No abstract

We report a case which was managed by spinal anaesthesia using Taylor's approach. The patient had an altered spine anatomy due to previous L4-L5 laminectomy and discectomy with L4, L5, S1 transpedicular fixation and fusion. Patient's history of post-operative confusion and apprehension about general anaesthesia (GA) made spinal anaesthesia our first choice. However, in view of the altered spine anatomy, Taylor's approach was used successfully to manage anaesthesia to avoid GA. Conclusion: Although SAB is a relative contraindication for patient with history of previous spine surgery mostly due to altered spine anatomy, SAB can be safely administered via Taylor's approach when general anaesthesia has to be avoided.

Securing airway is an important routine for any Anesthesiologist. Assessment of airway preoperatively is an essential part of predicting difficulty in airway management. Mallampati test (MP) is commonly applied during such preoperative assessments. However, Mallampati test is an indirect clinical sign in which thickness of the base of the tongue is assessed by whether it masks faucial pillar (palatoglossal and palatopharyngeal arches) or not. Though MP is an indirect assessment, this test is routinely applied because of ease of applying this test. This test however is not completely reliable in predicting difficulty in laryngoscopy and intubation and has high false-positive and false-negative outcome. The depth of floor of the mouth and thickness of tongue can be assessed to improve prediction of difficult airway. This depth can be measured by cheap and rapid test using ultrasonography. Material and Methods: In this study depth of the tissues in the floor of the mouth were measured by placing USG probe above hyoid bone in sagittal plane and measurement taken from skin to mucous membrane of tongue and attempted to establish any relationship between this thickness and difficulty in laryngoscopy as assessed by Cormack-Lehanne scoring. 60 ASA I & II patients undergoing elective surgeries under GA were assessed during the pre-anaesthetic evaluation and supra-hyoid USG depth in sagittal plane was measured and recorded. During laryngoscopy Cormack and Lehanne scoring was recorded for each of the subjects by 2 experienced anaesthesiologists who were blinded to the depth assessment.