 46% in Group E and Group I, respectively ( P < 0.0001). All other respiratory outcomes were preserved in Group E compared with Group I. Conclusion: Ultrasound-guided ISB with the aid of nerve stimulator through extrafascial approach reduces the incidence of hemidiaphragmatic paresis and also reduces respiratory function impairment when compared with intrafascial approach.