Background and Aim:The sonographic assessment of airway in the preoperative period has encouraging results in predicting difficult laryngoscopy.Materials and Methods:The prospective, observational study was conducted on 120 patients scheduled for elective surgery requiring general anesthesia and tracheal intubation. The depth of the pre-epiglottic space (Pre-E), the distance from the epiglottis to the midpoint of the distance between the vocal cords (E-VC) was measured sonographically. Similarly, hyomental distance ratio (HMDR) was sonographically measured with head in neutral and extended positions. The primary outcome was the efficacy of Pre E/E-VC, HMDR for predicting difficult laryngoscopy (Cormack–Lehane [CL] Grade 3, 4). The secondary outcome was to correlate these parameters to CL grading.Results:Difficult intubation was observed in 12.5% of patients. The mean ± standard deviation (SD) of Pre E/E-VC ratio was 1.33±0.335, 1.62±0.264 and 1.87±.243, 2.22±.29 for CL Grade 1, 2, 3, and 4, respectively (P = 0.00). The mean ± SD of HMDR was 1.11±.35, 1.12±.29, and 1.07±.39, 1.04 ± 0.01 for CL Grade 1, 2, 3, and 4, respectively (P = 0.00). Pre E/E-VC ratio of more than 1.77 cm had 82% sensitivity, specificity 80%, whereas HMDR less than1.085 had sensitivity 75% and specificity 85.3%, in predicting difficult laryngoscopy (P = 0.00).Conclusion:The sonographic measurement of the Pre E/E-VC ratio is a better predictor of CL grading as compared to HMDR. The noninvasive prediction of CL grading can be precisely done by Pre-E/E-VC ratio (range: 0–1.425 corresponds to CL Grade 1; 1.425–1.77 ≈ CL Grade 2; 1.77–1.865 ≈ CL Grade 3, more than 1.865 corresponds to CL Grade 4).
Background and Aims:Point of care ultrasound has the potential to become reliable airway assessment tool by accurate prediction of difficult laryngoscopy. We aimed to determine the feasibility of ultrasound in preoperative airway assessment.Methods:This prospective, observational study was conducted on 200 patients requiring general anaesthesia and tracheal intubation. The thickness of anterior soft tissue neck at the level of hyoid bone (DSHB), epiglottis (DSEM), and Pre-E/E-VC[depth of the pre-epiglottic space (Pre-E)/distance from the epiglottis to the midpoint of the distance between the vocal cords (E-VC)] were measured sonographically. The hyomental distance ratio (HMDR) was measured utilising distances with head in neutral and extended position. The primary outcome was the efficacy of the parameters in predicting difficult laryngoscopy[Cormack Lehane 3,4]. The secondary outcome was to correlate the parameters to CL grading.Results:Utilising receiver operating curves, cutoff value of HMDR for predicting difficult laryngoscopy was ≤1.0870 with sensitivity of 65%, specificity of 77%. The cutoff value, sensitivity andspecificity for Pre-E/E-VC were ≥1.785, 82.8% and 83.8%., respectively. The cutoff value of DSHB was ≥0.99 with sensitivity of 48% and specificity of 82%. The cutoff, sensitivity and specificity for DSEM were ≥1.615, 89.7%, and 64.8%, respectively. There was moderate positive correlations of DSHB, DSEM, and Pre-E/E-VC (r = 0.551 and 0.701, 0.787: P = 0.00), whereas moderate negative correlation observed with HMDR (r = -.0671: P = 0.00).Conclusion:The strong positive correlation of Pre-E/E-VC, DSEM, and moderate negative correlation of HMDR makes these ultrasound parameters reliable predictors for difficult laryngoscopy.
Nanoparticles offer novel openings for the management of dermal diseases. The skin being a largest organ of the body poses a barrier to all the delivery system including nanoparticles to permeate deep in to the cells or tissues. This barrier was ruptured in case of skin trauma or injury and also in the case of skin cancer. This conditions of the skin allowed the nanoparticles to permeate through the skin for the treatment of cancer. Worldwide research is going in to the formulation and development of the Nano carrier for the dermal delivery through the skin. But the little or negligible technology transfer occur from the R&D to Industry for the treatment of skin cancer using nanoparticles. The main aim of review is to discuss about the basic fundamentals of cancer with relate to dermal delivery of drug through Nanoparticles. The nanotechnologies for dermal delivery of drugs were explained for their effective tool for skin cancer. In this review types of skin cancer with various nanotechnologies were discussed along with pathology of disease and various therapies used. Further we had discussed challenges in developing the nanoparticles for the treatment in the skin cancer therapy. Finally various therapies like Chemotherapies, Immunotherapy, Gene therapy, Nano carriers combined with physical methods and Laser irradiation therapies were summarized.
Background: Airway assessment is an essential aspect of preanaesthetic assessment. Presently, prediction of difficult airway is based on clinical assessment of airway. Methods: Prospective Observational conducted at Department of Anesthesiology, Dr. RPGMC Kangra at Tanda, Himachal Pradesh. Results: It was observed that 44% patients (n=88) were in grade 2 followed by 27 % (n=54) in grade 1, grade 3 was observed in 24.5% patients (n=49) whereas Cormack Lehane grade 4 was seen in 4.5% patients (n=9) Conclusion: The thyromental distance was more than 6.5 cm in the majority of patients (87.5%) while 12.5% had a thyromental distance less than 6.5 cm. There was a significant difference in Thyromental distance between different Cormack Lehane grades (P=0.001) Keywords: Ultrasound, endotracheal intubation, direct laryngoscopy
Background: Difficult and failed tracheal intubation after direct laryngoscopy is a dreaded complication of general anesthesia as it is associated with serious morbidity and mortality. Methods: Prospective Observational conducted at Department of Anesthesiology, Dr. RPGMC Kangra at Tanda, Himachal Pradesh. Results: In the present study, the mean hyomental distance ratio was (mean±SD:1.1.±.127 and 1.04±.018) in predicting CL grade 3 and 4 respectively (P=0.010) and 1.12±.033, 1.11±.035 in grade 1 and 2 respectively. Conclusion: Ultrasound is better and fast in confirming endotracheal intubation. Keywords: Ultrasound, endotracheal intubation, direct laryngoscopy.
Background and aim: Breathing can help restore diaphragm function and increase lung capacity. In this study, we observed the effect of beathing exercise on Severity on covid-19 infection. Methods: A retrospective study of 20 COVID patients admitted at MSH, Palakwah, Una was conducted. Co-operative patients who were hemodynamically stable, and SpO2 90 to ≤93% on presentation, were included. All the patients were asked to perform breathing exercise everyday twice for 30 mins. Results: In this study, 10% in <41-year age group, 75% in 41-60 age group, and 15% aged above 60 years. 65% were males and 35% female. Obesity was the most common comorbidity (40%) followed by hypertension (35%). Mean duration of stay was 7.28±7.60 days. Face mask to 45% patients, Nasal prongs to 40% and NRBM to 15% patients. Conclusion: Breathing exercises improve SpO2 levels in Mild COVID-19 patients.
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