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Access statistics : Table of Contents
2011| September-October | Volume 55 | Issue 5
Online since
November 14, 2011
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REVIEW ARTICLES
Ultrasound of the airway
Pankaj Kundra, Sandeep Kumar Mishra, Anathakrishnan Ramesh
September-October 2011, 55(5):456-462
DOI
:10.4103/0019-5049.89868
PMID
:22174461
Currently, the role of ultrasound (US) in anaesthesia-related airway assessment and procedural interventions is encouraging, though it is still ill defined. US can visualise anatomical structures in the supraglottic, glottic and subglottic regions. The floor of the mouth can be visualised by both transcutaneous view of the neck and also by transoral or sublinguial views. However, imaging the epiglottis can be challenging as it is suspended in air. US may detect signs suggestive of difficult intubation, but the data are limited. Other possible applications in airway management include confirmation of correct endotracheal tube placement, prediction of post-extubation stridor, evaluation of soft tissue masses in the neck prior to intubation, assessment of subglottic diameter for determination of paediatric endotracheal tube size and percutaneous dilatational tracheostomy. With development of better probes, high-resolution imaging, real-time picture and clinical experience, US has become the potential first-line noninvasive airway assessment tool in anaesthesia and intensive care practice.
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21,852
4,832
27
Tracheal intubation in the ICU: Life saving or life threatening?
Jigeeshu V Divatia, Parvez U Khan, Sheila N Myatra
September-October 2011, 55(5):470-475
DOI
:10.4103/0019-5049.89872
PMID
:22174463
Tracheal intubation (TI) is a routine procedure in the intensive care unit (ICU), and is often life saving. However, life-threatening complications occur in a significant proportion of procedures, making TI perhaps one the most common but underappreciated airway emergencies in the ICU. In contrast to the controlled conditions in the operating room (OR), the unstable physiologic state of critically ill patients along with underevaluation of the airways and suboptimal response to pre-oxygenation are the major factors for the high incidence of life-threatening complications like severe hypoxaemia and cardiovascular collapse in the ICU. Studies have shown that strategies planned for TI in the OR can be adapted and extrapolated for use in the ICU. Non-invasive positive-pressure ventilation for pre-oxygenation provides adequate oxygen stores during TI for patients with precarious respiratory pathology. The intubation procedure should include not only airway management but also haemodynamic, gas exchange and neurologic care, which are often crucial in critically ill patients. Hence, there is a necessity for the implementation of an Intubation Bundle during routine airway management in the ICU. Adherence to a plan for difficult airway management incorporating the use of intubation aids and airway rescue devices and strategies is useful.
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10,004
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6
Preparation of the patient and the airway for awake intubation
Venkateswaran Ramkumar
September-October 2011, 55(5):442-447
DOI
:10.4103/0019-5049.89863
PMID
:22174458
Awake intubation is usually performed electively in the presence of a difficult airway. A detailed airway examination is time-consuming and often not feasible in an emergency. A simple 1-2-3 rule for airway examination allows one to identify potential airway difficulty within a minute. A more detailed airway examination can give a better idea about the exact nature of difficulty and the course of action to be taken to overcome it. When faced with an anticipated difficult airway, the anaesthesiologist needs to consider securing the airway in an awake state without the use of anaesthetic agents or muscle relaxants. As this can be highly discomforting to the patient, time and effort must be spent to prepare such patients both psychologically and pharmacologically for awake intubation. Psychological preparation is best initiated by an anaesthesiologist who explains the procedure in simple language. Sedative medications can be titrated to achieve patient comfort without compromising airway patency. Additional pharmacological preparation includes anaesthetising the airway through topical application of local anaesthetics and appropriate nerve blocks. When faced with a difficult airway, one should call for the difficult airway cart as well as for help from colleagues who have interest and expertise in airway management. Preoxygenation and monitoring during awake intubation is important. Anxious patients with a difficult airway may need to be intubated under general anaesthesia without muscle relaxants. Proper psychological and pharmacological preparation of the patient by an empathetic anaesthesiologist can go a long way in making awake intubation acceptable for all concerned.
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4
CLINICAL INVESTIGATIONS
Appropriate depth of placement of oral endotracheal tube and its possible determinants in Indian adult patients
Manu Varshney, Kavita Sharma, Rakesh Kumar, Preeti G Varshney
September-October 2011, 55(5):488-493
DOI
:10.4103/0019-5049.89880
PMID
:22174466
Background:
Optimal depth of endotracheal tube (ET) placement has been a serious concern because of the complications associated with its malposition.
Aims:
To find the optimal depth of placement of oral ET in Indian adult patients and its possible determinants viz. height, weight, arm span and vertebral column length.
Settings and Design:
This study was conducted in 200 ASA I and II patients requiring general anaesthesia and orotracheal intubation.
Methods:
After placing the ET with the designated black mark at vocal cords, various airway distances were measured from the right angle of mouth using a fibre optic bronchoscope.
Statistical Analysis:
The power of the study is 0.9. Mean (SD) and median (range) of various parameters and Pearson correlation coefficient was calculated.
Results:
The mean (SD) lip-carina distance, i.e., total airway length was 24.32 (1.81) cm and 21.62 (1.34) cm in males and females, respectively. With black mark of ET between vocal cords, the mean (SD) ET tip-carina distance of 3.69 (1.65) cm in males and 2.28 (1.55) cm females was found to be considerably less than the recommended safe distance.
Conclusions:
Fixing the tube at recommended 23 cm in males and 21 cm in females will lead to carinal stimulation or endobronchial placement in many Indian patients. The lip to carina distance best correlates with patient's height. Positioning the ET tip 4 cm above carina as recommended will result in placement of tube cuff inside cricoid ring with currently available tubes. Optimal depth of ET placement can be estimated by the formula "(Height in cm/7)-2.5."
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9,018
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3
REVIEW ARTICLES
Airway management in trauma
Rashid M Khan, Pradeep K Sharma, Naresh Kaul
September-October 2011, 55(5):463-469
DOI
:10.4103/0019-5049.89870
PMID
:22174462
Trauma has assumed epidemic proportion. 10% of global road accident deaths occur in India. Hypoxia and airway mismanagement are known to contribute up to 34% of pre-hospital deaths in these patients. A high degree of suspicion for actual or impending airway obstruction should be assumed in all trauma patients. Objective signs of airway compromise include agitation, obtundation, cyanosis, abnormal breath sound and deviated trachea. If time permits, one should carry out a brief airway assessment prior to undertaking definitive airway management in these patients. Simple techniques for establishing and maintaining airway patency include jaw thrust maneuver and/or use of oro- and nas-opharyngeal airways. All attempts must be made to perform definitive airway management whenever airway is compromised that is not amenable to simple strategies. The selection of airway device and route- oral or -nasal, for tracheal intubation should be based on nature of patient injury, experience and skill level.
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6,690
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1
Supraglottic airway devices in children
S Ramesh, R Jayanthi
September-October 2011, 55(5):476-482
DOI
:10.4103/0019-5049.89874
PMID
:22174464
Modern anaesthesia practice in children was made possible by the invention of the endotracheal tube (ET), which made lengthy and complex surgical procedures feasible without the disastrous complications of airway obstruction, aspiration of gastric contents or asphyxia. For decades, endotracheal intubation or bag-and-mask ventilation were the mainstays of airway management. In 1983, this changed with the invention of the laryngeal mask airway (LMA), the first supraglottic airway device that blended features of the facemask with those of the ET, providing ease of placement and hands-free maintenance along with a relatively secure airway. The invention and development of the LMA by Dr. Archie Brain has had a significant impact on the practice of anaesthesia, management of the difficult airway and cardiopulmonary resuscitation in children and neonates. This review article will be a brief about the clinical applications of supraglottic airways in children.
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10
CASE REPORTS
A critical incident report: Propofol triggered anaphylaxis
Archna Koul, Rashmi Jain, Jayashree Sood
September-October 2011, 55(5):530-533
DOI
:10.4103/0019-5049.89898
PMID
:22174476
Although propofol is one of the most commonly used drugs for induction of anaesthesia, it is not devoid of anaphylactic potential. Early detection of any suspected anaphylactic reaction during anaesthesia, prompt management, identification of the offending agent and prevention of exposure to the offending agent in the future is the responsibility of the anaesthesiologist. This is a case report of anaphylaxis to propofol at the induction of anaesthesia in a previously non-allergic 56 year-old man, planned to undergo laparoscopic nephrectomy, who responded to epinephrine infusion.
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5,888
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2
CLINICAL INVESTIGATIONS
Job satisfaction and stress levels among anaesthesiologists of south India
Rachel Cherian Koshy, Bhagyalakshmi Ramesh, Shabana Khan, Anand Sivaramakrishnan
September-October 2011, 55(5):513-517
DOI
:10.4103/0019-5049.89891
PMID
:22174471
Background:
Stress being high among practicing anaesthesiologists has effects on the quality of life. Methods to mitigate the stress have to be ensured to achieve job satisfaction.
Methods:
A survey was conducted through a questionnaire to know the various aspects of job satisfaction and job stress. The results of the data obtained were analyzed.
Results:
An anaesthetists work area may vary from a small private hospital to a large tertiary centre.Depending on the number of anaesthetists in a particular hospital, the working hours and on call duties would be distributed. Overworked anaesthetists are prone to burnout due to sleep deprivation. This could lead to fatigue related error. Lesser the number of anaesthetists would mean less support from colleagues in the event of complications. Having a good rapport with surgical colleagues also helps to prevent stress.Anaesthesiologists should have adequate monitors to avoid error in judgement. Chronic stress has serious health hazards. Keeping updated with latest developments in our field helps to improve the quality of care provided. Anaesthetists should also receive the recognition and remuneration due to them.
Conclusion:
To improve the quality of care provided to a patient,anaesthesiologists must cope with job stress. An anaesthetist must enjoy the work rather than be burdened by it.
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1
EVIDENCE BASED REPORT
Laryngeal mask airway vs the endotracheal tube in paediatric airway management: A meta-analysis of prospective randomised controlled trials
Abhiruchi Patki
September-October 2011, 55(5):537-541
DOI
:10.4103/0019-5049.89900
PMID
:22174478
A meta-analysis was performed on prospective randomised controlled trials to assess whether the laryngeal mask airway (LMA) offered any advantage over the conventional endotracheal tube in the paediatric age group. Using the Cochrane methodology, a literature search was carried out through peer-reviewed indexed journals in three medical databases to obtain all publications comparing the LMA with the endotracheal tube in the paediatric age group (age less than 12 years), available till December 2010. Data from 16 randomised controlled clinical trials were selected for analysis. A null hypothesis was formed against each of the seven issues tested using the Fisher's method of combining
P
values. The LMA was seen to have three advantages over the tracheal tube in the form of lower incidence of cough during emergence, lower incidence of postoperative sore throat and lower incidence of postoperative vomiting (
P
<0.05). It was seen to offer no advantage over the tracheal tube in incidence of bronchospasm or laryngospasm during emergence; also, it did not offer any advantage in increasing the efficacy of the airway seal. The only disadvantage the LMA had over the tracheal tube was its greater incidence of placement failure in the first attempt.
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4,635
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REVIEW ARTICLES
Teaching and training in fibreoptic bronchoscope-guided endotracheal intubation
US Raveendra
September-October 2011, 55(5):451-455
DOI
:10.4103/0019-5049.89866
PMID
:22174460
Fibreoptic-guided endotracheal intubation skill is a strongly desirable attribute of an anaesthesiologist, essential to deal with difficult airway situations. Facilities for formal training in this crucial area are limited. Various aspects of the available and desirable training in fibreoptic endoscopic skills are discussed.
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4,442
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CLINICAL INVESTIGATIONS
Improvement in Cormack and Lehane grading with laparoscopic assistance during tracheal intubation
Anjeleena K Gupta, Bimla Sharma, Arvind Kumar, Jayashree Sood
September-October 2011, 55(5):508-512
DOI
:10.4103/0019-5049.89889
PMID
:22174470
Background:
To use laparoscope as an easily available and easy to use alternative option to videolaryngoscope.
Aims:
The aim of the study was to assess the improvement in the glottic view using a conventional direct laryngoscope (DL) assisted by a laparoscope with its endovision system along with the time taken for tracheal intubation.
Settings and Design:
A prospective, double blind, randomized, controlled study was conducted in a tertiary care centre.
Methods:
Sixty patients with American Society of Anesthesiologists (ASA) physical status I and II requiring general anaesthesia and tracheal intubation for elective surgery were included in the study. The patients were anaesthetized, paralysed, DL was performed and Cormack and Lehane grade (C and L) noted, followed by the introduction of the laparoscope alongside the flange of the Macintosh laryngoscope and a further C and L grading done as seen on monitor. Demographic data, ASA physical status, airway assessment, mouth opening, modified Mallampatti class, jaw protrusion, thyromental and sternomental distances, optimal external laryngeal manipulation, time taken for intubation, pulse oximetry, blood on; tracheal tube, lip, dentition or mucosal trauma, sore throat, hoarseness of voice, excessive secretions and regurgitation were recorded.
Statistical Analysis:
Statistical analysis was done using statistics package for social sciences software (17.0 version). A
P
-value less than 0.05 was considered statistically significant.
Results:
Eighty-three percent of the patients showed improvement in glottic view after laparoscopic assistance. Eighty-one and 85% of the patients with C and L grade II and III respectively on DL had an improved glottic view with this technique. The mean time to intubate was 37 seconds.
Conclusions:
Laparoscopic assistance provided a better glottic view than DL in most patients (83%). It has a potential advantage over standard DL in difficult intubation.
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Comparison of intubating conditions between rocuronium with priming and without priming: Randomized and double-blind study
M Hanumantha Rao, Andal Venkatraman, R Mallleswari
September-October 2011, 55(5):494-498
DOI
:10.4103/0019-5049.89882
PMID
:22174467
Background:
Rocuronium produces faster neuromuscular blockade compared with other neuromuscular blocking drugs. It produces comparable intubating conditions to that of succinylcholine, but does not have the short intubation time of the latter. Hence, it may not be preferable for rapid sequence intubation, but rocuronium with priming may produce comparable intubating time and conditions to that of succinylcholine. Rocuronium with priming may be an alternative to succinylcholine in rapid sequence intubation in conditions where succinylcholine is contraindicated. The present study was conducted to compare the intubating conditions and intubation time of rocuronium with and without priming.
Methods:
Sixty patients of ASA physical status I and II, aged between 18 and 60 years, of both sexes, were divided into priming and control groups of 30 each. Patients in the priming group received 0.06 mg/kg of rocuronium and those in the control group received normal saline. All patients received fentanyl 1 mg/kg, followed by thiopentone 5 mg/kg for induction. Intubating dose of rocuronium 0.54 mg/kg in the priming group and 0.6 mg/kg in the control group were administered 3 min after priming. Onset time of intubation was assessed using a Train of Four stimuli, and the intubating conditions were compared by the Cooper scoring system.
Results:
The onset time of intubation was 50.67±7.39 s in the priming group and 94.00±11.62 s in the control group, with excellent intubating conditions in both the groups and without any adverse effects.
Conclusions:
Priming with rocuronium provides excellent intubating conditions in less than 60 s with no adverse effects.
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4,090
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2
CASE REPORTS
Idiopathic subglottic stenosis in pregnancy: A deceptive laryngoscopic view
John George Karippacheril, Umesh Goneppanavar, Manjunath Prabhu, Kiran Bada Revappa
September-October 2011, 55(5):521-523
DOI
:10.4103/0019-5049.89894
PMID
:22174473
A 28-year-old lady with term gestation, pre-eclampsia and a vague history of occasional breathing difficulty, on irregular bronchodilator therapy, was scheduled for category 1 lower segment caesarean section in view of foetal distress. A Cormack-Lehane grade 1 direct laryngoscopic view was obtained following rapid sequence induction. However, it was not possible to insert a 7.0 or 6.0 size styleted cuffed tracheal tube in two attempts. Ventilation with a supraglottic device was inadequate. Airway was secured with a 4.0 size microlaryngeal surgery tube with difficulty. Computed tomography scan of the neck following tracheostomy for failed extubation revealed subglottic stenosis (SGS) with asymmetric arytenoid calcification. This report describes the management of a rare case of unrecognised idiopathic SGS in pregnancy.
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4,483
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2
A rare presentation of a child with osteogenesis imperfecta and congenital laryngomalacia for herniotomy
Roshith Chandran, Nandini Dave, Amit Padvi, Madhu Garasia
September-October 2011, 55(5):534-536
DOI
:10.4103/0019-5049.89899
PMID
:22174477
Sometimes anaesthesiologists come across rare congenital anomalies in their practice. The inherent complications associated with the disorder necessitate tailor-made approaches for providing anaesthesia to even seemingly simple surgical interventions. Here, we share our experience of anaesthesia management of an infant with congenital laryngomalacia and recently diagnosed osteogenesis imperfecta type 1 who had presented to us with an acute abdomen for a semi-emergency herniotomy.
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3,579
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Acute airway obstruction, an unusual presentation of vallecular cyst
Sameer M Jahagirdar, P Karthikeyan, M Ravishankar
September-October 2011, 55(5):524-527
DOI
:10.4103/0019-5049.89896
PMID
:22174474
A 18-year-old female presented to us with acute respiratory obstruction, unconsciousness, severe respiratory acidosis, and impending cardiac arrest. The emergency measures to secure the airway included intubation with a 3.5-mm endotracheal tube and railroading of a 6.5-mm endotracheal tube over a suction catheter. Video laryngoscopy done after successful resuscitation showed an inflamed swollen epiglottis with a swelling in the left vallecular region, which proved to be a vallecular cyst. Marsupialisation surgery was performed on the 8
th
post admission day and the patient discharged on 10
th
day without any neurological deficit.
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EDITORIAL
Newer airway devices: Future promising?
S Bala Bhaskar
September-October 2011, 55(5):439-441
DOI
:10.4103/0019-5049.89858
PMID
:22174457
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3,052
1,159
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CLINICAL INVESTIGATIONS
Optimal anaesthetic depth for LMA insertion
Sudeep Krishnappa, Pankaj Kundra
September-October 2011, 55(5):504-507
DOI
:10.4103/0019-5049.89887
PMID
:22174469
Purpose:
A fixed dose of propofol administered rapidly can be insufficient or in excess resulting in airway complications and haemodynamic disturbances. This study is designed to assess whether loss of motor response to jaw thrust can be a reliable clinical indicator of anaesthetic depth for laryngeal mask airway (LMA) insertion.
Methods:
One hundred and twenty ASA I and II patients scheduled for general anaesthesia on day care basis were randomly allocated into two groups. Following pre-oxygenation, anaesthesia was induced to accomplish LMA insertion either with a 3 mg/kg propofol (Group CD,
n
=60) or in dose to abolish jaw thrust response (Group JT,
n
=60). Mean arterial pressure (MAP) and heart rate were continuously monitored while LMA insertion conditions were recorded using 6 variable, 3 point score.
Results:
85% patients developed apnea in group CD when compared to 2% in group JT,
P
<0.0001. Despite similar insertion score, propofol consumption was significantly more in group CD when compared to group JT. More than 20% fall of MAP from baseline was noted in group CD after induction but there was no significant hypotension at any time in group JT.
Conclusion:
Loss of motor response to jaw thrust provides satisfactory LMA insertion conditions.
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2,994
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3
LETTERS TO EDITOR
Anaesthesia risk stratification: Time to think beyond American society of anesthesiologists physical status classification
Anila D Malde
September-October 2011, 55(5):542-544
DOI
:10.4103/0019-5049.89903
PMID
:22174480
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[PubMed]
2,858
596
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Mallampati class 'zero' - yet another cause?
G Indira
September-October 2011, 55(5):544-545
DOI
:10.4103/0019-5049.89905
PMID
:22174481
[FULL TEXT]
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[PubMed]
2,865
411
2
CLINICAL INVESTIGATIONS
A modification in the tube guide to facilitate retrograde intubation: A prospective, randomised trial
Gaurav Jain, Dinesh K Singh, Ghanshyam Yadav, Surender K Gupta, Santosh Tharwani
September-October 2011, 55(5):499-503
DOI
:10.4103/0019-5049.89883
PMID
:22174468
Background:
The technique of anterograde over a retrograde guide is considered to be more reliable and preferable in comparison to only retrograde one, for improving the success rate of retrograde intubation. As the prior technique requires a lengthy guidewire to negotiate the whole channel of a tube guide, we designed a side eye at one end of tube guide, which obviated the above requirement while maintaining the integrity of the whole channel assembly. The efficacy of this modified technique was compared with the conventional one for retrograde intubation procedure.
Methods:
In a prospective, randomised fashion, 98 cases posted for surgery of carcinoma buccal mucosa were included in this trial. These cases were randomised to the conventional (Group I) or the modified technique (Group II) for retrograde intubation. Intubation time (first attempt), total number of successful intubations, cause of failures and any associated side effects were recorded and compared between the groups.
Results:
The total number of successful intubations were significantly higher in group II (95.83%, 46/48 cases) as compared to group I (66.66%, 31/48 cases) (
P
<0.001). Mean intubation time was 118±22 second in group I versus 124±26 second in group II (
P
=0.39). The side effects did not differ significantly between the groups.
Conclusions:
Improvising the tube guide resulted in a significant rise in the number of successful intubations through a modified retrograde intubation technique, with no side effects. This should encourage the use of retrograde intubation technique as a first option for difficult airway management.
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1
CASE REPORTS
Recannulation of a stenosed old tracheostomy wound in vocal-cord palsy: Anaesthetic management
Rashmi Pal, KK Arora, S Pandey
September-October 2011, 55(5):518-520
DOI
:10.4103/0019-5049.89893
PMID
:22174472
Tracheostomy still remains a life-saving procedure to secure a patent airway in emergency situations. Anaesthetic management of tracheostomy in paediatric patients with bilateral vocal cord immobility and acute respiratory distress in emergency has always been a great challenge to the anaesthesiologists. Administering general anaesthesia in a child for recannulation of tracheostomy in emergency is far more challenging. We report a case of a 4-year-old male child in whom tracheostomy tube was accidentally removed 2 months back and the wound got stenosed gradually leading to acute respiratory distress. Emergency dilatation and recannulation of tracheostomy wound was planned under general anaesthesia and the case was managed successfully.
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2,760
367
2
CLINICAL INVESTIGATIONS
Fibreoptic bronchoscopy without sedation: Is transcricoid injection better than the "spray as you go" technique?
Alka Chandra, Jayant N Banavaliker, Manoj Kumar Agarwal
September-October 2011, 55(5):483-487
DOI
:10.4103/0019-5049.89877
PMID
:22174465
Aim:
The aim of the study was to compare transcricoid injection with "spray as you go" technique for diagnostic fibreoptic bronchoscopy, to perform the procedure without sedation and to record any complication or side effects.
Methods:
Sixty patients belonging to the age group 20-70 years, undergoing diagnostic bronchoscopy over a period of 6 months, were randomly selected and divided into two groups alternatively to receive 3 ml of 4% lignocaine by a single transcricoid puncture (group I) or 2 ml of 4% lignocaine instilled through the bronchoscope on to the vocal cords and further 1 ml of 2% lignocaine into each main bronchus (group II). Additional dose of lignocaine as required was given in both the groups. All patients were given intramuscular atropine 0.6 mg, 20 min before the procedure. Nebulisation with 3 ml of 4% lignocaine was given to all patients. The time from nasal insertion of the bronchoscope to reach the carina was recorded, and the total dose of lignocaine required in both the groups was calculated and compared. The cough episodes during the procedure, systolic blood pressure, and pulse rate were compared before the procedure and 5 min after the procedure in both the groups. A 0-10 visual analogue scale (VAS) was used to assess discomfort 30 min after the procedure.
Results:
The time to reach carina was more in group II (
P
<0.02), and cough episodes were also more in group II (
P
<0.05) than in group I. The vitals before the procedure were comparable in both the groups, but 5 min after the procedure the vitals were more stable in group I than in group II, and the total dose of lignocaine required in group II was more than in group I (
P
<0.001). However, the VAS score was comparable in both the groups.
Conclusion:
Transcricoid puncture for diagnostic bronchoscopies without sedation was associated with no complication and discomfort and required lesser dose of local anaesthetic with more stable vitals and good conditions for bronchoscopists.
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2,543
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2
OBITUARY
Dr. Kapil Dev Prasad
A Sahoo
September-October 2011, 55(5):441-441
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2,576
235
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REVIEW ARTICLES
Have technological advances decreased our clinical skills?
Dilip Pawar
September-October 2011, 55(5):448-450
DOI
:10.4103/0019-5049.89864
PMID
:22174459
In recent years, we have seen a surge in introduction of newer devices with new technology for management of difficult airway. These devices have made our management procedures easier and safer. In the absence of availability of these devices earlier, anaesthetists had developed specific clinical skills to manage these situations, which have been passed on from one generation to the other as table side teaching. These skills have served us well all these years. Do we still need them when the new devices are available to us? Probably yes! Because the newer devices are not failsafe and may fail to achieve to secure the airway sometimes. They are expensive and may not be affordable for most of our institutions and may not be available in all the hospitals in our country. These devices are new addition to our armamentarium, not as substitute but a complement to our clinical skills. Now, the question is how the usage of these devices has affected our clinical practice pattern and do these devices have any limitations? Let's try to understand.
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CASE REPORTS
Cervical epidural analgesia in a case of oral cancer undergoing reconstructive surgery
Sridevi M Mulimani, Dayanand G Talikoti
September-October 2011, 55(5):528-529
DOI
:10.4103/0019-5049.89897
PMID
:22174475
We report a case of successful administration of cervical epidural analgesia in combination with general anaesthesia for a 50-year-old male patient of chronic obstructive pulmonary disease with carcinoma of tongue undergoing reconstructive surgery. Cervical epidural analgesia was provided with intermittent doses of 0.25% bupivacaine intraoperatively in addition to general anaesthesia and intermittent doses of 0.125% bupivacaine with tramodol 1 mg/kg postoperatively. It provides marked decrease in requirement of anaesthetic drugs, rapid recovery, reduced intensive care unit stay, and less pulmonary complications.
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LETTERS TO EDITOR
Protection against aspiration of gastric contents: The laryngeal mask airway Proseal vs endotracheal tube
Shivinder Singh, Ravindra Chaturvedi, RN Shukla, Ratnesh Shukla
September-October 2011, 55(5):545-546
DOI
:10.4103/0019-5049.89907
PMID
:22174483
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Laryngeal mask airway classic as a rescue device after accidental extubation in a neonate in prone position
Susheela Taxak, Ajith Gopinath
September-October 2011, 55(5):542-542
DOI
:10.4103/0019-5049.89902
PMID
:22174479
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Use of lubricating jelly for laryngeal mask airways
Saikat Sengupta, Mohua Biswas Roy
September-October 2011, 55(5):545-545
DOI
:10.4103/0019-5049.89906
PMID
:22174482
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Use PEEP for treating capnothorax
Sadhana S Kulkarni, Savani Kulkarni
September-October 2011, 55(5):550-552
DOI
:10.4103/0019-5049.89913
PMID
:22174488
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1,603
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One airway many modifications
Prashant Kumar, Sanjay Johar, Mukesh Bajaj, Sarla Hooda
September-October 2011, 55(5):552-552
DOI
:10.4103/0019-5049.89914
PMID
:22174489
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Comparison of oscillometric blood pressure measurement by two clinical monitors
GP Prashanth
September-October 2011, 55(5):548-549
DOI
:10.4103/0019-5049.89910
PMID
:22174486
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Fibreoptic-aided retrograde intubation: Is it useful to combine two techniques?
Preeti Goyal Varshney, Nisha Kachru
September-October 2011, 55(5):546-547
DOI
:10.4103/0019-5049.89908
PMID
:22174484
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Authors' reply
Sabyasachi Das, Mohan C Mandal, Bidyut B Gharami, Payel Bose
September-October 2011, 55(5):547-548
PMID
:22174485
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Authors' reply
Harihar V Hegde, Rajashekar R Mudaraddi, Vijay G Yaliwal, P Raghavendra Rao
September-October 2011, 55(5):550-550
PMID
:22174487
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