Venugopal Achuthan Nair

Abstract

Aims: Difficult tracheal intubation still contributes significantly to anaesthesia related morbidity and mortality. Poor visualisation of laryngeal structures and multiple attempts at intubation are the leading causes with the conventional laryngoscopes. Though the recently introduced video assisted devices have significantly improved the ease of intubation by their superior laryngeal visualisation, the duration of intubation may vary. Here we compared the ease of tracheal intubation using Macintosh conventional direct laryngoscope (DL) and C- MAC videolaryngoscope (VL) in patients with expected difficult tracheal intubation. Materials and Methods: A total of 140 patients undergoing elective surgery under general anaesthesia with Modified Mallampati Class 3 and 4 found during the preoperative airway assessment were equally recruited to either of the groups. We compared the duration of tracheal intubation, visualisation of the laryngeal inlet, additional optimising manoeuvres required, and number of attempts at intubation and incidence of oral trauma assessed at extubation between the two groups. Statistical Analysis: Analysis done using Statistical Packages for the Social Sciences (SPSS) software; Windows version 11.0 (SPSS Inc., Chicago, IL, USA). Results: Intubation time was significantly longer in patients with VL than DL (P 0.0001) whereas visualisation of laryngeal inlet was significantly better with VL (P 0.001). Additional optimisingmanoeuvres (P 0.001) and incidence of oral trauma (P 0.012) were significantly less with VL whereas intubation attempts were found comparable (P 0.586). Conclusion: Though VL provided significantly better laryngeal view with less need for optimising manoeuvres and less oral trauma compared to DL, the duration of intubation was significantly more with the former. Keywords: Anaesthesia; C MAC-D Blade, Difficult airway, Intubation, Laryngoscope.

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Abstract

Pheochromocytoma is a rare tumor of adrenal gland, treatable, curable cause of hypertension and may lead to premature death if not treated early. Medical management by multidisciplinary team is essential for hemodynamic stability during the perioperative period. General anaesthesia with thoracic epidural block offers adequate stress control as hemodynamic fluctuations are quite common and significant during induction, peritoneal insufflation and tumor manipulation. Newer modalities of diagnosis, short acting drugs to control hypertension, vigilant anaesthetic management with beat to beat monitoring of hemodynamics significantly improves patient’s safety. Laparoscopic mobilisation of the adrenal helps in minimal manipulation of the tumour and thus minimising the resultant catecholamine surge. However, hypotension upon ligation of adrenal vein is inevitable. Noradrenaline (NA) remains the vasopressor of choice which has to be continued post operatively. A thorough pre-anaesthetic evaluation, preparation and execution with a multimodal analgesic pain management in a high dependency unit aid in early ambulation and discharge of the patient. Keywords: Adrenal tumour, Catecholamine, Laparoscopy, Multiple Endocrine Neoplasia.

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