It has been suggested that the size of the base of the tongue is an important factor determining the degree of difficulty of direct laryngoscopy. A relatively simple grading system which involves preoperative ability to visualize the faucial pillars, soft palate and base of uvula was designed as a means of predicting the degree of difficulty in laryngeal exposure. The system was evaluated in 210 patients. The degree of difficulty in visualizing these three structures was an accurate predictor of difficulty with direct laryngoscopy (p less than 0.001).

Esmolol, an ultra-short-acting cardioselective betaadrenergic blocker, was investigated in a double-blind prospective protocol for its ability to control haemodynamic responses associated with tracheal intubationEsmolol is a cardioselective, beta-adrenergic blocking agent with a short duration of action because it is metabolized by a blood esterase,l The short duration of action permits rapid titration by intravenous infusion to a desired level of beta blockade. Likewise, cessation of esmolol infusion rapidly terminates the beta blockade.Numerous studies have reported hypertension and tachycardia associated with laryngoscopy and tracheal intubation that may be detrimental. 2-s Two recent studies utilized esmolol to block haemodynamic response after intubation in man following induction of anaesthesia with ketamine 6 or diazepare, N20 (50 per cent) and pancuronium. 7 The latter study 7 was conducted in patients scheduled for elective myocardial revascularization to determine the dosage that might safely and effectively reduce cardiovascular responses to intubation. Gold et al. 6 found that peak heart rates and systolic pressures following intubation after ketamine induction were significantly attenuated by esmolol. Likewise, Menkhaus et al. 7 observed significant reductions in heart rate, mean arterial pressure and CAN" ANAESTH SOC I 1986 / 33:5 / pp556-62

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