Introduction: Laryngoscopy induces haemodynamic response which has implications for patients with cardiovascular illnesses. We devised this study to compare the laryngoscopic view of the glottis obtained with the Macintosh, McCoy and Miller blades, and corresponding haemodynamic changes. Material and Methods: 105 ASA grade I and II patients randomly divided into three groups were intubated using Macintosh, McCoy and Miller blade respectively. Cormack and Lehane grade of glottic view obtained, heart rate, systolic and diastolic blood pressure at baseline, immediately before induction, following induction, and at 1, 3 and 10 minutes after intubation were noted. Epi Info 7.2 was used for statistical analysis. Chi square and ANOVA tests were applied to compare haemodynamic parameters. Results: 18 patients (51.4%) were CL grade I and 17 (48.6%) were CL grade II in Macintosh, 24 (68.6%) were CL grade I and 11 (31.4%) were CL II in McCoy and, 32 (91.4%) were CL I and 3 (8.6%) were CL II in Miller group. Rise in heart rate following intubation was greatest with Miller blade, followed by Macintosh and least with McCoy, and was statistically significant (P< 0.01). Rise in both, systolic and diastolic blood pressure following intubation was highest with the Miller blade, followed by Macintosh and least with McCoy, and the difference compared with baseline values was statistically significant (P<0.01). Conclusions: Miller blade provides best visualization of larynx but McCoy blade produced least haemodynamic response, hence the latter is preferable when less haemodynamic response is desired.

Introduction: Cannulation of internal jugular vein is an indispensable requirement for patients undergoing cardiac surgeries. Generally it is done before induction by giving patients mild sedation and local infiltration of local anaesthetic agent over the neck. In spite of that, patients do complain of discomfort during the procedure which is then accompanied by haemodynamic changes, especially during subcutaneous tunneling and placement of sutures to secure the cannula. The superficial cervical plexus innervates the skin of the jaw, neck and the area close to the clavicle. Keeping this in mind, this study was designed to compare the analgesic effect of the superficial cervical plexus block with local infiltration, and assess the sympathetic response during internal jugular vein cannulation. Material and Methods: An open labelled, prospective, randomized controlled trial was conducted to compare pain relief during internal jugular cannulation after local infiltration with that after superficial cervical plexus block. 200 ASA grade III & IV patients scheduled for various cardiac surgeries were recruited for this study. They were randomly assigned to receive either superficial cervical plexus block (Group I) or local infiltration (Group 2) for analgesia during the cannulation. Patients were monitored for changes in haemodynamic values and evaluated for pain during various stages of the cannulation procedure. Any side effects were also noted. Due to demographic profile of our patients and the ease of use, a simple verbal pain score was used to assess pain. Results: There was statistically no difference in both the groups with respect to demographic profile like age and sex. The pain scores and values of haemodynamic parameters during the procedure of subcutaneous tunneling/dilatation were lower in Group I than in Group II. The difference was statistically significant. No complications were noted in any groups. Conclusion: The study confirmed that superficial cervical plexus block is superior to local infiltration in terms of pain relief during internal jugular vein cannulation in awake patients. Patients in the superficial cervical plexus block group showed more stable haemodynamics throughout the procedure than those in the local infiltration group.