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Context: To establish the usefulness of King Vision ® video laryngoscope (KVL) in patients with rapid sequence anesthesia. Aims: This study aims to compare the role of KVL on glottic visualization, intubation time and associated sympathetic response in routine intubations to those intubations done with cricoid pressure (CP). Settings and Design: Randomized controlled study in a tertiary care hospital. Methodology: Seventy-six patients intubated with KVL were randomized to two groups – Group C (who did not receive any CP) and Group CP – who received CP. The percentage of glottic opening (POGO), intubation time, subjective assessment, and number of attempts taken to introduce KVL and endotracheal tube (ETT) were noted. The saturation, end-tidal carbon dioxide concentration and hemodynamic response (heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and rate pressure product) in the peri-intubation period were also recorded. Results: The demographics, airway, and technical characteristics of insertion of KVL and ETT were comparable between the groups ( P > 0.05). POGO score was 100% in both groups. The significant time in insertion of KVL (Group C 29.87 ± 11.64 s and Group CP 40.68 ± 18.93 s, P = 0.004) and ETT (Group C 17.53 ± 8.71 s and Group CP 22.42 ± 10.77 s, P = 0.033) contributed to prolonged overall intubation time in CP (Group C 41.11 ± 11.65 s and Group CP 51.05 ± 17.31 s, P = 0.005). The intergroup and intragroup hemodynamic variables did not show any statistical significance ( P > 0.05) over time. Conclusion: Although overall intubation time with KVL is prolonged in patients with CP, it provides excellent glottic view, eases intubation, and causes insignificant hemodynamic variation.

Background: Induction of anaesthesia and endotracheal intubation are associated with adverse haemodynamic effects which are detrimental in hypertensive patients. Although etomidate is found to be a cardio stable induction agent, its advantages in hypertensive patients are not yet investigated. Aim of the present study is to compare the haemodynamic parameters following induction of anaesthesia with etomidate and propofol in normotensive and hypertensive patients. Methods: In a prospective comparative study, 120 patients aged 18 to 60 years, of both sex and ASA status I & II posted for elective surgery under general anaesthesia were divided into 4 groups of 30 each. Anaesthesia was induced with either propofol or etomidate. Heart rate(HR), Systolic Blood Pressure(SBP), Diastolic Blood Pressure(DBP), Mean Arterial Pressure(MAP) and SpO2 were noted down at baseline, pre-induction, after induction, at laryngoscopy and 1, 3 & 5 minutes post intubation. Results: There was a significant fall in HR after induction with propofol which was more in the hypertensive group. After intubation, a rise in HR was observed in all 4 groups which returned to baseline by 5 minutes. A fall in MAP, SBP and DBP were observed in all the groups following induction, which shooted up after intubation. The fall in MAP with propofol was significantly higher when compared to etomidate which offered stable haemodynamic conditions. Conclusion: The present study suggests that induction of anaesthesia with etomidate is associated with better stability of MAP in normotensive as well as hypertensive patients when compared with propofol. However, HR is better maintained with propofol. Thus there is no clear evidence supporting induction by etomidate in hypertensive patients.

Middle lobe syndrome refers to a clinical condition that is characterized by recurrent or chronic collapse of the middle lobe of the right lung. Inefficient collateral ventilation, infection and inflammation in the middle lobe or lingula are thought to play a role in the pathogenesis of this condition. MLS can be obstructive or non-obstructive; the management varies according to the aetiology. Patients with proven endobronchial lesions or malignancy are usually offered surgical resection while most patients with non-obstructive aetiology respond to medical treatment consisting of bronchodilators, mucolytics and broad-spectrum antibiotics. We present a case of MLS who was managed conservatively in our ICU but did not respond and required surgical intervention later.