JAIPUR AWARD ABSTRACTS: AIRWAY
Year : 2020 | Volume
: 64 | Issue : 13 | Page : 54--59
Jaipur Award Abstracts: Airway
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. Jaipur Award Abstracts: Airway.Indian J Anaesth 2020;64:54-59
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. Jaipur Award Abstracts: Airway. Indian J Anaesth [serial online] 2020 [cited 2020 Aug 5 ];64:54-59
Available from: http://www.ijaweb.org/text.asp?2020/64/13/54/277897
Abstract ID: ISAP516: Lung isolation during robotic lobectomy, which is more efficient- double lumen tube or bronchial blocker?
Karnati Sravani, Ruby.J.Babu , Deep V , Karnate Ramachandra Reddy
Manipal Hospital, Bangalore
Background and Aims: Due to the lateral decubitus position and surgical equipment used in robotic lobectomy, emergency access to the patient is limited.1 Double lumen tube (DLT) and single-lumen tube with an incorporated channel for bronchial blocker (Univent®) are commonly used for one lung ventilation (OLV) during lobectomy.2 Device displacement and airway trauma can cause cardiopulmonary instability. We compared the two techniques to evaluate their safety profile during robotic lobectomy.
Methods: After hospital ethical committee approval, retrospective data of patients undergoing robotic lobectomy from May 2012 to till date were accessed from hospital electronic databank. Demography, indication and duration of surgery, type of OLV device used, time interval between onset of anaesthesia to onset of surgery, intraoperative hemodynamics, oxygen saturation (SpO2), end tidal carbondioxide (EtCO2), peak airway pressures (PAP), recovery following surgery, intra and post-operative complications were noted. Patients were divided into two groups based on the technique used for OLV and compared using Student t-test or Chi-square test.
Results: OLV was achieved with DLT in 16 patients and Univent® in 12 patients. Demography, indication, duration for surgery, time interval between onsets of anaesthesia and surgery were similar between groups. Intraoperative parameters including variation in hemodynamics, PAP, SpO2 and EtCO2 were similar between groups. One patient had clinically significant hypotension due to blood loss in the Univent® group. Four (25%) and one (8%) patients required postoperative elective ventilation (odds ratio 0.27) in DLT and Univent® groups respectively.
Conclusion: Both DLT and Univent® can be safely used to achieve OLV during robotic lobectomy.
Arslan ME, Ozgok A. Complications of robotic and laparoscopic urologic surgery relevant to anesthesia. Mini-invasiveSurg 2018;2:4.Richard B. Weiskopf, Javier H. Campos; Current Techniques for Perioperative Lung Isolation in Adults. Anesthesiology 2002;97(5):1295-1301.
Abstract ID: ISAP518: Comparison of macintosh laryngoscope, c-mac videolaryngoscope and airtraq for intubation in lateral position
T. Rabbani, Farheen Sultana, Padmaja Durga, Sapna Annaji Nikhar
Nizam Institute of Medical Sciences, Hyderabad
Background & Aims: Endotracheal intubation in lateral position is a challenge and ideal tool to secure the airway remains unevaluated. This study was conducted to compare the intubation difficulty and time needed for intubation among the three techniques, Macintosh, C-MAC, Airtraq for lateral intubation.
Methods: A prospective randomized controlled study was conducted in 120 patients, undergoing elective surgeries under general anesthesia requiring oral endotracheal intubation, randomized into three equal groups of 40 each, Group M – intubated using Macintosh and Group C- C-MAC and Group A- Airtraq in lateral position. The ease of ventilation, the success of intubation, the difficulty in intubation, time required for glottic visualization, intubation and complications of intubation were noted.
Results: The three groups were comparable in the demographic and airway assessment parameters. The success rate of intubation was 100% with all the techniques and no major complication noted. In group M the time taken for glottic visualization (17.5(9.3) sec) was greater than group A (12.5(4.2) sec) and group C (10.9(3.7) sec ) (p=0.000). The time taken for intubation was least with C-MAC (6.9(2.7) sec) when compared to Airtraq (9.8(4.8) sec) and Macintosh (M 11.1(5.9) sec) (p=0.000). Total time required for intubation was least with C-MAC (p=0.000). Intubation difficulty score of 0 was observed 36 (90%) in group C and 29 (72.5%) in group A and 16 (40%) M group patients. (p=0.00).
Conclusion: Video-laryngoscopes are preferable for intubation condition in lateral position. C-MAC facilitates rapid and easier intubation in lateral position.
Bhat R, Sanickop CS, Patil MC, Umrani VS, Dhorigol MG. Comparison of Macintosh laryngoscope and C-MAC video laryngoscope for intubation in lateral position. J Anaesthesiol Clin Pharmacol. 2015;31(2):226–229. doi:10.4103/0970-9185.155221S. R. Lewis, A. R. Butler, J. Parker, T. M. Cook, O. J. Schofield-Robinson, A. F. Smith. Videolaryngoscopy versus direct laryngoscopy for adult patients requiring tracheal intubation: A Cochrane Systematic Review. British Journal of Anaesthesia 2017; 119 (3): 369–83.
Abstract ID: ISAP090: Assessment of positive end-expiratory pressure on diaphragmatic functions in patients undergoing laparoscopic colorectal surgery using pocus: A randomized, comparative study
Neha Singh, Bibha Kumari
Indira Gandhi Institute of Medical Sciences, Patna
Background and aim: Atelectasis due to impaired respiratory mechanics and pulmonary gas exchange during general anaesthesia is compounded by alteration in chest wall mechanics due to compression resulting from pneumoperitoneum and position. PEEP has shown to counterbalance the diaphragm cranial shift increasing FRC and decreasing respiratory system elastance.This study aimed to determine the effect of PEEP on diaphragmatic functions in patients undergoing laparoscopic colorectal surgery using POCUS.
Methods: A prospective, randomized, comparative study was conducted between September 2018 and August 2019 after obtaining institutional ethical clearance. 90 patients fulfilling the inclusion criteria were allocated into three groups of 30 patients each. Standard anesthesia protocol was used for all three groups. Group I received mechanical ventilation without PEEP, group II received PEEP of 5 cm of H2O, and group III received PEEP of 10 cm of H2O. Excursion of diaphragm was measured using USG before induction of anesthesia, after pneumoperitoneum, after Trendelenburg position, every hour thereafter until completion of surgery, after recovery and 6 hour postoperatively. The vitals and lung function were recorded.
Results: Amongst three group of patients with statistically similar age, sex, BMI and other confounding parameters, diaphragmatic excursion was lowest in Group I followed by Group II and maximum in Group III. The difference was statistically significant but at the cost of high mean PIP in Group III.
Conclusion: In our study, PEEP of 5 cm of H2O was found effective in preserving diaphragmatic excursion and reducing compression atelectasis during laparoscopic colorectal surgeries.
Rashwan DAE, Mahmoud HE, Nofal WH, Sabek EA. Ultrasonographic Evaluation of the Effect of Positive End-expiratory Pressure on Diaphragmatic Functions in Patients Undergoing Laparoscopic Colorectal Surgery: A Prospective Randomized Comparative Study. J Anesth Clin Res. 2018; 9: 843. doi:10.4172/2155-6148.1000843Choi S, Yang SY, Choi GJ, Kim BG, Kang H. Comparison of pressure- and volume-controlled ventilation during laparoscopic colectomy in patients with colorectal cancer. Sci Rep. 2019;9(1):17007. Published 2019 Nov 18. doi:10.1038/s41598-019-53503-9
Abstract ID: ISAP175: The effect of head elevation in proseal laryngeal mask airway insertion: A randomized controlled trial
Tom Paruppallil Kurian, Nalini K.B, Gayatri Sasikumar
Ramaiah Medical College and Hospital, Bangalore
Background & Aims: The sniffing position has been shown to be effective for facemask ventilation, direct laryngoscopy and intubation. We aim to determine the effect of head elevation in Proseal LMA (PLMA) insertion.
Methods: After obtaining ethical committee clearance and consent, 123 patients of ASA grade I and II with age group 18 – 60 years of either gender were randomly allocated to group without a pillow (Group C) or with an uncompressible firm pillow- 4cm (Group LP) or 8cm (Group HP). Appropriate sized PLMA was placed in one of the following groups using standard digital technique and the first attempt success rate, number of Attempts, insertion time and post-operative complications (blood stain on PLMA and Sore throat) was evaluated.
Results: The first attempt success rate was higher in the Group LP than the Group HP and the Group C [97.56 % vs. 53.66 % vs 73.1 % respectively, P < 0.001]. The mean insertion time of PLMA was faster for Group LP than for Group C and Group HP (16.12 ± 5.35 vs 21.90 ± 4.48 vs 25.14 ± 8.79 respectively, P < 0.001).
Conclusion: We conclude that PLMA insertion with head elevation of 4 cm had higher first attempt success rate, faster mean insertion time and lower incidence of postoperative complications when compared with 8cm head elevation.
H. J. Kim, K. Lee, S. Bai, M. H. Kim, E. Oh, Y. C. Yoo, Influence of head and neck position on ventilation using the air-Q® SP airway in anaesthetized paralysed patients: a prospective randomized crossover study. BJA. 2017; 118(3): 452-457. https://doi.org/10.1093/bja/aew448Yun MJ, Hwang JW, Kim SH, Hong HJ, Jeon YT, Park HP. Head elevation by 3 vs. 6 cm in ProSeal laryngeal mask airway insertion: a randomized controlled trial. BMC Anesthesiol. 2016;16(1):57. Published 2016 Aug 5. doi:10.1186/s12871-016-0220-3
Abstract ID: ISAP682: A randomized study to compare the efficacy of fiberoptic bronchoscope and lma ctrach for visualization of laryngeal structures at the end of thyroidectomy- a preliminary study
Mayank Agarwal, Geetanjali T. Chilkoti, Ashok Kumar, Medha Mohta
University College of Medical Sciences and Guru Teg Bahadur Hospital
Background & Aims: To rule out Recurrent laryngeal Nerve palsy after thyroidectomy, frequently used techniques are direct laryngoscopy, videolaryngoscopy and fiberoptic-assisted visualization via LMA; latter being ideal. Recently, LMA CTrach, has been found encouraging for this indication. Till now, no study has compared the fiberoptic bronchoscope with LMA CTrach for this indication.
Methods: Following institutional ethics committee approval and informed consent, 30 patients of ASA class I & II scheduled for elective thyroidectomy were included. Patients with upper airway obstruction, increased risk of aspiration and restricted mouth opening were excluded. Patients were randomized between Group FB (Fiberoptic bronchoscope assisted visualization) and Group CT (LMA CTrach-assisted visualization). Primary outcome was time taken for optimal view: secondary outcomes were grade of laryngeal view, ease of visualization, hemodynamics during the procedure and related complications. Being a preliminary study, sample size of 30 with 15 patients in each group was taken. Statistical tests used were chi-square and unpaired t-test.
Results: The mean time taken (in seconds) to achieve optimal laryngeal view was significantly low in group CT i.e. 136.67±68.98 vis-a vis 220.67±95.98 in group FB (p<0.05). Both groups were comparable for grade of view of laryngeal structures (p=0.462), ease of visualization (p=0.713), requirement of corrective maneuvers (p=0.50) and hemodynamic variability. Only one patient each in group FB and CT had coughing and laryngospasm, respectively.
Conclusion: LMA CTrach, a potential alternative in terms of the time taken to view optimal laryngeal view when compared with fiberoptic bronchoscope. Other parameters like grade of laryngeal view, ease of visualization, requirement of corrective maneuvers and complications were comparable.
Chilkoti G, Mohta M, Saxena AK. Preliminary experience with LMA CTrach for assessment of glottic structures during thyroidectomy. Anaesth Intensive Care. 2016;44(6):785-786.Ellard L, Brown DH, Wong DT. Extubation of a difficult airway after thyroidectomy: use of a flexible bronchoscope via the LMA-Classic™. Can J Anaesth. 2012;59(1):53-7.
Abstract ID: ISAP326: Comparison of volume control ventilation vs pressure control ventilation in robotic renal transplantation surgery
Sharmila N, Margi Barot, Manisha Modi, Bina Butala
B J MEDICAL COLLEGE, AHMEDABAD
Background & Aims: Ventilating a patient in general anesthesia during robotic assisted surgeries is found challenging to anesthesiologist due to steep trendelenburg position, pneumoperitonium associated ventilatory changes, long duration of surgery. This study was conducted to compare the effect of volume control ventilation and pressure control ventilation on respiratory mechanics, airway compliance, ventilation and oxygenation and hemodynamic stability.
Methods: After ethical committee approval and consent, 82 patients of end stage renal disease aged between 18 to 55 years of either gender, scheduled for elective robotic assisted renal transplantation were included in the prospective study. After induction of balanced general anesthesia either volume control or pressure control mode was selected randomly by sealed envelope method. Airway pressures, lung compliance, arterial blood gas analysis, hemodynamic variables were measured at baseline(T1), 30mins after pneumoperitonium generation (T2), 10mins after clamp release(T3), at the end of surgery(T4).
Results: Demographic profile, hemodynamic variables, O2 saturation and minute ventilation were comparable between two groups. Airway pressure was significantly higher in volume control ventilation group at T2 and T3 as compared to pressure control ventilation group(p<0.001). Lung compliance and PaCO2 were also better in pressure control ventilation group than in volume control ventilation group(p<0.0001).
Conclusion: Pressure control ventilation should be preferred in robotic surgeries as it offers lower airway pressure, greater dynamic compliance and a better preserved ventilation perfusion matching for the same levels of minute ventilation.
Jaju R, Jaju PB, Dubey M, Mohammad S, Bhargava AK. Comparison of volume controlled ventilation and pressure controlled ventilation in patients undergoing robot-assisted pelvic surgeries: An open-label trial. Indian J Anaesth. 2017;61(1):17–23. doi:10.4103/0019-5049.198406Kalmar, A.F., Foubert, L., Hendrickx, J.F., Mottrie, A., Absalom, A., Mortier, E.P. Et al. (2010). Influence of steep Trendelenburg position and CO(2) pneumoperitoneum on cardiovascular, cerebrovascular, and respiratory homeostasis during robotic prostatectomy. BJA 2010;104(4): 433-9.
Abstract ID: ISAP552: Ventilation with nasopharyngeal airway in patients with predicted difficult mask ventilation
Atisha Patel, Sanjiv Upadhyay
Sterling Hospital, Ahmedabad
Background & Aims: Inadequate ventilation or failure to ventilate is an often encountered situation in patients with a predicted difficult mask ventilation (DMV). To overcome this situation, as an alternative to mask ventilation, we used an appropriate sized nasopharyngeal airway with an attached connector that could connect the airway to a circuit, for ventilation in apneic, adult patients during induction of general anaesthesia. This study investigates the efficiency of ventilation using a nasopharyngeal airway in patients with predicted DMV.
Methods: Twenty-five adult patients of ASA grade I and II, posted for surgeries requiring general anaesthesia, with one or more predicted DMV factors such as obesity, presence of a beard, having sleep apnea, absence of teeth, and Malampatti score of III or IV, after preoxygenation, were ventilated with 100% O2 using a nasopharyngeal airway fitted with an endotracheal tube connector for ventilation using the circle system, during the induction of anesthesia. Capnometry (ETCO2) and cutaneous pulseoxymetry (SPO2) were the parameters monitored to evaluate the efficiency of this method.
Results: Thirteen males and twelve females with one or more predictors of DMV were a part of this study. During the procedure the mean SPO2 and ETCO2 were 98.5±1.0% and 31.5±1.6 mmHg respectively, with no incidences of desaturation or an abnormal ETCO2 beyond the normal range in any of the patients.
Conclusion: Our results suggest that nasopharyngeal ventilation is an effective method of ventilation during the induction phase of general anaesthesia in patients with predicted DMV and hence is a good alternative to mask ventilation.
Kapoor M, Rana S, Singh A, Vishal V, Sikdar I. Nasal mask ventilation is better than face mask ventilation in edentulous patients. J Anaesth. Clin. Pharm. 2016; 32(3): 314-318.Kundra P, Parida S. Awake airway control in patients with anticipated difficult mask ventilation. Indian J Anaesth. 2014;58(2):206–208. doi:10.4103/0019-5049.130831
Abstract ID: ISAP580: Role of acromio axillo suprasternal notch index(aasi) as a new predictor of difficult visualization of larynx in comparision with modified mallampati test
Sneha Rajur, Madhu. K. P, Nethra. S. S
Bangalore Medical College and Research Institute, Bangalore.
Background and Aims: Maintenance of patent airway is the primary responsibility of anaesthesiologist1. About one-third of deaths during general anaesthesia are solely related to inability to maintain patent airway2. Therefore in pre-operative airway assessment we should be able to predict potential difficult airway, allowing management plan to be developed ahead of time. We hypothesized that Acromioaxillo suprasternal notch index (AASI), new simple bedside test is a better predictor of difficult visualization of larynx in comparision with Modified mallampati test (MMP). Hence this study was taken to test the validity of AASI in comparision with MMP.
Methods: After ethical committee clearance and informed written consent, 320 patients of ASA I and II posted for elective surgery under general anaesthesia were included in this study. In routine pre-anaesthetic check up, AASI and MMP were noted during airway assessment. After induction of anaesthesia, a blinded anaesthetist did laryngoscopy, intubated the patient and noted Cormack-Lehane (CL) grading of laryngeal view. The data observed was analysed using Receiver operating characteristic curve (ROC) analysis to compare AASI and MMP and results were noted. P value of <0.05 was considered statistically significant. AASI of >0.49 is considered significant for difficult visualization of larynx.
Results: AASI had better sensitivity (88.89%v/s 22.22%), specificity (98.63%v/s 95.22%), PPV (85.71%v/s 26.32%), NPV (98.97%v/s 93%) and diagnostic accuracy (97.81%v/s 89.03%) in comparision with MMP respectively (P value:0.001).
Conclusion: Our study concluded that AASI is a better predictor of difficult airway with higher sensitivity and PPV in comparison with MMP and can be used as simple bedside test during routine pre-anaesthetic evaluation.
Yentis SM. Predicting difficult intubation- Worthwhile exercise or pointless ritual? Anaesthesia 2002;57:105-9.Kamranmanesh MR, Jafari AR, Gharaei B, Aghamohammadi H, NK MP, Kashi AH. Comparison of acromioaxillosuprasternal notch index (a new test) with modified Mallampati test in predicting difficult visualization of larynx. ActaAnaesthesiologicaTaiwanica. 2013 Dec 1;51(4):141-4.
Abstract ID: ISAP505: Comparative evaluation of patient comfort score and recall of procedure during retrograde intubation with two different doses of dexmedetomidine infusion
Tanmay Tiwari, Ashish Wallian, Satish Dhasmana, Vinita Singh
King Georges Medical University, Lucknow
Background & Aims: Retrograde intubation is one of the recommended non-invasive alternative methods of difficult airway management in ASA difficult airway algorithm.1 It requires effective sedation and patient preparation. We compared intubating conditions for two different doses of dexmedetomidine infusion during retrograde guided intubation.
Methods: After institutional ethical clearance, prospective randomized double blind study was conducted in 60 patients of either sex of ASA PS I & II with anticipated difficult airway. Patents were randomized to receive dexmedetomidine 1.0μg/kg (Group A) or dexmedetomidine 1.5μg/kg (Group B). We used the drug dose similar to our previous study for awake fiber-optic intubation2. The modified Observer Assessment Awareness and Sedation (OAA/S) was primary outcome and secondary outcome in terms of ease of intubation, facial grimace score, cough severity, hemodynamic response, patient recall and discomfort were assessed. Continuous data were summarized as Mean ± SD while categorical in number and %. Continuous groups were compared by independent Student's 't' test. Categorical groups were compared by chi- 2-square (χ) test. SPSS software (version 17.0) was used for analysis.
Results: Groups were comparable in terms of demographic and baseline parameters. OAA/S (p=0.001), cough severity (p<0.001), facial grimace score (p<0.001), grading of discomfort during procedure (p<0.001) and recall of procedure scale (p=0.038) were found significantly better/lower in Group B as compared to Group A. However, ease of intubation scale, tolerance to endotracheal tube, intubating time and complications were not significantly different (p>0.05) between the two groups.
Conclusion: Dexmedetomidine in a dose of 1.5ug/kg is optimum and safe for retrograde intubation with clinically manageable hemodynamic side effects.
American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Practice guidelines for management of the difficult airway. an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 2003; 98:1269–77.Dhasmana SC. Nasotracheal fiberoptic intubation: patient comfort, intubating conditions and hemodynamic stability during conscious sedation with different doses of dexmedetomidine. J Maxillofac Oral Surg 2014;13:53–8.
Abstract ID: ISAP952: Comparison of oropharyngeal volume versus modified mallampati grading for prediction of difficult laryngoscopy. Does road end here?
Neha Singh, Parnandi Bhaskar Rao, Arvind Singh, Sukdev Nayak
Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Bhubaneswar
Background & Aims: Unanticipated difficult airway may lead to increased airway related morbidity and mortality. Various tests and combined indices were proposed for prediction, but none proved to be of much help.(1) We hypothesised that the oral cavity volume plays a crucial role in predicting physiological airway difficulty and may act as a predictor.
Methods: After approval from institutional ethics committee, 215 adult ASA status I/II patients, 18– 70 years, undergoing elective surgery requiring tracheal intubation were enrolled. Written informed consent was taken from all the participants. Anesthesiologists with > 3 years' experience had performed airway assessment. (1) Oral cavity volume was measured thrice by keeping water in mouth in supine position and the mean was taken as OPV. Following induction of anaesthesia, laryngoscopy was attempted with Macintosh blade 3 for women and size 4 for men and modified Cormack and Lehane score (CL) was noted (2). I/II was considered easy and grade III/ IV represented difficult intubation. Failed first attempt was followed by change of blade / external laryngeal manipulation to secure airway.
Results: Predictive accuracy was assessed by measuring the area under the receiver–operating curve (ROC), which showed a cut-off value of 74.16 ml. The area under the curve of the ROC was 0.84.
Conclusion: The oropharyngeal volume can be used as a physiological predictor of difficult laryngoscopy. Different technique may be devised for real time measurement and comparative studies shall help to understand it better.
Grauer D, Cevidanes LS, Styner MA, Ackerman JL, Proffit WR. Pharyngeal airway volume and shape from cone-beam computed tomography: relationship to facial morphology. Am J Orthod Dentofacial Orthop. 2009;136(6):805–814. doi:10.1016/j.ajodo.2008.01.020Ochroch EA, Eckmann DM. Clinical application of acoustic reflectometry in predicting the difficult airway. Anesth Analg. 2002;95:645-9.