Lalit Gupta

Background: Tracheal intubation in cervical spine injury patients with application of Manual In Line Stabilization (MILS) of the cervical spine in neutral position is a challenge for the anesthesiologist since it makes visualization of the larynx more difficult using conventional laryngoscopy. Our study was conducted to compare ease of intubation using Airtraq and Intubating laryngeal mask airway (ILMA) in simulated cervical spine injury patient using MILS. Materials and Methods: 100 ASA I/II patients (without cervical spine injury), aged 18-60 years were randomly allocated in two groups -Group A: Airtraq (n=50), Group I: ILMA (n=50). General anaesthesia was given as per standard protocol in all the patients, after that MILS was applied and patients intubated using Airtraq in group A and ILMA in group I with neck in neutral position. Time taken for intubation, number of attempts for intubation, ease of intubation with Airtraq/ILMA, hemodynamics and complications were compared. Results: The mean time taken for intubation in the Group A was 12.6 ± 6.6 seconds and in the Group, I was 85.8 36.6 seconds (p Conclusion: Airtraq is a safer and faster alternative when compared to ILMA in patients with simulated cervical spine injury using manual in line stabilization. Keywords: Airtraq, Intubating laryngeal mask airway, Cervical spine immobilization.

Adult-onset Still ’s disease (AOSD), is a chronic systemic inflammatory 1 disorder rarely encountered in clinical practice, described by Sir George Frederick Still in 1897. AOSD is of unknown aetiology with the incidence estimated to be 0.16 per 100,000 persons with articular and extra-articular or systemic manifestations. AOSD has a more acute course than compared to rheumatoid arthritis in adults, often affecting many parts of the body before settling in the various joints. Its diagnosis is made by exclusion. Securing airway mainly tracheal intubation may be difficult due to involvement of cervical spine, temporomandibular joint and laryngeal involvement (crico-arytenoid arthritis). In addition, intermittent disease flare-ups with laryngeal involvement may cause delayed extubation. This case highlights the anaesthetic concerns involved with the Still’s disease. Keywords: Still disease, Adultonset Still’s disease (AOSD), Chronic systemic inflammatory disorder

Introduction: Spinal myoclonus under regional anaesthesia necessitates awareness about its manifestation with a framework for immediate plan of action. Case: A 52 year old male patient posted for open reduction and internal fixation with Interlocking nail for both bone leg fracture lower limbs. Combined spinal and epidural anesthesia (CSE) was administered. He developed abnormal movements in lower limb after 2hrs of subarachnoid block. These uncoordinated movements initially thought to be due to weaning of the effect of spinal anesthesia were later found to be spinal myoclonus which resolved over a period of three hours after giving GABA agonists. Conclusion: Spinal myoclonus, a rare disorder requires high clinical suspicion of the entity for diagnosis and can be managed successfully with GABA agonist drugs. Keywords: Combined spinal and epidural anaesthesia, Myoclonus, GABA agonist.

Maintenance of airway during anaesthesia is very important to anaesthesiologist. A prospective, randomized study was conducted in 90 patients (ASA-I & II) posted for various surgeries under general anaesthesia with endotracheal intubation to evaluate differences in glottic view, attempts and duration of laryngoscopy and intubation attempts along with hemodynamic variability associated with the three blades- Macintosh, McCoy and Miller laryngoscope blade. Patients were randomly allocated in three groups. In first group laryngoscopy was done with Macintosh blade, in second group with Miller blade, in third group with McCoy blade. In this study it was found that McCoy laryngoscope is distinctly superior to the Macintosh and Miller with less hemodynamic changes and better glottic visualization. Degree of difficulty in intubation was more with Miller blade in comparison to Macintosh and McCoy blade which is statistically significant (p value < 0> Keywords: Cormack lehane grade, Macintosh blade, McCoy blade, Miller blade, Degree of difficulty in intubation.