Research and Opinion in Anesthesia and Intensive Care最新文献

{"title":"Ketorolac versus paracetamol adjunct to lidocaine for intravenous regional anesthesia in patients undergoing hand and forearm surgeries","authors":"M. Abdelrady, Golnar Fathy, Omar Ali, K. Abdel-Rahman","doi":"10.4103/roaic.roaic_94_20","DOIUrl":"https://doi.org/10.4103/roaic.roaic_94_20","url":null,"abstract":"Background We aimed to compare the influence of adding ketorolac as an adjunct to lidocaine for intravenous regional anesthesia (IVRA) on postoperative analgesia and both motor and sensory blockade. Patients and methods A total of 51 patients undergoing operations under IVRA were randomly assigned to receive lidocaine 3 mg/kg (group 1), lidocaine 3 mg/kg plus ketorolac 30 mg (group 2), and lidocaine 3 mg/kg plus paracetamol 300 mg (group 3). Results There was rapid sensory and motor blockade onset and slower recovery in ketorolac group when compared with the other groups and also in paracetamol when compared with lidocaine (P≤0.05). The mean time to first request of intramuscular diclofenac was longer in the ketorolac group (5.6±0.8 h) compared with the lidocaine group (2.5±0.4 h) and paracetamol group (4.4±0.3 h, P=0.000). The total consumption of intramuscular diclofenac was 75 mg (75–150 mg) in the ketorolac group versus 75 mg (75–150 mg) in the paracetamol group and 150 mg (75–150 mg) in lidocaine group (P=0.001). The mean visual analog scale (VAS) scores were lesser in the ketorolac group when compared with the other groups at all time points (P≤0.05), except before tourniquet and immediately after tourniquet, with the highest VAS (P>0.05). Patient satisfaction was better in the ketorolac group. Conclusion Overall, 20 mg of ketorolac is more effective than 300 mg of paracetamol when added to lidocaine for IVRA, with faster onset and slower recovery of both sensory and motor blockade, lower postoperative VAS scores, delayed timing of the first analgesic request, and decreased total analgesic requirements.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132710979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of early enteral and parenteral nutrition on postoperative outcome after abdominal surgery","authors":"F. Faris, A. Fattah, Marwa Ali, Sayed Ali","doi":"10.4103/roaic.roaic_64_20","DOIUrl":"https://doi.org/10.4103/roaic.roaic_64_20","url":null,"abstract":"Introduction Nutritional support is a vital therapy of most surgical patients. Early initiation via the enteral route has a significant effect on postoperative recovery. The prognostic role of C-reactive protein (CRP) and albumin can be explained by their abilities to reflect inflammation in the acute phase in critical settings and assess the nutritional status of critically ill patients, respectively. This indicates the prognostic value of the CRP/albumin ratio in postoperative patients admitted to the ICU. Aim To determine the effect of early enteral versus parenteral nutrition on ICU outcome in postoperative abdominal surgical patients and the value of CRP/albumin ratio as an inflammatory marker for both groups. Patients and methods A prospective cohort nonrandomized study included 80 consecutive postoperative major abdominal surgical patients at the Critical Care Department, Cairo University, over 1-year duration. Forty (50%) patients received enteral nutrition 6 h after surgical procedures and 40 (50%) patients received parenteral nutrition 6 h after surgical procedures. Nutritional status and inflammatory markers were screened. All patients were followed up during the ICU stay and up to 3 months. Sepsis-related organ-failure assessment (SOFA) scoring was done every 48 h. Results The study included 57 (71.3%) males with mean age 48.5±18.4 years. Esophagogastrectomy was done in 29 (36.25%) patients, repair of intestinal obstruction in 26 (32.5%) patients, and pancreaticoduodenectomy in 25 (31.25%) patients. Mean ICU stay was 5.16±2.56 days. A statistically significant improvement in serum protein and albumin levels was found at postoperative day (POD)3 and POD5 in comparison with POD1 in the enteral group (P=0.001). There was a statistically significant improvement in serum calcium levels in the enteral group (P=0.001) at POD7. There was a significant decrease in the white-blood cell count at POD7 in comparison with POD1 in both enteral and parenteral groups (P=0.017, 0.041), respectively. There was a significant decrease in CRP levels at POD3, POD5, and POD7 in comparison with POD1 in both enteral and parenteral groups (P<0.001). There was a highly statistically significant decrease in CRP/albumin ratio at days 3, 5, and 7 postoperatively in both enteral and parenteral groups (P<0.001). There was a strong positive significant correlation between CRP/albumin ratio and SOFA score at POD3 in the whole study group (r=0.728, P>0.001). Conclusion Starting nutrition in early postoperative abdominal surgeries either enteral or parenteral had a significant decrease in the parameters of infection. Early enteral nutrition in postoperative abdominal surgeries had significantly improved nutritional status, ICU survival, and decreased in-hospital mortality. There was a strong positive correlation between CRP/albumin ratio and SOFA score in postoperative abdominal surgery patients who started early nutrition.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130791349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Myocardial scaring in ischemic heart diseases: role of late gadolinium-enhanced cardiac MRI","authors":"M. Abdullah, A. Abdelhady, Elsayed E. Elsayed, A. Ibrahim, M. Soliman","doi":"10.4103/roaic.roaic_96_20","DOIUrl":"https://doi.org/10.4103/roaic.roaic_96_20","url":null,"abstract":"Objective To highlight the role of late gadolinium-enhanced cardiac magnetic resonance (LGE-CMRI) examination in the detection of location and transmural extent of myocardial scarring in relatively short CMRI examination duration. Background It is important to identify viable myocardium in patients with known or suspected ischemic heart disease to improve their long-term survival and to allow patients to avoid the risks associated with revascularization therapy. Patients and methods A total of 30 consecutive patients with suspected or having previous attack of ischemic heart disease were examined by different sequences of CMRI. Morphological, functional, and viability evaluation for distinction of viable and nonviable myocardium had been done by two independent observers. Results Regarding the distribution of LGE myocardium, almost perfect interobserver agreement was observed on per patient basis (κ=1.0 and 95% confidence interval=1.0–1.0) (P=1.0) and on per segment basis(κ=0.98 and 95% confidence interval=0.97–1.0) (P=0.84). On evaluation of transmural extent of LGE on per-segment basis, a substantial interobserver agreement was noted regarding the detection of 1–25% myocardial wall enhancement (κ=1.0 and 95% confidence interval=1.0–1.0). Otherwise, an almost perfect interobserver agreement was noted on detection of other degrees of mural extent of LGE (P=0.94). On correlation of segments with abnormal wall motion abnormalities and LGE, it was noticed that segmental wall motion abnormality could predict myocardial scarring with 58.08% sensitivity and 99.7% specificity; however, normal wall motion cannot exclude myocardial scarring. The overall duration needed for complete CMRI examination was ±35–40 min, with mean duration of 37.5±1.92 min. Conclusion CMR examination is a robust technique that can provide functional, morphological, and viability information in a relatively short CMRI examination duration (±35–40 min), which allow risk stratification of patients and predicting their outcomes.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124861338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcome predictors after acute stroke in Egyptian patients admitted to the ICU (OPASEP study)","authors":"Sherif Abdelmonem, T. Zaytoun, Mahmoud Elabd","doi":"10.4103/roaic.roaic_30_21","DOIUrl":"https://doi.org/10.4103/roaic.roaic_30_21","url":null,"abstract":"Introduction ‘Stroke’ is the term commonly used to describe the sudden onset of a neurological deficit such as weakness or paralysis due to disturbance of the blood flow to the brain. The term is applied loosely to cover ischemic and hemorrhagic episodes. Objective The aim of this study was to evaluate the predictors of poor outcome after either acute ischemic or hemorrhagic stroke among patients throughout 30 days after their admission to ICUs at Alexandria Hospitals. Patients and methods In this prospective observational study, 817 patients were enrolled over a period of 6 months from critical care units at Alexandria University hospitals, ‘either free hospitals, insured hospitals or paid hospitals,’ as well as nongovernmental insurance hospitals. Cases included patients with acute stroke, either acute ischemic stroke or hemorrhagic stroke. Patients with Glasgow outcome scale (severe disability, vegetative, or dead) were considered to have poor prognosis. Results Poor prognosis occurred in 56.5% of patients (461/817 patients). Overall, 47.5% of patients had ventilator-associated pneumonia (VAP), 42.5% had seizures, 21.3% had deep vein thrombosis, and 25.7% of patients developed acute kidney injury (AKI). The most significant predictors of poor outcome included development of hospital-acquired pneumonia/VAP [odds ratio (OR) 128.871; 95% confidence interval (CI) 67.253–246.941; P<0.001], occurrence of bed sores (OR 10.287; 95% CI 5.865–18.045; P<0.001), occurrence of bloodstream infections (OR 4.463; 95% CI 2.445–8.147; P<0.001), occurrence of seizures (OR 4.005; 95% CI 2.35–6.826; P<0.001), and occurrence of AKI (OR 3.532; 95% CI 1.944–6.416; P=0.001), which were significantly associated with poor outcomes. Conclusion The poorest prognostic factors for patients with acute stroke are development of hospital-acquired pneumonia or VAP, followed by development of bed sores, occurrence of bloodstream infection, and occurrence of AKI.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123357040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of magnesium sulfate added to bupivacaine in transversus abdominis plane block for postoperative analgesia after inguinal herniorrhaphy","authors":"Ezzat Siam, D. Abo Alia, Rehab Fathy, Mohamed Elshahaly","doi":"10.4103/roaic.roaic_87_20","DOIUrl":"https://doi.org/10.4103/roaic.roaic_87_20","url":null,"abstract":"Background Transversus abdominis plane block (TAPB) has proven to be an effective component of multimodal analgesic regimens for a variety of abdominal procedures. Magnesium sulfate (MgSO4) N-methyl-D-aspartate receptor antagonist has the potential to be an ideal adjuvant in TAPB. We studied the efficacy of MgSO4 as an adjuvant to bupivacaine in TAPB in patients scheduled for inguinal hernia repair. Patients and methods A total of 50 adult male patients aged 20–60 years, American Society of Anesthesiologists class I or II, and scheduled for elective primary unilateral open inguinal hernia repair were studied. Patients were randomly allocated into two groups: group 1 (n=25) included 18 ml of 0.25% bupivacaine with 2 ml 0.9% NaCl, and group 2 (n=25) included 18 ml of 0.25% bupivacaine with 2-ml MgSO4 10% (200 mg). They were evaluated for pain at 0, 1, 2, 3, 4, 8, 12, 16, 20, and 24 h. Time to first rescue analgesic and duration of postoperative analgesia were noted. Results Group 2 showed longer duration of postoperative analgesia (P<0.001); lower postoperative visual analog scale scores during rest, where P values at 4, 8, 12, 16, and 20 h postoperatively were less than 0.001, 0.038, 0.037, 0.015, and 0.006, respectively; and lower postoperative visual analog scale scores during movement, where P values at 4, 8, 12, 16, and 20 h postoperatively were less than 0.001, 0.001, 0.001, 0.009, and 0.037, respectively. Group 2 patients had longer time till rescue analgesia, less total dose of opioids, and more patient satisfaction. Conclusions MgSO4 (150 mg) as an adjuvant to bupivacaine in ultrasonographic‑guided TAPB prolongs the duration of analgesia, reduces postoperative pain scores, and decreases demands for rescue analgesics.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132676927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adequacy and safety of inhalational anesthesia with supplemental transtracheal block in patients with myasthenia gravis","authors":"Rachita Naik, S. Rajan, J. Paul, L. Kumar","doi":"10.4103/roaic.roaic_15_21","DOIUrl":"https://doi.org/10.4103/roaic.roaic_15_21","url":null,"abstract":"","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124086600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute myocardial infarction with multiple coronary thrombosis in a young multidrug addict (amphetamines, cannabinoids, and tramadol): a case report","authors":"M. Laimoud, F. Faris","doi":"10.4103/roaic.roaic_97_20","DOIUrl":"https://doi.org/10.4103/roaic.roaic_97_20","url":null,"abstract":"Background Our case was acute ST-segment elevation myocardial infarction with multiple coronary thrombosis, despite aggressive anticoagulation and antiplatelet therapy in a young, relatively low-risk patient, on three abused drugs. Case summary A 38-year-old male smoker patient with a BMI of 31 kg/m2 and a background of multiple drug addiction, was admitted after an hour of severe retrosternal compressing chest pain. Upon admission, he had cardiac arrest in ventricular fibrillation. Resuscitation was done, including defibrillation shocks and invasive mechanical ventilation with a cardiopulmonary resuscitation (CPR) time of 17 min and the patient was transferred to the catheterization laboratory with extensive anterior and inferior myocardial infarctions. Coronary angiography showed an unusual thrombosis in multiple coronary branches with coronary spasms and total occlusion of left anterior descending artery for which primary percutaneous coronary intervention was done. Admission laboratory screening showed high blood levels of amphetamines, cannabinoids, and tramadol. The patient was kept under invasive ventilation for 10 days, with difficult weaning due to severe drug-withdrawal manifestations, ventilator-associated pneumonia, and hemodynamic instability that necessitated intravenous inotropic drip and intra-aortic balloon counter pulsation. The patient regained near-normal left ventricular function after baseline severe regional and global dysfunction. Conclusion The authors postulated a relationship between the use of amphetamines, potentiated by cannabinoids and tramadol, and occurrence of acute thrombosis of multiple major coronary arteries especially with concurrent cigarette smoking.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132123522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound-guided vascular catheterization in critically ill patients with nonpulsatile continuous circulation veno-arterial extracorporeal membrane oxygenation or ventricular assist device support","authors":"M. Laimoud, M. Alanazi","doi":"10.4103/roaic.roaic_8_21","DOIUrl":"https://doi.org/10.4103/roaic.roaic_8_21","url":null,"abstract":"Background Vascular access can be challenging in patients with obesity, impalpable pulsations, hemodynamic instability, thrombocytopenia, and coagulopathy. Our aim was to study the clinical effectiveness of vascular ultrasound (US) in arterial and venous catheterizations in critically ill patients with nonpulsatile circulation admitted at cardiac critical care units and to compare with the landmark techniques. Patients and methods This retrospective study included adult patients from January 2015 to January 2019 who had been admitted to the adult cardiac critical care unit with left ventricular assist device or veno-arterial extracorporeal membrane oxygenation and required vascular access. Results In 152 critically ill patients, 292 vascular catheters were inserted. The first-attempt success was achieved in 77.9 versus 34.6% (P=0.001) and the whole procedural success was 100 versus 67.5% (P=0.001) in the US and landmark groups, respectively. The number of attempts was 1.7±0.6 versus 1.2±0.4 (P=0.001) and the complications occurred in 2.5 versus 21.2% (P=0.001) in the US and landmark groups, respectively. Jugular catheterization was done in 42.9 versus 19.3% (P=0.001), while subclavian cannulation was done in 5 versus 42.3% (P=0.001) in the US and landmark groups, respectively. Iatrogenic pneumothorax happened in 0 versus 3.1% (P=0.001), accidental puncture of the adjacent artery happened in 0 versus 14.7% (P=0.001), and hematoma formation happened in 2.5 versus 9% (P=0.03) in the US and landmark groups, respectively. Conclusion Arterial and venous catheterizations guided by US in critically ill patients with nonpulsatile circulation and unstable hemodynamics were associated with higher success and more safety compared with the landmark techniques.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133140931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound-guided four quadrants transversus abdominis plane (TAP) block in emergency laparotomies and the effect of adding magnesium sulfate or dexamethasone as an adjuvant to bupivacaine: a randomized controlled trial","authors":"O. Mohamed, Huda Abd El-Azim, S. Mohamed","doi":"10.4103/roaic.roaic_4_21","DOIUrl":"https://doi.org/10.4103/roaic.roaic_4_21","url":null,"abstract":"Context The lateral transversus abdominus plane (TAP) block can provide sensory blockade of the T10–L1 abdominal dermatomes, which works well for lower abdominal surgery, but it is insufficient in extended upper incisions that may be needed in emergency laparotomies. So, concomitant use of the subcostal TAP block can extend the sensory blockade to the T7 abdominal dermatomes. Aims This clinical trial aimed to evaluate the efficacy and safety of ultrasound-guided four quadrants TAP block in emergency laparotomies and the effect of adding dexamethasone or magnesium sulfate as an adjuvant. Settings Minia University Hospital. Design This is a prospective double-blind, randomized, controlled study. Patients and methods After approval of the Faculty of Medicine Council and Research Ethics Committee − Minia University and clinical trial registration, this study was conducted on 90 adult patients with emergency laparotomies under general anesthesia who equally assigned into three groups that all received preincisional four quadrants TAP block using 38 ml of bupivacaine hydrochloride 0.25%, plus 2 ml of saline in group C, +2 ml of dexamethasone (8 mg) in group D, and +2 ml of magnesium sulfate (200 mg) in group M. Results The four-quadrants TAP block was effective in attenuating the hemodynamic stress response and providing intraoperative and postoperative analgesia [only two (6.7%) patients needed intraoperative fentanyl in the control group and the mean time of the first postoperative analgesia was 6.3±0.9 h] without notable complications. The mean time of the first analgesic request was significantly longer in group M (10.8±3.8 h) and group D (9.6±4.2 h) when compared with group C (6.3±0.9 h); consequently, the postoperative paracetamol doses were significantly lower in group M (1619.5±780.2) and group D (1942.5±969.9) than in group C (3638.8±1251) with no significant difference between D and M groups. Conclusions Four quadrants TAP block was safe and effective in intraoperative and postoperative analgesics in emergency laparotomies. Adding magnesium sulfate or dexamethasone as adjuvants prolonged the duration of analgesia. Magnesium sulfate was superior.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114665875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endotracheal intubation using three different devices in patients with limited neck extension","authors":"Nagwa Elkobbia, Hossam Rida, M. Moustafa, M. Shaat","doi":"10.4103/roaic.roaic_20_21","DOIUrl":"https://doi.org/10.4103/roaic.roaic_20_21","url":null,"abstract":"Background Direct laryngoscopes have been developed for many optical fiberscopes to provide a better view of the glottis without alignment of the oral, pharyngeal, and tracheal axes. Recently, video laryngoscopes have become increasingly important devices in difficult airway management. Purpose This study aimed to compare between direct laryngoscopy, C-MAC, and the C-MAC D-blade for orotracheal intubation in patients with limited neck extension and to assess the hemodynamics and the possible complications of orotracheal intubation in patients with limited neck extension using the three different devices. Patients and methods Thirty adult patients subjected to general anesthesia were randomly categorized into three equal groups: in group I, endotracheal intubation was performed using direct laryngoscopy with a conventional Macintosh blade, in group II C-MAC video laryngoscopy was performed with a conventional Macintosh blade, and in group III C-MAC video laryngoscopy was performed with a D-blade. Then, an assessment of the laryngoscopic view and the whole procedure of laryngoscopy and intubation was carried out. Conclusion This study validates the efficacy of the C-MAC Macintosh blade and the D-blade when compared with a direct laryngoscope in patients with limited neck extension. The D-blade has been found to be more effective in reducing hemodynamic responses to laryngoscopy and intubation, resulting in improvement of the laryngoscopic view with a high success rate; it facilitates the smooth performance of laryngoscopy and intubation from the first attempt with the least use of assisting maneuvers while achieving the shortest endotracheal tube (ETT) insertion time, with no occurrence of complications.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124197613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}