Indian journal of anaesthesia
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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. ⋯ 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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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. ⋯ 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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Optimal depth of endotracheal tube (ET) placement has been a serious concern because of the complications associated with its malposition. ⋯ 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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To use laparoscope as an easily available and easy to use alternative option to videolaryngoscope. ⋯ 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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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. ⋯ 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.