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1.  Assessment of Truflex™ articulating stylet versus conventional rigid Portex™ stylet as an intubation guide with the D-blade of C-Mac™ videolaryngoscope during elective tracheal intubation: study protocol for a randomized controlled trial 
Trials  2013;14:298.
Background
A variety of videolaryngoscopes with angulated blade have been recently introduced into clinical practice. They provide an indirect view of the glottic structures in normal and challenging clinical settings. Despite the very good visualization of the laryngeal structures by these devices, the insertion and advancement of the endotracheal tube may be prolonged and occasionally fail as it does not conform to the enhanced angulation of the blade. To overcome this handicap, it is recommended to use a pre-shaped, styleted tracheal tube during intubation. Unfortunately, these malleable rigid stylets permit only a fixed shape to the advancing endotracheal tube. This may necessitate withdrawal of endotracheal tube-stylet assembly for reshaping, before undertaking a new attempt. This may cause soft tissue injury and hemodynamic disturbance.
This single-blinded randomized clinical trial aims to overcome these handicaps using a novel method of dynamically changing the shape of the advancing endotracheal tube by Truflex™ articulating stylet as per need during D-blade C-Mac™ videolaryngoscopy.
Methods
One hundred and fifty four patients between 18 and 60 years of age belonging to either sex undergoing tracheal intubation under uniform general anesthetic technique will be randomly divided into Portex™ malleable stylet group and Truflex™ articulating stylet group. The primary efficacy variable of success/failure between the two groups will be analyzed using the chi square test. For comparison of intubation times and the Intubation Difficulty Score, ANOVA will be used. Primary efficacy endpoint results will be successful or failed tracheal intubation in the first attempt, total intubation time and the intubation difficulty score. Secondary efficacy endpoints will be overall user satisfaction graded from 1 to 10 (1 = very poor, 10 = excellent), Cormack and Lehane’s grading, glotticoscopy time and ETT negotiation time and total number of intubation attempts. Result of safety endpoints will include dental and airway trauma, hemodynamic disturbances, arrhythmias or cardiac arrest.
Trial registration
Current Controlled Trials ISRCTN57679531; Date of registration 12/02/2013
doi:10.1186/1745-6215-14-298
PMCID: PMC3848553  PMID: 24041300
Videolaryngoscope; Tracheal intubation; Truflex stylet
2.  Neiguan and Jianshi Acupoint Stimulation Aids Hemodynamic Stability in a Cervical Cord Trauma Patient 
Archives of Trauma Research  2012;1(3):123-125.
A 36-year-old male patient with posttraumatic cervical cord damage and resultant quadriparesis, demonstrated hypotension and periods of bradycardia. For most of his two-month stay in the Intensive Care Unit (ICU), he was dependent on dopamine support to maintain hemodynamic stability. Keeping in mind evidence from the literature, that electrostimulation of acupoints Neiguan (PC - 6) and Jianshi (PC - 5) has therapeutic efficacy in restoring hypotension, we treated this patient with two six-hour periods of electrostimulation at these acupoints. We noted beneficial hemodynamic effects, with a resultant successful withdrawal of dopamine support lasting for up to 48 hours. This case report demonstrates the therapeutic efficacy of electrostimulation of PC - 5 and PC - 6 acupoints to wean a patient off chronic dopamine support, and this warrants further investigation.
doi:10.5812/atr.8009
PMCID: PMC3876545  PMID: 24396760
Acupuncture; Hypotension; Shock; Hemodynamic
4.  Airway management in trauma 
Indian Journal of Anaesthesia  2011;55(5):463-469.
Trauma has assumed epidemic proportion. 10% of global road accident deaths occur in India. Hypoxia and airway mismanagement are known to contribute up to 34% of pre-hospital deaths in these patients. A high degree of suspicion for actual or impending airway obstruction should be assumed in all trauma patients. Objective signs of airway compromise include agitation, obtundation, cyanosis, abnormal breath sound and deviated trachea. If time permits, one should carry out a brief airway assessment prior to undertaking definitive airway management in these patients. Simple techniques for establishing and maintaining airway patency include jaw thrust maneuver and/or use of oro- and nas-opharyngeal airways. All attempts must be made to perform definitive airway management whenever airway is compromised that is not amenable to simple strategies. The selection of airway device and route- oral or -nasal, for tracheal intubation should be based on nature of patient injury, experience and skill level.
doi:10.4103/0019-5049.89870
PMCID: PMC3237145  PMID: 22174462
Airway algorithms; airway management; airway trauma
5.  Fentanyl and Midazolam induced Respiratory Arrest and Neuromuscular Paralysis during Day Care Surgery 
We report a 44 year-old, American Society of Anesthesiologist Class I (ASA I), female patient scheduled for elective excision of a small lipoma of the left thigh. She went into a 90 minute apnea and complete muscle paralysis as evidenced by the absence of all stimulatory responses by a peripheral nerve stimulator after receiving midazolam (1.0 mg) and fentanyl (100 μg) intravenously for sedation and analgaesia. The patient made an uneventful recovery after 90 minutes. No cause and effect relationship could be established between the administered drugs and this unusual response.
PMCID: PMC3074711  PMID: 21509238
Day case surgery; Midazolam; Fentanyl; Apnea; Muscle paralysis; Case report; Oman
6.  An Unnoticed Broken Sheathed Metallic Stylet in an Endotracheal Tube 
We report a 58-years old patient, who underwent surgery for a fracture to the neck of the femur. Tracheal intubation was performed with the aid of a stylet; however, 15 minutes later, it was brought to the notice of the attending anesthesiologist that a broken piece of stylet had been left inside the lumen of the endotracheal tube. Prior to this, there was no evidence of a foreign body in the endotracheal tube or tracheobronchial tree. The broken piece of stylet was successfully retrieved with the help of a Kocher’s forceps.
PMCID: PMC3074643  PMID: 21509094
Broken stylet; Endotracheal tube obstruction; Foreign body; Case report; Oman

Results 1-6 (6)