AN OBSERVATIONAL STUDY COMPARING FREMANTLE SCORE AND MODIFIED INTUBATION DIFFICULTY SCORE FOR EASE OF INTUBATION ON VIDEOLARYNGOSCOPY IN PEDIATRIC PATIENTS UNDERGOING SURGERIES UNDER GENERAL ANESTHESIA WITH ENDOTRACHEAL INTUBATION

After obtaining approval from institutional ethical committee and informed consent from the parents ,total number of 182 patients between the age group of 2-8 years undergoing elective surgeries under general anesthesia  will be included in the study • Risk identification with detailed preoperative evaluation will be done. They will be explained the general procedure of intubation. All the patients will be kept nil by mouth for 6 hours prior to surgery. On the day of surgery patients will be brought to the operation theatre. A peripheral IV catheter was placed before entering the operating room with patients. Before induction of anaesthesia, 3 lead ECG, baseline blood pressure, mean arterial blood pressure, saturation, heart rate will be recorded in each patient. Standard monitoring of pulse rate, systolic, diastolic and mean blood pressure and saturation will be done intra-operatively. Standard protocol of General Anaesthesia will be followed in all patients as follows: 1)Pre anaesthesia check-up as per the proforma I 2) Pre-op counseling 3) General Anaesthesia induction- Premedication – Injection Glycopyrrolate 0.004mg/kg i.v, Injection Midazolam 0.05mg/kg iv. Followed by, Injection Ketamine 2mg/kg iv, Injection Fentanyl 2mcg/kg i.v and Injection Propofol 2mg/kg iv. The drugs will be diluted and given slowly. Patient will be given – Inj. ATRACURIUM 0.5mg/kg , IPPV and then video-laryngoscopy will be performed. During video-laryngoscopy, Modified Intubation difficulty Score (mIDS) and Fremantle score will be noted. Also Time taken for intubation (in seconds) will a be noted. It is the time from introduction of the laryngoscope blade into the mouth to the visual appearance of capnography trace on the monitor.  Patient will be then intubated with portex(uncuffed/microcuffed/cuffed)  ETT according to calculated size. The intubation will be done by trained anaesthesiologists (after 1 year of training). Maintainance – Inj. ATRACURIUM 0.5mg/kg + IPPV close circuit + Sevoflurane. After conclusion of surgery, Patient will be reversed by Neostigmine 0.05mg/kg + Glycopyrrolate0.01mg/kg and extubation of endotracheal tube from tracheal will be performed after thorough oropharyngeal suctioning and after confirmation of spontaneous adequate regular respiration.