Background Airway anesthesia is pivotal for successful awake intubation provided either topically or by nerve blocks. The widespread use of ultrasonography allows anesthesiologists to evaluate complex and varied anatomy before needle insertion. This study aims to evaluate the effect of ultrasound-guided technique for the block of the internal branch of the superior laryngeal nerve in difficult airway patients in comparison to blind anatomical technique. Sixty patients aged 18–60 years, of either sex, with the American Society of Anesthesiologists’ physical status (ASA) I–II were divided into two groups 30 patients of each. Group (L): using anatomical landmark technique to bilateral block internal branch of the superior laryngeal nerve (ibSLN) with 1 mL 2% Lidocaine and group (U): using ultrasound technique to bilateral block the ibSLN with 1 mL 2% Lidocaine. Assessment of the excellence of airway anesthesia during intubation by using the 5 points grading scale, time for intubation, effects on hemodynamic variables, and evaluation of patient awareness of pain and discomfort during fiber-optic intubation using numerical rating scale were compared. Results The duration of tracheal intubation was shorter in the ultrasound group as compared to the anatomical group; also, patient comfort was significantly better in the ultrasound group besides the effect of tracheal intubation on hemodynamics which was significant with a higher peak value during intubation and post-intubation in the anatomical group compared to the ultrasound group. Conclusions This study concludes that an ultrasound-guided block of ibSLN used as a part of the preparation of the airway for awake fiber-optic intubation enhances the quality of airway anesthesia and patient tolerance during the procedure.

Background Assessing fluid responsiveness is the key to successful resuscitation of critically-ill sepsis patients. The use of IVC variation is favored among the dynamic methods of fluid responsiveness assessment in the ICU because it is non-invasive and inexpensive; moreover, it does not demand a high level of training. The aim of this study is to determine the value of the IVC respiratory variability for predicting fluid responsiveness in spontaneously breathing sepsis patients with acute circulatory failure. Results In this prospective observational study, fifty-eight spontaneously breathing sepsis patients admitted in the ICU were enrolled after the approval of the departmental Research Ethical Committee, and the informed written consent had been taken from the patients. Ultrasonographic and echocardiographic parameters were measured “IVC parameters and stroke volume (SV)” with calculation of the inferior vena cava collapsibility index (IVCCI) and cardiac output. These values were obtained before (baseline) and after volume expansion with a fluid bolus. The study showed that twenty-nine patients (50%) were considered to be responders, with an increase in CO by 10% or more after fluid challenge. There was a significant difference between responders and non-responders in baseline IVCCI (p value < 0.001). There were no significant differences between responders and non-responders in terms of demographic and baseline clinical characteristics. Also, there was statistically significantly larger maximum (IVC max) and minimum (IVC min) inferior vena cava diameters before volume expansion in non-responders than in responders with p value 0.037 and 0.001 respectively. The suggested cut off value regarding baseline IVCCI to predict response to fluid infusion is 0.32 with a high chance of response above this figure (a sensitivity of 72.41% and a specificity of 82.76%). Conclusions Inferior vena cava collapsibility index assessment can be a sensitive and a good predictor of fluid responsiveness, being based on a safe and a non-invasive technique compared to other methods such as central venous pressure (CVP) measurement and pulmonary artery catheter insertion.

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