Background: Cervical spine immobilization results in a poor laryngeal view on direct laryngoscopy leading to difficulty in intubation. This randomized prospective study was designed to compare the laryngeal view and ease of intubation with the Macintosh, McCoy, and King Vision video laryngoscopes in patients with immobilized cervical spine. Method: Ninety adult patients of ASA grade I-II with immobilized cervical spine using manual inline axial cervical spine stabilization technique, undergoing elective cervical surgery were enrolled. The patients were randomly allocated into three groups to achieve tracheal intubation with Macintosh (MAC group n=30), McCoy (MCC group n=30), or King Vision video laryngoscopes (KVL group). When the best possible view of the glottis was obtained, the Cormack-Lehane laryngoscopy grade and the percentage of glottic opening (POGO) score were assessed. Other measurements included the intubation time, the intubation difficulty score, and the intubation success rate. Haemodynamic parameters and any airway complications were also recorded. Result: King Vision video laryngoscope reduced the intubation difficulty score, improved the Cormack and Lehane glottic view, and the POGO score compared with the McCoy and Macintosh laryngoscopes. The first attempt intubation success rate was also high in the King Vision video laryngoscope group. However, there were no statistically significant differences in the time required for successful intubation and the overall success rates between the devices tested. No dental injury or hypoxia occurred with either device. Conclusion: The use of a King Vision video laryngoscope resulted in better glottis visualization, easier tracheal intubation, and higher first attempt success rate as compared to Macintosh and McCoy laryngoscopes in immobilized cervical spine patients.

Background:Allogenic blood transfusion is associated with several potential complications, especially in patients with cancer. The objective of this prospective single-centre study was to identify the rates of perioperative blood transfusion and overtransfusion in a tertiary-level cancer hospital.Methods:Between March and May 2008, we studied all adult patients undergoing elective major cancer surgery under anaesthesia and recorded intra- and immediate post-operative (within 24 h) blood transfusions and post-operative investigations. Overtransfusion was defined as post-transfusion haemoglobin (Hb) exceeding 10 g/dL.Results:One hundred and eighty-six of 1175 (16%) patients received perioperative blood transfusion. The main trigger for intraoperative transfusion was blood loss exceeding the patient's maximum allowable blood loss (92, 49%). Ninety-five (51%) transfused patients had post-transfusion Hb more than 10 g/dL. The rate of overtransfusion was not higher in patients who received single-unit transfusions.Conclusion:The perioperative transfusion rate in patients undergoing cancer surgery was 16%. More than half of these patients were overtransfused. Following this audit, point-of-care facilities for intraoperative haemoglobin measurement have been introduced.

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Authors' Contribution RDB and ABK conceived and designed the experiments, performed experiments, interpreted the data and wrote the article. All other authors helped in preparation of the manuscript.