Parapharyngeal tumors often distort the airway anatomy leading to obstruction and hinderance for intubation thus posing a challenge for the anesthetist at securing airway with least damage to the nearby structures. We present our experience through a series of 5 such cases in children managed successfully using video laryngoscope. Working in places where availability of advanced airway equipment such as pediatric size fiberoptic is unavailable, a video laryngoscope can help to appropriately assess the airway and prevent disastrous outcomes.

Purpose: The aim of this study is to compare the laryngeal view in Airtraq and Macintosh LARYNGOSCOPES.Methods: This descriptive observational study was conducted on hospitalized patients at Shohadaye Ashayer Hospital who were candidate for elective surgery with general anesthesia. One anesthesiologist evaluated and recorded glottis view with Macintosh laryngoscopy based on cormack lehane score and another anesthesiologist who was unaware of the observations of the previous anesthesiologist evaluated and recorded glottis view with Airtraq laryngoscope.Results: The mean age of patients was 30.6 ± 8.89 years old. Mean BMI 22.10±3.25 kg/m2 and duration of intubation was 28.3±6.92 seconds. The Airtraq laryngoscope significantly decreased the Cormack-Lehane score (P=0.043). Cormack lehane score With the Macintosh laryngoscope was I in 187 patients (69%), II in 56 patients (21.3%), III in 20 patients (7.8%) and IV in 5 patients (1.9%) and with laryngoscope Airtraq was I in 248 cases (93.6%), II in 16 patients (5.2%) and III in 3 patients (1.1%). Improvement in view of larynx was observed in 194 cases (73.0%) with Airtraq laryngoscope and lack of improvement was seen in 73 (27.0%) cases.Conclusion: Considering the high rate of improvement in observation of view of larynx with an Airtraq laryngoscope, decreasing the Cormack-Lehane score, and facilitating the tracheal intubation, Airtraq laryngoscope is a safe and useful for tracheal intubation in elective surgery with general anesthesia.

Background: Macrolide-resistant streptococcus isolates may show constitutive or inducible resistance to clindamycin.Objective: The aim of this study was to determine the frequency of erythromycin resistant phenotypes in streptococcus isolates from LARYNGOSCOPES in Shahid Rajaei hospital, Qazvin.Methods: This descriptive study was conducted in streptococcus isolates from LARYNGOSCOPES in Shahid Rajaei hospital, 2013. The isolates were examined by Kirby Bauer disc diffusion method using erythromycin and clindamycin disks on Mueller-Hinton agar (according to Clinical and Laboratory Standards Institute standards). Inducible clindamycin resistance was tested by D-test in erythromycin resistant isolates. Data were analyzed using Chi-square test.Findings: The phenotypes detected among the 23 isolates were as follows: one (4.35%) inducible clindamycin resistance (iMLSB), 6 (26.11%) constitutive clindamycin resistance (cMLSB), 5 (21.72%) MS phenotype and 11 (47.82%) wild type. The association between erythromycin and clindamycin resistance of the streptococcus isolates and D-test was not statistically significant.Conclusion: With regards to the results, laryngoscope can potentially carry erythromycin and clindamycin resistant isolates. Therefore, infection control is necessary before using this instrument.

Aims and Background: Esophageal foreign body can be harmful. Esophagoscopy is the most common method of foreign body extraction. But in many cases during laryngoscopy the foreign body is visible in hypopharynx region and anesthesiologist can remove it with a Magill forceps. In these cases laryngoscopy should give an appropriate and sufficient view from hypopharynx. The aim of this study was to compare two common laryngoscopy blades including Miller and Macintosh in producing direct view of hypopharynx and the possibility of foreign body removal, in order to present the preferred method.Materials and methods: After performing lateral and anteroposterior neck radiography for confirming foreign body existence above the 7th cervical spine, patients over 10 years old with history of swallowed foreign body and candidate for esophagoscopy, were included in this study. Randomly one of the Miller and Macintosh blades was chosen and after induction of anesthesia and laryngoscopy the grade of hypopharynx view was recorded. In this grading system created by author, increasing grade of hypopharynx was associated with better view of hypopharyngeal inlet and more possibility of visualizing and removing foreign body. After laryngoscopy and in case of visualizing, attempt to remove the foreign body by Magill forceps was done.Findings: In 60 patients, with similar BMI and Demographic data , the Grade 4 of hypopharyngeal view ,creating a better view for the removing foreign bodies, was approximately 3 times more common in Macintosh group than Miller one (56.% vs. 20%).In grade 4 of hypophangeal view the success rate of Macintosh blade was (94.1%) and for Miller it was(50%)(P value:0.04).Overall, the success rate of Macintosh blade in all grades was 4.3 times more than Miller blade.Conclusions: Comparing laryngeal view and success rate of two LARYNGOSCOPES (Macintosh and Miller) showed that grade 4 of laryngoscopy, which seems to be more appropriate for removing foreign body, is more common in Macintosh group than the other one. Regarding the success rate, we observed that Macintosh blade had a higher chance of removing foreign body. In general, the success rate of the Macintosh laryngoscope was more than Miller.

Background: Laryngoscopy and intubation cause activation of the sympathetic nervous system and can results in tachycardia, arrhythmias and hypertension. Hypertensive patients demonstrate a relatively greater rise in catecholamine secretion and an increased sensitivity to them. Aim of the study is to compare the haemodynamic stress response associated with orotracheal intubation using videolaryngoscope or Macintosh laryngoscope in controlled hypertensive patients. Methods: Sixty hypertensive, American Society of Anesthesiologist’, s class II, patients were randomly divided in to two groups. In group V (videolaryngoscope), intubation was done with i-scope videolaryngoscope. In group M (Macintosh), intubation was done using Macintosh laryngoscope. Primary objectives of the study pulse rate (PR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean blood pressure (MBP) were noted immediately after and at 1, 2, 3, 5 and 10 minutes after intubation. Results: The demographic data were comparable in both groups. There was no significant difference at baseline for mean (SD) PR, SBP, DBP and MBP at baseline and after induction/before intubation (p>0. 05). The mean (SD) PR, SBP, DBP and MBP were significantly higher in Macintosh laryngoscope group as compared to i-scope videolaryngoscope immediately after intubation, 1, 2, 3, 5 and 10 minutes after intubation (p<0. 001). Conclusion: We found that intubation with the use of i-scope videolaryngoscope results in less haemodynamic stress response than Macintosh laryngoscope in controlled hypertensive patients.

Introduction: Endotracheal intubation is the optimal way for airway management. Before tracheal intubation, laryngoscopy must be done on the patient for visualization of glottis, vocal cords and inlet of trachea. If laryngoscopy is done appropriately and airway class has lower score according to Cormack & Lehane classification (C& L), the hemodynamic changes will be low and safe. The LARYNGOSCOPES are many kinds but the most common is Macintosh which has two blades; standard blade and English blade. In this study we compared these two blades but further investigations are needed for choosing the best blade in different situations.Objective: Comparison the standard blade and English blade of Macintosh laryngoscope in airway classification of elective surgical patients.Materials and Methods: In this clinical trial with replacement interventional study, seventy patients who scheduled for elective surgery and general anesthesia with endotracheal intubation were chosen. They randomly divided to two groups (35 patients in each group) according to series of cards that was written group I or group II standard and English blade. They was chosen with anesthesia nurse after induction of anesthesia and neuromuscular blocking, At first, laryngoscopy was carried out with standard blade then with English blade in group I and with English blade then standard blade in group II. The view of the glottis was graded according to (C& L) classification for each blade during laryngoscopy procedure. (grade 1; visualizing all parts of glottis and vocal cords, grade 2; only posterior extremity of glottis was visible, grade 3; only epiglottis was seen, grade 4; no recognizable structures. Grade 3 and 4 were considered as difficult laryngoscopy in this study). The trachea was intubated at the second attempt during laryngoscopy procedure. The grading of glottic view were compared, and analyzed with SPSS (V10) and Mc Nemar Test.Results: Among 70 patients, difference in the view of glottis was seen in 15 patients. Lower grade according C& L classification and more complete view of glottis was seen in 13 patients with English blade and 2 patients with Standard blade. There wasn’t seen grade IV of difficult laryngoscopy but grade III of difficult laryngoscopy was seen in 3 patients, the glottis view was more appear in 2 patients with English blade and 1 patient with standard blade. The view of glottis and airway classification base on (C& L) for English blade was: class I in 60 patients (85.7%), class II in 9 patients (12.9%), and this view for standard blade was: class I in 50 patients (71.4%), class II in 18 patients (25.7%). This differences were statistically significant (P=0.006) between two kind of blades.Conclusion: According to this study, laryngoscopy with English blade of Macintosh provided lower grade of airway and more complete view of glottic opening in comparison with standard blade.

Background: To determine if the GlideScopeâ videolaryngoscope (GVL) could attenuate the hemodynamic responses to orotracheal intubation compared with conventional Macintosh laryngoscope.Objectives: The aim of this relatively large randomized trial was to compare the hemodynamic stress responses during laryngoscopy and tracheal intubation using GVL versus MCL amongst healthy adult individuals receiving general anesthesia for elective surgeries.Patients and Methods: Ninety five healthy adult patients with American Society of Anesthesiologists physical status class I or II that were scheduled for elective surgery under general anesthesia were randomly allocated to either Macintosh or GlideScope arms. All patients received a standardized protocol of general anesthesia. Hemodynamic changes associated with intubation were recorded before and at 1, 3 and 5 minutes after the intubation. The time taken to perform endotracheal intubation was also noted in both groups.Results: Immediately before laryngoscopy (pre-laryngoscopy), the values of all hemodynamic variables did not differ significantly between the two groups (All P values>0.05). Blood pressures and HR values changed significantly over time within the groups. Time to intubation was significantly longer in the GlideScope (15.9±6.7 seconds) than in the Macintosh group (7.8±3.7 sec) (P<0.001). However, there were no significant differences between the two groups in hemodynamic responses at all time points.Conclusions: The longer intubation time using GVL suggests that the benefit of GVL could become apparent if the time taken for orotracheal intubation could be decreased in GlideScope group.

Background: Studies have shown that postoperative sore throat (POST) is the most common complication of tracheal intubation; however, its actual incidence and extent are not well documented. Objective: The aim of this study was to evaluate and compare the incidence of POST and hemodynamic changes after using macintosh laryngoscope (MCL), glidescope laryngoscope (GSL), and laryngeal mask airway (LMA) for elective surgery. Methods: This randomized double-blind clinical trial was conducted on 90 patients undergoing elective surgery in Shahid Rajaee Hospital in Qazvin, Iran. Patients were randomly divided into three groups based on the used intubation techniques including MCL, GSL, and LMA. The incidence of POST, hemodynamic changes, laryngoscopy duration, intubation duration, and number of attempts were compared in three groups and analyzed by ANOVA, independent t-test and chi-square. Findings: POST incidence was significantly higher in the MCL group compared to other two groups (P<0. 05). Duration of laryngoscopy was significantly longer in the MCL group compared to the GSL group (8. 2± 2. 4 vs. 6. 8± 1. 7; P=0. 02). Regarding hemodynamic variables, only heart rate in the LMA group 3 minutes after intervention was significantly lower compared to other two groups (P=0. 02). Conclusion: POST incidence was higher after using GSL and hemodynamic changes were less by using LMA. The preferred method for older people or cardiovascular patients is LMA. Further studies are needed to confirm these results.

Background: During the COVID-19 pandemic, severe respiratory failure is a life-threatening condition, and life-saving tracheal intubation is a high-risk aerosol- and droplet-generating procedure. It is crucial to protect healthcare workers without compromising patient safety during intubation. The use of personal protective equipment (PPE) and different types of LARYNGOSCOPES are measures to reduce the risk of infectious transmission that might impact the intubation process. Objectives: This study aimed to evaluate the effects of different levels of PPE and types of LARYNGOSCOPES on the duration of the intubation process and its success rate. Methods: We conducted an open, randomized, parallel clinical trial on non-COVID-19 adult patients scheduled for elective and emergency surgeries under general anesthesia from November 2021 to May 2022. Patients were divided into three groups: Group 1 was intubated using a video-guided laryngoscope with operators wearing level three PPE; group 2 was intubated using a direct laryngoscope with operators wearing level three PPE; and group 3 was intubated using a direct laryngoscope with operators wearing level two PPE. Intubation was performed by 2nd- and 3rd-year anesthesia residents. Results: The duration of intubation varied significantly among the groups, with Group 1 taking the longest time (P = 0.046). Group 3 had a higher success rate for first-attempt intubation (P = 0.056). Conclusions: The use of PPE and video-guided laryngoscopy had varying effects on the intubation procedure, with the most notable impact being on the overall length of intubation. Further research with a larger sample size is needed to validate these findings.

To compare intubating conditions and hemodynamic changes between Bonfils Intubation Fiberscope and Macintosh laryngoscopy without administering neuromuscular blocking drugs (NMBDs). METHODS: In this randomized controlled trial, 80 male and female patients, scheduled for elective surgery, aged 15 to 60 years, ASA class II or I, non-obese, non smokers, without anticipated difficult intubation; were randomly allocated into two groups of 40: Bonfils and Macintosh. Following adequate hydration and preoxygenation, midazolam 0.03 mg.kg-1 was administered, followed by intravenous alfentanil 20 mg.kg-1, lidocaine 1.0 mg.kg-1, and propofol 2 mg.kg-1 sequentially. Trachea was then intubated using Bonfils Intubation Fiberscope in the Bonfils group and conventional Macintosh laryngoscopy in the Macintosh group. Intubating condition, mean arterial blood pressure, heart rate, pulse oximetry, and success rate were measured. RESULTS: Clinically acceptable intubating condition scores did not differ significantly between the groups (P=0.465). Compared to the baseline values, heart rate rose significantly after intubation only in the Macintosh group (P<0.001). Although mean arterial blood pressure increased immediately after intubation in the Macintosh group (P=0.022), its post-intubation values were significantly less than baseline in both groups (P<0.001). Intubation time took much longer in the Bonfils group (40 s) than the Macintosh group (11 s), P<0.001. In the absence of NMBDs, Bonfils Intubation Fiberscope compares well with Macintosh laryngoscopy in terms of success rate and intubating conditions, but with less mechanical stress and hemodynamic compromise and longer intubation time.