Comparative study of awake endotracheal intubation with Glidescope video laryngoscope versus flexible fiber optic bronchoscope in patients with traumatic cervical spine injury

BackgroundThe Gldiescope video laryngoscope (GVL) as a recent intubating device has gained much popularity in difficult intubation over the last decade. It can be used as a substitute to flexible fiber optic bronchoscope (FOB) in intubating challenges. The object of this study is to compare the utility of GVL and FOB for intubating time, attempts, effects on hemodynamics, adverse effects, patient satisfaction and post intubation neurological outcome during awake intubation in traumatic cervical spine injury.MethodsFifty patients undergoing post traumatic cervical spine fixation under general anesthesia were randomly allocated to two groups in a prospective, controlled non-blinded study. All patients were premedicated with glycopyrrolate 0.2 mg iv and midazolam 1 mg iv that be repeated up to 0.05 mg/kg followed with a bolus dose of remifentanil 1.5 μg/kg then a continuous remifentanil infusion of 0.15 μg/kg/min for 3 min before procedure. Each patient underwent a wake endotracheal intubation with either GVL (G group) or FOB (F group) with manual in line stabilization (MILS). Intubating time, intubating attempts, hear rate (HR), mean arterial pressure (MAP), oxygen desaturation (SO₂ < 90%), sore throat, patient satisfaction and postintubation neurological outcome were recorded.ResultsIntubating time was significantly lower in G group compared with F group (26 ± 5 versus 72 ± 11 respectively), while the percentage of the first successful intubating attempt was insignificantly higher in G group (88%) than in F group (72%). Both HR and MAP were significantly increased only in F group during intubation in comparison with the basal line values. Both devices were safe for post neurological outcome. No significant differences of adverse effects or patient satisfaction were recorded between groups.ConclusionThe GVL is a safe surrogate for FOB during awake intubation for post traumatic cervical spine fixation.     

Alternative techniques for tracheal intubation

Alternative rigid blade intubation devices available in recent years include the Glidescope, Airtraq and Bonfils laryngoscopes. The Macintosh blade works by displacing the tongue to one side and into the submandibular space while the tip of the device sits in the vallecula lifting the hyoid and so the epiglottis forward to reveal the laryngeal inlet. Under less favourable intubating conditions, the tongue is not accommodated in the submandibular space and tends to be compressed downwards. As a result the vallecula is not accessible and the blade tip is less able to be drawn forward. The retro-molar Bonfils avoids this problem by starting from a posterior position in the mouth and approaching the larynx below and alongside the tongue. The Bonfils also serves as a rigid stylet inside the tracheal tube again producing minimal tongue displacement. Airtraq also compresses the tongue less and usually sits on the posterior pharyngeal wall where it maintains the laryngeal view with a minimum of effort. It houses the tracheal tube in a channel that delivers it into the device's field of view. While better optical systems have tended to improve visualization of the laryngeal inlet, this has not necessarily resulted in easier intubation conditions, shorter intubation times or improved overall success rates. Part of the problem has been that they have limited fields of view compared with the stereoscopic view of tube advancement down to the larynx as afforded by Macintosh.     

Effectiveness and Superiority of Rehabilitative Treatments in Enhancing Motor Recovery Within 6 Months Poststroke: A Systemic Review

Objective

To investigate the effects of various rehabilitative interventions aimed at enhancing poststroke motor recovery by assessing their effectiveness when compared with no treatment or placebo and their superiority when compared with conventional training program (CTP).

Expérimentation animale,peut-on s’en passer ?

Animal experiment is a subject of controversies. Some people, defenders of animals, think that it is not acceptable to use for scientific purposes at the risk of making them suffer or assert that the results obtained with animals are not transposable in the human beings. Others, in particular researchers in biology or medicine, think that the animal models are essential for the biomedical search. This confrontation of the opinions bases largely on an evolution of the place of animals in our society. The regulations authorize the use of animals for scientific purposes but oblige to make it under restrictive conditions. The application of 3Rs — replacement, reduction, and refinement — expressed in 1959 by Russel and Burch is an ethical guide to improve the welfare of animals in research. The alternative methods do not allow, in the present state of the knowledge, to answer all the scientific questions in biology and medicine research. They are, most of the time, complementary methods of the in vivo methods.     

Anesthetic care and perioperative complications of children with Morquio syndrome

Objectives: Our objective was to make recommendations based on our experience and findings from this study regarding the anesthetic care of children with Morquio syndrome (MS). We emphasize information not readily available in the Anesthesiology literature. Aim: To describe the unique nature of difficulties, especially the relationship of the head and neck to airway patency. In addition, we aim to examine 83 intubations performed in 28 patients and report on observed preferences. Background: Much of the available literature in Anesthesiology consists of case reports of single or small groups of cases, many describing a nonhomogenous population inclusive of many mucopolysaccharidoses. Methods/Materials: We retrospectively studied 28 children with MS who underwent 108 surgical procedures at our pediatric hospital, which provides multidisciplinary, comprehensive care to children with skeletal dysplasia. Results: Cervical fusion was performed in 22 of 28 patients in our study. Eight children after cervical fusion became difficult to intubate for subsequent surgical procedures. In addition, we found airway abnormalities including tortuous appearance of the trachea and bronchi, evident on chest radiograph, as a result of the abnormalities in the hyaline cartilage and deposits of glycosaminoglycans. Conclusion: Morquio syndrome results in abnormalities of not only upper airway but also of large airways. Information from 83 intubations of 108 anesthetics (in 28 patients) shows a preference for Glidescope when intubating children with MS. Displacing the tongue anteriorly prior to intubation by manual retraction using a ring forceps or a piece of gauze helps to access the larynx in children with MS.     

Participation in mindfulness-based stress reduction is not associated with reductions in emotional eating or uncontrolled eating

The adverse health effects and increasing prevalence of obesity in the United States make interventions for obesity a priority in health research. Diet-focused interventions generally do not result in lasting reductions in weight. Behavioral interventions that increase awareness of eating cues and satiety have been postulated to result in healthier eating habits. We hypothesized that participation in a program called mindfulness-based stress reduction (MBSR) would positively influence the eating behaviors and nutritional intake of participants through changes in emotional eating (EE), uncontrolled eating (UE), and type and quantity of food consumed. Forty-eight veterans at a large urban Veterans Administration medical center were assessed before MBSR, after MBSR, and 4 months later. For all participants (N = 48), MBSR participation was not associated with significant changes in EE or UE. In addition, there were no significant differences in the intake of energy, fat, sugar, fruit, or vegetables at either follow-up time point as compared with baseline. Enhanced mindfulness skills and reduced depressive symptoms were seen over time with medium to large effect sizes. Changes in mindfulness skills were significantly and negatively correlated with changes in EE and UE over time. Overall, there was no evidence that participation in MBSR was associated with beneficial changes in eating through reductions in disinhibited eating or significant changes in dietary intake. Randomized studies are needed to further define the relationship between mindfulness program participation and eating behaviors.     

Fracture separation of the lower humeral epiphysis due to birth injury: a case report

A case of traumatic separation of the lower humeral epiphysis due to birth injury is reported. In the past 20 years, only 3 similar cases have been reported in the English literature. Following a manipulative reduction and immobilization of the arm in a collar and cuff for 3 weeks the baby made an uneventful recovery. When seen 10 months after injury, the baby had regained full movements of the elbow except for the last 10 ° of extension.     

Glidescope视频喉镜在头颈外科手术老年患者气管插管中的应用

目的评价Glidescope视频喉镜用于头颈外科手术老年患者气管插管的临床效果。方法择期行头颈外科手术的老年患者40例,随机分为Glidescope视频喉镜组(G组20例)和直接喉镜组(L组20例)。全部患者均于麻醉前进行改良Mallampati分级评估,分析比较两组患者声门暴露情况(Cormark-Lehane分级)、插管时间,记录麻醉诱导前(T0)、诱导后(T1)、插管后不同时点(T2～T5)的血流动力学变化。结果与L组比较,G组患者获得较好的声门暴露,且插管时间缩短(P<0.05)。两组患者T1时点MAP、HR较T0时点有所降低(P<0.05),T2～T5不同时点MAP、HR较T0时点有不同程度增加(P<0.05),两组比较差异无统计学意义(P>0.05)。结论 Glidescope视频喉镜可以为头颈外科手术老年患者创造更好的插管条件,提高插管成功率。     

高度近视白内障超声乳化术69例临床分析

目的　通过对高度近视白内障超声乳化摘除及人工晶体植入术的临床总结 ,分析高度近视白内障超声乳化术后视力的影响因素。方法　对 6 9例 (93眼 )眼轴 >2 6mm的高度近视并发白内障患者施行角膜内隧道切口超声乳化摘除及人工晶体植入术。结果　术后 1个月裸眼视力≥ 0 4者 5 5只眼 (5 9 14 % ) ,矫正视力≥ 0 4者 6 7只眼 (72 0 4 % )。结论　高度近视并发白内障行超声乳化摘除及人工晶体植入 ,能够有效提高患者视力 ,手术安全 ,疗效可靠