Anesthesia, essays and researches
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To observe the various pressor responses to laryngoscopy and intubation in normotensive patient undergoing elective surgery under general anesthesia and use of three different attenuating doses (400, 800, 1200 mcg) of intranasal nitroglycerine administered five minutes before laryngoscopy and intubation, to observe the efficacy and safety. ⋯ Best results of attenuation of pressor response were seen with 400 and 800 micrograms of intranasal nitroglycerine. One thousand and two hundred micrograms dose caused maximum increase in heart rate and caused maximum fall in blood pressure, hence it is advisable to use increased dose with caution in attenuation of pressor response to laryngoscopy and intubation.
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Unanticipated difficult intubations on the operation table have often tested all the anesthetists' intubation skill. The understanding of the causative factor and accordingly using the correct instrument from the difficult intubation kit requires experience and thorough knowledge on the part of the anesthetist. We describe a case of difficult intubation due to scar contracture of anterior tonsillar pillar formed after a previous surgery.