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Background This work was conducted to examine the efficiency of using C-MAC video stylet (VS) in awake intubation by comparing it to the standard method using fibreoptic bronchoscope (FOB).Patients and methodology Eighty patients were included in this study and divided into two groups according to the device used for awake intubation: VS group and FOB group.Results The intubation time ranged between 25 and 245 s with median of 45.5 s in VS group, while in the FOB group, it ranged between 36 and 279 s with median of 80 s with P value < 0.001. Successful intubation was done in 36 patients (90%) on the first attempt in VS group versus 29 patients in the FOB group (72.5%) with P value 0.04. As regard SpO2, insignificant difference was found all through measurement times. Heart rate and mean arterial blood pressure showed significant increase in FBO group more than in CMAC-VS group at 1 and 5 min after intubation with P value < 0.001.Conclusion Using the C-MAC VS in awake intubation proved to be easier and more successful than using the FOB.

This work was conducted to examine the efficiency of using C-MAC video stylet (VS) in awake intubation by comparing it to the standard method using fibreoptic bronchoscope (FOB). Eighty patients were included in this study and divided into two groups according to the device used for awake intubation: VS group and FOB group. The intubation time ranged between 25 and 245 s with median of 45.5 s in VS group, while in the FOB group, it ranged between 36 and 279 s with median of 80 s with P value < 0.001. Successful intubation was done in 36 patients (90%) on the first attempt in VS group versus 29 patients in the FOB group (72.5%) with P value 0.04. As regard SpO2, insignificant difference was found all through measurement times. Heart rate and mean arterial blood pressure showed significant increase in FBO group more than in CMAC-VS group at 1 and 5 min after intubation with P value < 0.001. Using the C-MAC VS in awake intubation proved to be easier and more successful than using the FOB. [ABSTRACT FROM AUTHOR]

Background and objectives: Lipoma represents very common soft tissue tumour, which may appear anywhere in the body. Appearance of a giant lipoma at the nape of neck, can severely compromise neck extension especially in elderly patients where age related degenerative changes in airways present significant challenges to anesthesiologists in airway management whenever needed. This paper evaluates the role of Ambu® aScope™ 3 in such a patient. Case report: An expected case of difficult airway where an old man presents with a huge lipoma of 15.5 × 12.4 cm at the nape of neck where we achieved awake intubation using a non-fiberoptic flexible bronchoscope Ambu® aScope™ 3. In the absence of fiberoptic bronchoscope, this device helped us secure airway in this very challenging case. Conclusion: Ambu® aScope™ 3 can be used for elective awake intubations in patients with difficult airways.

Abstract: Objective: Anesthesia of patient for direct laryngoscopy (DL) and microlaryngosurgery (MLS) was technically challenging. The anesthetist had usually concern about the loss of spontaneous ventilation and occurrence of obstruction after induction with IV drugs. The aim of this study was to compare between flexible fibro-optic bronchoscope and direct rigid laryngoscope during awake intubation in patients with laryngeal mass scheduled for direct laryngoscopic surgery (DL) and microlaryngosurgery (MLS). It was a study to assess the best way for intubation with the least side effects, discomfort to the patients and high success rate of intubation. Methods: Fourty adult patients Malampati 1,2 and ASA I,II,III with small laryngeal mass or polyp scheduled for direct laryngoscope (DL) and microlaryngoscopic surgery. They were randomly computerized divided into two groups 20 patients in each group; Group FO; intubation with flexible fibro-optic bronchoscope. Group RL; intubation with rigid laryngoscope. Results: The time of intubation was statistically significantly higher in fibro-optic group (group FO) (92±34s) than rigid laryngoscope group (group RL) (35±5s). There were two patients in group RL needed 2nd intubation attempt for better visualization of the view but there were six patients in group FO needed 2nd intubation attempt for suction of secretion and blood. According to modified six point scale the patients ranged between 1 and 3 in group FO while they range between 2 and 4 in group RL. Conclusion: The study suggested that the flexible fibro-optic bronchoscope was very comfortable to the patients and less traumatic with less cardiovascular stress but it took longer time and had a higher incidence of 2nd attempt and failure rate. Accordingly, it recommend the use of flexible fibro-optic bronchoscope in expected small size and non-bloody mass with prepared rigid laryngoscope and tube with stylet to be ready to use if needed. [Copyright &y& Elsevier]

Abstract: Background: The Gldiescope video laryngoscope (GVL) as a recent intubating device has gained much popularity in difficult intubation over the last decade. It can be used as a substitute to flexible fiber optic bronchoscope (FOB) in intubating challenges. The object of this study is to compare the utility of GVL and FOB for intubating time, attempts, effects on hemodynamics, adverse effects, patient satisfaction and post intubation neurological outcome during awake intubation in traumatic cervical spine injury. Methods: Fifty patients undergoing post traumatic cervical spine fixation under general anesthesia were randomly allocated to two groups in a prospective, controlled non-blinded study. All patients were premedicated with glycopyrrolate 0.2mg iv and midazolam 1mg iv that be repeated up to 0.05mg/kg followed with a bolus dose of remifentanil 1.5μg/kg then a continuous remifentanil infusion of 0.15μg/kg/min for 3min before procedure. Each patient underwent a wake endotracheal intubation with either GVL (G group) or FOB (F group) with manual in line stabilization (MILS). Intubating time, intubating attempts, hear rate (HR), mean arterial pressure (MAP), oxygen desaturation (SO2 <90%), sore throat, patient satisfaction and postintubation neurological outcome were recorded. Results: Intubating time was significantly lower in G group compared with F group (26±5 versus 72±11 respectively), while the percentage of the first successful intubating attempt was insignificantly higher in G group (88%) than in F group (72%). Both HR and MAP were significantly increased only in F group during intubation in comparison with the basal line values. Both devices were safe for post neurological outcome. No significant differences of adverse effects or patient satisfaction were recorded between groups. Conclusion: The GVL is a safe surrogate for FOB during awake intubation for post traumatic cervical spine fixation. [Copyright &y& Elsevier]

Abstract: Pulmonary aspiration of gastric contents during the perioperative period has significant morbidity and mortality. The aspiration may occur immediately before, during or after the actual act of endotracheal intubation. Fasting before elective surgery (nil per os [NPO] after midnight) is based on the historical presumption that the absence of intake of solids and fluids will minimize the gastric fluid volume at the time of induction of anaesthesia, thus decreasing the risk of pulmonary aspiration of the gastric contents. But this fasting is not possible in emergency surgery. The practice of routine administration of OCM for abdominal computed tomography (CT) for abdominal surgeries requiring general anaesthesia or in obtunded patients violates the nothing per os role that is crucial part of anaesthesia and can lead to aspiration causing morbidity and even mortality. Awake intubation may be a suitable alternative in such high risk cases for aspiration. [Copyright &y& Elsevier]