BACKGROUND AND AIMS:Intrathecal morphine (ITM) and erector spinae plane block (ESPB) decrease postoperative pain in standard cardiac surgery. In this study, we compared the analgesic efficacy of ITM and B/L ESPB in patients undergoing open heart surgeries. METHODS:After approval from the institutional ethics committee and written informed consent from patients scheduled for open heart surgeries, they were randomized into two groups: Group ITM patients received ITM (5 mcg/kg), whereas Group ESPB patients received bilateral ESP block (0.3 mL/kg of 0.5% ropivacaine on either side). The primary outcome was to compare postoperative fentanyl consumption during the first 24 hours of ICU stay after extubation. Secondary outcomes were postoperative VAS at rest and on cough during the first 24 hours, pre- and postoperative pulmonary function, and number of rescue analgesics. Quantitative variables were presented as mean (SD) or median (IQR). Categorical variables were expressed as numbers or percentages. Spirometry variables were compared over time between the groups using Friedman test. RESULTS:The ITM group had significantly less median fentanyl consumption compared to the ESPB group during the first 24 hours postoperative period [0 (0-75) μg vs. 234 (160-336) μg (95% CI, 171.65, 255.38); P < 0.001]. The VAS score at rest and during cough was significantly better in the ITM group. FEV1 and FVC reduced postoperatively in both groups with significantly better values in the ITM group. CONCLUSION:ITM administered prior to induction provides superior postoperative analgesia compared to bilateral ESPB in patients undergoing open-heart surgery. It significantly reduces opioid requirements, improves patient satisfaction, and enhances postoperative pulmonary function.

Background and Aims: The traditional approach to combined lumbar and sacral plexus block require multiple injections with the patient in the lateral or prone position. We designed a study to compare the novel single puncture, dual injection, anterior approach targeting the branches of the lumbosacral plexus versus lumbar epidural for postoperative analgesia. Material and Methods: The present study enrolled 134 adult patients scheduled for unilateral lower limb orthopedic surgery under combined spinal epidural anesthesia without epidural activation. Study participants were randomly assigned to either group B (lumbosacral plexus block) or group E (lumbar epidural). Postoperatively, patients in group ‘B’ received the ultrasound-guided single puncture, dual injection, block via anterior approach targeting the branches of the ipsilateral lumbosacral plexus, while patients in group ‘E’ received lumbar epidural. All patients received patient-controlled epidural analgesia (PCEA). The primary objective of the study was to compare postoperative analgesia as assessed by numerical rating scale (NRS) score at predefined time points (0, 1, 3, 6, 12, 18, and 24 h) between groups. The secondary objectives were the comparison of sensory block, motor block, rescue analgesic requirement, complications, and patient satisfaction. Results: Patients in group B had significantly lower median (quartile) NRS scores (at rest and movement) at predefined time points compared to patients in group E (P-value < 0.001). The median PCEA pump boluses attempted and delivered were significantly lower in group B (P-value < 0.001), and a lesser number of patients required rescue analgesia in group B than in group E (P-value < 0.001). Group B had fewer patients with hypotension and PONV and a significantly higher median satisfaction score than group E (P < 0.001). Conclusions: The ultrasound-guided single puncture, dual injection, anterior approach targeting branches of the lumbosacral plexus provides better postoperative analgesia and is as safe as epidural analgesia.

Compartmental glossectomy has emerged as an oncologically sound approach for tongue carcinoma; however, it is often associated with the need for reconstruction due to the resulting floor-of-mouth defect. This prospective study focuses on reconstruction, including its surgical and functional outcomes for speech and swallowing, using the Infra Hyoid Myocutaneous Flap (IHMCF) after compartmental resection for tongue squamous cell carcinoma. A total of 36 patients with histologically proven squamous cell carcinoma of the lateralized tongue were enrolled during the study period from January 2021 to November 2022. Patients undergoing conventional compartmental resections were included in the study. The male-to-female ratio was 5:1, and the median age of the cohort was 43.5 years. The T-stage distribution for the study population was: T2–18; T3–16; and T4a − 2. Outcomes were assessed objectively using cine fluoroscopy for swallowing and subjectively for speech. The flap outcomes were evaluated for survival, partial necrosis, and complete necrosis. Partial necrosis was termed for superficial epithelial necrosis with preserved underlying muscle. Complete flap survival was seen in 83.3

Pedicled latissimus dorsi flap (LDF) based on the thoracodorsal artery provides large vascularized skin paddle along with underlying muscle. This study describes the relevance and feasibility of undertaking reconstruction of complex head and neck defects with pedicled LDF with emphasis on salvage situations and non-availability of pectoralis major flap. Retrospective cohort study on all consecutive cases of LDF reconstruction performed from July 2022 to June 2025. Modifications to the traditional LDF harvest introduced were: transaxillary tunnel creation in the supine, arm-abducted position and subpectoral tunnelling was avoided by careful division of the pectoralis major humeral fibres. 16 patients underwent LDF reconstruction for head and neck defects during the study period. The indications for selecting the LDF for reconstruction were: recurrent head and neck cancer with vessel-depleted neck and prior use of pectoralis major (n = 5), salvage following necrosis of pectoralis major flap (n = 4) and primary form of reconstruction in female patients (n = 8). The head and neck sites reconstructed were: gingivobuccal complex (n = 11), tongue (n = 4) and temporal bone (n = 1). Flap survival rate was documented at 87.5

Accurate staging of unfavorable intermediate- or high-risk prostate cancer (PCa) is essential for treatment decisions. Conventional imaging often fails to detect lymph node, bone, and visceral metastases, and for this purpose 68Ga-prostate-specific membrane antigen (PSMA)-11 PET/CT is clinically used. This prospective, multicenter, International Atomic Energy Agency-supported trial evaluated the accuracy of 68Ga-PSMA-11 PET/CT for initial staging compared with MRI and histopathology and the impact of 68Ga-PSMA-11 PET/CT on determining surgical eligibility. Methods: In a prospective, international study supported by the International Atomic Energy Agency, 775 patients with high-risk or unfavorable intermediate-risk PCa from 12 centers across 11 countries-including low-, middle-, and high-income settings, scheduled for radical prostatectomy based on conventional imaging (including bone scanning and pelvic MRI) underwent 68Ga-PSMA-11 PET/CT before treatment. PET and MRI findings were compared with radical prostatectomy histopathology, and the impact of PET on radical prostatectomy was assessed. Results: 68Ga-PSMA-11 PET/CT detected metastatic disease (M1) in 20.4% of cases, altering management and preventing prostatectomy in 24.0%. The accuracy for seminal vesicle invasion was 90.1% for 68Ga-PSMA-11 PET/CT versus 57.3% for MRI, and for lymph node metastases it was 91.1% for 68Ga-PSMA-11 PET/CT versus 69.7% for MRI. In 13.1% of patients (78/593), there were discordant results between 68Ga-PSMA-11 PET/CT and histopathology. 68Ga-PSMA-11 PET/CT had false-negative lymph node findings in 8.6% of cases, with the most clinically significant being 4.5% of patients incorrectly staged as N0. False-positive lymph node findings at 68Ga-PSMA-11 PET/CT occurred in 4.5% of patients. Conclusion: 68Ga-PSMA-11 PET/CT significantly improves staging accuracy, reducing the indication for prostatectomy and impacting treatment decisions. These findings, from a broad international cohort including low-, middle-, and high-income countries, support the global adoption of 68Ga-PSMA-11 PET/CT into standard staging protocols for high-risk PCa.

Minimally invasive transoral approaches have transformed the management of T1-T2 and select T3 oropharyngeal malignancies by reducing morbidity while maintaining oncologic adequacy. However, access to transoral robotic surgery (TORS), lasers, or other advanced platforms remains limited in many settings. The objective of this manuscript is to describe the feasibility, technique, and outcomes of a transoral endoscopic approach to the oropharynx using routinely available instruments. We report a technical description and clinical outcome of a 35-year-old male with a sarcomatoid squamous cell carcinoma arising from the base of tongue. Following elective tracheostomy and ipsilateral neck dissection, the primary tumour was excised transorally using a 30-degree 4-mm nasal endoscope and standard laparoscopic instruments under endoscopic guidance. Key anatomic, airway, and tumour-related selection criteria were considered before adopting this approach. Complete transoral excision with adequate three-dimensional margins was achieved without mandibulotomy or pull-through approaches. Postoperative recovery was uneventful, with early initiation of oral feeds and decannulation by postoperative day 7. At 9-month follow-up, there was no evidence of residual or recurrent disease, and functional outcomes for swallowing were excellent. Transoral endoscopic approach using commonly available endoscopic and laparoscopic instruments is a feasible, cost-effective alternative for carefully selected oropharyngeal tumours. This technique may expand access to minimally invasive oncologic surgery in centres lacking robotic or laser technology.

OBJECTIVES:To compare the incidence of pharyngocutaneous fistula and pharyngeal closure time between barbed and conventional polyglactin sutures after total laryngectomy. METHODS:A single-blinded, randomized clinical trial was conducted from February 2023 to October 2024 at a tertiary academic center. Participants included adults with advanced laryngeal or hypopharyngeal carcinoma undergoing primary total laryngectomy with primary pharyngeal closure. Salvage laryngectomies and patients requiring patch pharyngoplasty were excluded. Patients were randomized 1:1 to pharyngeal closure with either a continuous 3-0 polyglycolic acid barbed suture or a continuous 3-0 polyglactin (Vicryl) suture. The primary outcome was the incidence of pharyngocutaneous fistula. The secondary outcome was pharyngeal closure time. RESULTS:Sixty patients were randomized (median age, 59.7 years; 95% men). Pharyngocutaneous fistula occurred in 5 of 30 patients (16.7%) in the Vicryl group and in none of the 30 patients in the barbed suture group; this difference did not reach statistical significance. Median pharyngeal closure time was shorter in the barbed suture group (15 min) compared with the Vicryl group (25 min). CONCLUSION:In this randomised pilot clinical trial, the use of barbed sutures was associated with shorter pharyngeal closure time and a numerically lower fistula rate. These findings suggest potential technical advantages of barbed sutures, although larger, adequately powered trials are required to confirm an effect on pharyngocutaneous fistula incidence. TRIAL REGISTRATION:Clinical Trials Registry-India Identifier: CTRI/2023/06/054351. LEVEL OF EVIDENCE:Level 2.

Background: Airway management in pediatric patients remains challenging. Video laryngoscopes have improved intubation, but external airway maneuvers may still be required. This study compared jaw thrust and backward upward rightward pressure (BURP) maneuvers with the conventional technique for glottic visualization during video laryngoscopy. Subjects and Methods: Ninety pediatric patients (3–10 years) with normal airways were randomized into three groups. Under general anesthesia, C-MAC laryngoscopy images were obtained using conventional technique, BURP, and jaw thrust. Cormack–Lehane (CL) grade, percentage of glottic opening (POGO) score, and glottic area were recorded. Intubation was performed using the assigned technique: conventional (Group C), BURP (Group B), or jaw thrust (Group J). Intubation time, attempts, airway trauma, and postoperative sore throat were noted. Results: Jaw thrust produced the greatest improvement in CL grade and POGO score (97.8% vs. 76.7% in Group C and 88.9% in Group B) and glottic area (5332.8 pixel2 vs. 4452.7 pixel2 in Group B and 3469.8 pixel2 in Group C). It also significantly reduced intubation time (7.93 s vs. 8.23 s in Group B and 9.57 s in Group C) and total insertion time. Conclusions: Jaw thrust provided superior glottic visualization compared to BURP and conventional techniques, with faster intubation and better overall intubation characteristics in pediatric patients using video laryngoscopy.

This study evaluated transfer learning in classifying skeletal metastases on bone scintigraphy. The primary objective was to assess its performance in detecting skeletal metastases, while the secondary objective was to compare its performance to human readers. A total of 2,510 patients with known malignancies were included – 2,368 retrospectively recruited and 142 prospectively enrolled. Scans were categorized as normal, benign-degenerative, or metastasis based on clinical consensus, follow-up, biopsy, radiology, or SPECT/CT findings. The retrospective data were randomly divided into training (1,895) and validation (473) sets, while the prospective cohort served as an independent testing set. Google’s InceptionV3 was used for image embedding, and 13 supervised ML algorithms were tested. The Log Loss value of a random classifier was used to select the optimal models for testing, while Stuart-Maxwell test compared models’ performance to human readers. Eight ML models with Log Loss value less than that of the random classifier achieved AUCs > 0.900 on training and validation, with all but one (Support Vector Machine) maintaining AUCs > 0.900 on testing. Logistic Regression performed best (≥ 0.993 in all metrics), while Neural Networks, Gradient Boosting, and Random Forest also demonstrated robust performance (≥ 0.817 in all metrics). Notably, ML models interpreted 142 images in 0.027–1.770 s compared to 10.07–18.00 min by human readers; less experienced readers performed significantly worse (P ≤ 0.002) than the models, whereas experienced reader’s performance was comparable (P ≥ 0.280). Transfer learning demonstrates commendable performance in classifying skeletal metastases on bone scintigraphy, outperforming less experienced readers while matching experienced reader’s performance.

Kinsbourne syndrome, also known asor opsoclonus-myoclonus-ataxia syndrome, is a rare paediatric neurological disorder characterised by abnormal eye movements, myoclonus, and ataxia. Its anaesthetic management presents significant challenges, especially when one-lung ventilation (OLV) is required in the prone position. This case report describes the anaesthetic management of a two year-old child with Kinsbourne syndrome undergoing T9-T11 paravertebral neuroblastoma excision. Because of the patient's size and the need for lung isolation, a Fogarty embolectomy catheter was used for OLV. Anaesthesia was induced with intravenous fentanyl, propofol, and atracurium, followed by the insertion of a 4.0 mm cuffed endotracheal tube to facilitate Fogarty catheter insertion. The catheter was positioned in the right bronchus under fibre-optic guidance; after which, a 4.5 mm cuffed tube was inserted, and the patient was placed in the prone position. Continuous fibre-optic monitoring ensured proper catheter placement. Anaesthesia was maintained with oxygen, air, and isoflurane. The patient remained haemodynamically stable, was extubated postoperatively, was observed in the paediatric intensive care unit for 24 hours, and was subsequently transferred to the ward. This case highlights the challenges of OLV in paediatric patients and demonstrates the effectiveness of a Fogarty catheter for lung isolation when traditional devices are unsuitable, emphasising the importance of multidisciplinary collaboration and continuous monitoring.

Background: Hypotension following induction of general anesthesia (GA) is commonly observed. Ultrasound (US) measurement of collapsibility index (CI) of the inferior vena cava (IVC) for predicting postinduction hypotension has been studied. As there is limited data available comparing the diagnostic accuracy of subclavian vein (SCV) versus IVC-CI, we performed this observational study. Methods: A total of 132 adult patients scheduled for elective surgery under GA were enrolled. US measurements of three readings of maximum and minimum diameters of SCV and IVC were recorded during both quiet and deep breathing, and the mean of three values was calculated. CI was derived using the formula: (dmax – dmin) × 100/dmax. Subsequently, GA was administered using standard technique, irrespective of the findings of SCV and IVC measurements. The administered drugs and dosage were recorded. Hemodynamic parameters were collected at baseline and then at every minute for the first 20 min. The primary objective was to compare the diagnostic accuracies of SCV-CI and IVC-CI for prediction of postinduction hypotension during quiet breathing. The secondary objectives were to compare the diagnostic accuracies during deep breathing and find the correlation between IVC-CI and SC-CI during quiet and deep breathing, incidence of hypotension, and time required to acquire US images. Results: Fifty-seven patients developed postinduction hypotension. During quiet breathing, SCV-CI ≥10% had a sensitivity of 68% and specificity of 56% (area under curve [AUC] [95% confidence interval {CI}] of 0.659 [0.56–0.75]; P = 0.002), while IVC-CI ≥34% had a sensitivity of 70% and specificity of 59% (AUC [95% CI] of 0.672 [0.58–0.76]; P = 0.001) for prediction of postinduction hypotension. During deep breathing, both SCV-CI and IVC-CI had moderate accuracy (P = 0.001 for both). Pearson’s correlation showed a significant positive correlation between SCV-CI and IVC-CI with a correlation coefficient (r) of 0.313 during quiet breathing and 0.379 during deep breathing (P < 0.001). The time required for acquiring US images was significantly less for SCV compared to IVC during both quiet and deep breathing (P < 0.001 for both). Conclusion: Both SCV-CI and IVC-CI were found to have good and comparable diagnostic accuracy for the prediction of postinduction hypotension. We also found a significant positive correlation between SCV-CI and IVC-CI. In comparison to IVC, US scanning of SCV took lesser time to acquire the images.

A BSTRACT Background: Despite being a technically demanding procedure, the laparoscopic approach for choledochal cyst excision (LEC) has gained popularity in the last two decades. We conducted a study to evaluate the outcomes of the initial cohort of LEC and Roux-en-Y hepaticojejunostomy performed at our center. Subjects and Methods: A retrospective observational study was conducted. Medical records of patients who underwent LEC from July 2019 to April 2023 at our institute were retrieved and analyzed. Results: Twenty-eight patients were included in our study, of which 68% ( n = 19) were females. The median age of the cohort was 5.5 years. 26/28 patients (92.8%) were diagnosed with Type 1 Choledochal cyst (CC), and Type 4a CC was noted in two children (7.2%). Majority of our patients were symptomatic. Pain in the abdomen was the predominant symptom noted in 26/28 patients (93%), eight children (28.5%) presented with jaundice. Antenatal diagnosis of choledochal cyst (CC) was established in one child (3%). Anomalous pancreaticobiliary junction was noted in 10/28 patients (35%) on magnetic resonance cholangiopancreatography. Clavien–Dindo Grade 3A and 3B complications were noted in 7% of patients each, Grade 1 in 17.5%, and Grade 2 in 3.5%. The overall morbidity rate was 28%, and there was no mortality. No cases of malignancy were reported. On a 3-month follow-up, 27/28 patients (96.5%) underwent hepatobiliary iminodiacetic acid scan, which showed good tracer clearance. Conclusions: Laparoscopic excision of CC in 28 pediatric patients demonstrated safety and efficacy. The average surgery duration was 240 min, with a low conversion rate to open surgery (3.5%). The study confirms that laparoscopic approach as a viable option, although it requires an experienced surgical team.

This article discusses the role of various imaging modalities in diagnosing and managing surgical renal conditions in pediatric patients. It emphasizes the importance of tailored surgical interventions based on accurate imaging assessments. The cases presented cover a range of conditions, including pelvic-ureteric junction obstruction, vesicoureteric reflux, congenital renal anomalies, and postoperative management. The article underscores the pivotal role of various imaging modalities in diagnosing and managing a spectrum of surgical renal conditions in pediatric patients, providing valuable insights for clinical decision-making.

Background: Videolaryngoscopes (VLS) frequently provide superior views of the glottis compared with traditional direct laryngoscopy (DL), especially during unexpected difficult airways. Chest compressions during attempts to intubate the trachea make it a difficult situation. Although VLS have been compared with DL for intubation during resuscitation, there is a paucity of literature comparing VLS with integrated screen and distant screen with DL during continued manual chest compressions. Materials and methods: This was a prospective, randomized, crossover observational manikin study. A total of 20 participants performed intubation, while manual chest compression was continuing, with each of the three devices on six occasions, but in different, randomized order. The primary outcome parameter was the total time taken for successful intubation. The secondary outcome criteria included the number of attempts, ease of intubation, and the device preference. Results: Time taken for successful intubation and ease of intubation were significantly better with C-MAC VLS and DL as compared with Tuoren VLS (C-MAC vs Tuoren p < 0.000 for both; DL vs Tuoren p < 0.001 for time and p = 0.021 for ease). There was no significant difference between C-MAC and DL (p = 1.0 for time and p = 0.69 for ease). There was no significant difference with regard to the number of attempts for successful intubation with any of these devices (p = 0.310). C-MAC was the most and Tuoren was the least preferred device. Conclusion: C-MAC VLS and Macintosh DL are significantly easier to use and require significantly less time to achieve successful intubation as compared with the Tuoren VLS during continued manual chest compression. Among the devices tested, C-MAC VLS was the most preferred for endotracheal intubation during uninterrupted manual chest compressions.

Central neuraxial anaesthesia is the preferred approach for caesarean deliveries leading to less frequent use of general anaesthesia. The 2025 guidelines for managing general anaesthesia in obstetrics recommend rapid sequence induction and intubation for parturients requiring general anaesthesia for caesarean delivery. If the initial intubation attempt fails, the team should "Call for help for difficult airway" (Code D) and prioritise oxygenation (SpO(2) > 95%). Tracheal intubation may be attempted by a more experienced operator after re-optimising position and considering alternate airway devices. The primary anaesthesia team can opt for a 2(nd) generation supraglottic airway (SGA) device as a rescue device or continue the anaesthetic using a face mask (FM). Maintaining oxygenation is critical. If satisfactory oxygenation is achieved with 2(nd) generation SGA or FM, the decision to continue will depend upon maternal and fetal condition. If satisfactory ventilation cannot be maintained with 2(nd) generation SGA or FM following failed tracheal intubation, the team declares "complete ventilation failure" and proceeds to surgical cricothyroidotomy. Should maternal cardiac arrest occur, proceed to "resuscitative hysterotomy" to improve chances of saving mother and baby. Post-resuscitation care should continue in the ICU to return the parturient to normalcy. Parturients may have a physiologically difficult airway in addition to anatomical reasons for airway difficulty. Specific steps to deal with associated pathophysiological changes constitute an important aspect of airway management in obstetrics. If a difficult airway is encountered, an "Airway Alert Card" must be given to the parturient and her responsible relatives to avoid similar life-threatening situations in future.

BACKGROUND:Low frequency repetitive transcranial magnetic stimulation (rTMS) can suppress local neural circuits beyond the stimulation period and can be a potential treatment option for focal epilepsy. This study analysed the short-term effect of rTMS on seizure frequency, EEG, behavior, and cognition in children with drug refractory focal epilepsy (DRFE). METHODS:This is a single center, randomized double-blind sham controlled clinical trial (CTRI/2019/02/017,440). Children aged 5 to 18 years with DRFE with ≥ four focal seizures per month despite on ≥ two appropriately chosen antiseizure medications (ASMs) randomly received active or sham rTMS treatment along with the ongoing ASMs. Intervention comprised of 45 min rTMS sessions of 0.5 Hz (1200 pulses at 110 % of resting motor threshold (RMT) targeted over seizure focus using figure-of-8 coil for 10 consecutive days. The primary outcome was to compare the proportion of children who achieved >50 % seizure reduction in active and sham arm at 8-week post-therapy. RESULTS:Forty-nine children were enrolled in the trial (25 active and 24 sham). All randomized participants received the allocated treatment. No attrition occurred. Active rTMS therapy led to >50 % seizure reduction in 76 % (19/25) children versus 12.5 % (03/24) in sham arm (p < 0.0001) with absolute risk difference (95 % CI) between the groups was 0.68 (0.52, 0.84). Mean (SD) reduction in spike wave index (SWI) in sleep EEG was 34.4(29.9) with rTMS vs -1.89(22.5) in sham arm with absolute risk difference (95 % CI) -36.4(-51.7, -21.1). Between active and sham group mean (SD) change in Intelligence quotient (IQ) was 3.7(2.8) vs -0.91(3.1), p value 0.001; Child Behavior Checklist (CBCL) scores improved in behavioral domains of inattention (-5.5(3.8) vs 0.41(2.7), p < 0.001; hyperactivity -3.8(4.1) vs -0.5(2.8), p < 0.006 and aggression -4.1(2.4) vs 0.40(2.8), p < 0.001. Adverse effects were primarily limited to headache and scalp discomfort. CONCLUSION:Adjunctive low frequency rTMS may induce better short-term seizure control and electrographic improvement compared to sham stimulation in children with DRFE. These results will serve as a basis for a larger multicentric clinical trial.

Background: Managing difficult airways with restricted mouth opening remains a challenge. In this regard, flexible bronchoscopes (FB) are considered the gold standard, offering precise tube placement. However, they require expertise and can be time-consuming. Video-laryngoscopes (VLs), such as the CMAC D-blade, provide enhanced glottic visualization and may reduce intubation time. While VLs are gaining popularity, data comparing them with FBs in this setting are limited. This study evaluates whether the CMAC D-blade VL can reduce intubation time compared to FB while maintaining similar success rates. Methods: In this randomized controlled trial, 100 adult patients scheduled for elective head and neck or oral and maxillofacial surgery with anticipated difficult airways were randomized to receive awake nasotracheal intubation using either an FB or CMAC D-blade VL. The primary outcome was intubation time. Secondary outcomes included first-attempt success rate, overall success rate, and satisfaction scores. Results: Out of 100 patients, 97 patients completed the study (FB: n = 49, VL: n = 48). Median intubation time was significantly shorter in the VL group (62 [53-71] sec) compared to the FB group (118 [107-134] sec; p < 0.0001). Success rates and intubation scores were similar, but anesthesiologist and patient satisfaction scores were better in the FB group. Conclusion: The CMAC D blade video-laryngoscope reduces intubation time while maintaining similar success rates compared to the flexible bronchoscope for awake nasotracheal intubation with limited mouth opening. Despite the time advantage, the flexible bronchoscope was preferred by anesthesiologists and patients had more comfort.