Background and Aims:Ultrasonography has emerged as a novel, portable, non-invasive tool encouraging airway assessment and procedural interventions. This study assesses the feasibility of ultrasound for block of internal branch of superior laryngeal nerve (ibSLN) block during upper airway anaesthesia to aid awake fibre-optic intubation.Methods:Forty American Society of Anesthesiologists’ physical status I–II patients, aged 18–60 years, deemed to have a difficult airway (modified Mallampati class III–IV or inter-incisor distance <2.5 cm) and planned for awake fibre-optic intubation were randomised to either landmark group (L, n = 20) or ultrasound group (U, n = 20). All patients received nebulised 4% lignocaine (3 mL) and transtracheal injection 3 mL 2% lignocaine. Group L received landmark-guided bilateral ibSLN block with 1 mL 2% lignocaine. Group U received bilateral ibSLN block with 1 mL 2% lignocaine using a high-frequency ultrasound transducer to define the SLN space. The primary objective was assessment of quality of airway anaesthesia. Secondary objectives were time for intubation, haemodynamic parameters and patient perception of discomfort during procedure.Results:The quality of anaesthesia was significantly better in Group U than in Group L (P < 0.001). The mean time for intubation was shorter in Group U (71.05 ± 9.57 s) compared to Group L (109.05 ± 30.09 s, P < 0.001). Heart rate, mean arterial pressure and patient perception of discomfort were significantly increased in Group L.Conclusion:Ultrasound for ibSLN block as a part of preparation for awake fibre-optic intubation improves quality of airway anaesthesia and patient tolerance.

Background and Aims:BlockBuster® Laryngeal Mask Airway, a newer supraglottic airway device, is claimed to be an efficient conduit for endotracheal intubation. Intubating laryngeal mask airway (LMA) is an established device for the same. This randomised study was undertaken to evaluate the success rate of blind intubation using either of these LMAs.Methods:Sixty patients of age group 20-60 years undergoing general anaesthesia were randomised in 2 groups, of 30 patients each, for tracheal intubation using either BlockBuster® LMA (Group B) or the Intubating LMA Fastrach® (Group F). After induction of anaesthesia, LMAs were inserted and on achieving adequate ventilation with the device, fibreoptic scopy was performed to assess the glottis visualisation score. Blind intubation was attempted through the supraglottic airway devices (SAD). The primary objective was first pass successful intubation and secondary outcomes were ease, time for LMA insertion, oropharyngeal seal pressure (OSP), LMA removal time, fibreoptic scoring and complications. Data was analysed using SPSS V22 software.Results:The first-attempt success rate of tracheal intubation was 90% in Group B and 66.6% in Group F (P = 0.028), while the overall success rate of intubation was 96.6% in Group B and 89.9% in Group F (P = 0.3). The OSP in Group B was 33.7 ± 1.8 and 22.7 ± 1.5 cm H2O in Group F (P = 0.001). Complications such as sore throat and blood stain were reduced with BlockBuster® LMA.Conclusion:BlockBuster® LMA provides higher first pass success rate of blind tracheal intubation with less complications like sore throat and blood staining.