Background and Aims:Accurate prediction of the Cormack-Lehane (CL) grade preoperatively can help in better airway management of the patient during induction of anaesthesia. Our aim was to determine the utility of ultrasonography in predicting CL grade.Methods:We studied 100 patients undergoing general endotracheal anaesthesia. Mallampati (MP) class, thyromental distance (TMD) and sternomental distance (SMD) were noted. Ultrasound measurements of the anterior neck soft tissue thickness at the level of the hyoid (ANS-Hyoid), anterior neck soft tissue thickness at the level of the vocal cords (ANS-VC) and ratio of the depth of the pre-epiglottic space (Pre-E) to the distance from the epiglottis to the mid-point of the distance between the vocal cords (E-VC) were obtained. CL grade was noted during intubation. Chi-square test was employed to determine if there was any statistical difference in the measurements of patients with different CL grades. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were calculated for the various parameters.Results:The incidence of difficult intubation was 14%. An ANS-VC >0.23 cm had a sensitivity of 85.7% in predicting a CL Grade of 3 or 4, which was higher than that of MP class, TMD and SMD. However, the specificity, PPV and accuracy were lower than the physical parameters. The NPV was comparable.Conclusion:Ultrasound is a useful tool in airway assessment. ANS-VC >0.23 cm is a potential predictor of difficult intubation. ANS-Hyoid is not indicative of difficult intubation. The ratio Pre-E/E-VC has a low to moderate predictive value.

Study DesignProspective, randomised controlled, single centre study of 45 patients posted for two level lumbar fixation surgery in the prone position.PurposeTo compare intra-abdominal pressure (IAP), mean airway pressure mean airway pressure and blood loss during the spine surgery in prone position using three different positioning systems.Overview of LiteratureStudies have correlated IAP with the amount of perioperative bleeding. However, IAP and airway pressures while assessing the bleeding comparing two or more prone positioning systems are unclear.MethodsThis prospective study was conducted on a cohort of 45 patients scheduled for two-level lumbar fixation. Patients were randomly allocated to a spine table, Wilson's frame, and thermomodulated pads. Bladder pressure as an indicator of IAP, mean and peak airway pressures, and blood loss were monitored.ResultsIAP increased whenever patient position was changed to prone .The increase in pressure was more in the Wilson's frame group but was statistically significant only on prolonged positioning. Adopting the prone position always increased the mean airway pressure, but the increased was significant only in the Wilson's frame group. Mean airway pressure decreased in the spine table group and was statistically significant. The blood loss in the spine table group was significantly less as compared to the other groups.ConclusionsPositioning on a spine table results in less blood loss and low mean airway pressure. The Wilson's frame results in high IAP, increased mean airway pressure, and more blood loss. The thermomodulated frame increases mean airway pressure and produces a moderate increase in IAP and airway pressure.

Background: The application of head fixation device and tightening of the pins on the scalp acts as an intense noxious stimulus with an increased hemodynamic response. We aimed at comparing the efficacy of scalp nerve block (SNB) using levobupivacaine against intravenous fentanyl bolus dose followed by continuous intravenous infusion for attenuation of pain and hemodynamic response to pin fixation. Methods: One hundred and eight patients undergoing elective supratentorial craniotomy under general anesthesia were randomly allocated to two groups: Group F received a bolus of intravenous fentanyl (2 μg/kg) followed by continuous maintenance infusion and Group S, in which a bilateral SNB was performed with 20 ml of 0.5% levobupivacaine. Hemodynamic variables and pain scores were the primary outcomes noted. Intraoperative isoflurane and additional fentanyl requirements, emergence time and any side effects were also recorded. Results: The variation in hemodynamics in terms of heart rate (per minute) at pin fixation (Group F [95.88 ± 7.79] and Group S [89.02 ± 5.42]) was significant (P < 0.001). There was a significant change in mean arterial blood pressure (mm Hg) between the groups at pin fixation Group F (104.70 ± 9.18) and Group S (92.88 ± 6.92) (P < 0.001). A significant reduction in pain and intraoperative fentanyl requirements was also seen. Emergence from anesthesia was significantly longer in Group F as compared to Group S (P < 0.001). No group had any significant complication. Conclusion: SNB is a reasonably safe and effective means for smooth control over hemodynamics and lesser intraoperative analgesic requirements compared to the fentanyl infusion in adult patients undergoing supratentorial craniotomies.

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