Anaesthesia for endoscopic surgery

Anaesthesia for endoscopic airway surgery involves unique challenges. The anaesthetist and surgeon are working in close anatomical proximity and the concept of shared airway is never more relevant. Understanding the planned procedure and the needs of the surgeon for access to the surgical field will enable the provision of anaesthesia and airway management using a variety of techniques. Planning for safe induction, maintenance and emergence of anaesthesia will also be guided by the specific pathology and patient characteristics and requires effective communication between the surgeon and anaesthetist.     

Nutritional status and intestinal parasites among young children from pastoralist communities of the Ethiopian Somali region

Pastoralist children in the Ethiopian Somali Regional State (ESRS) are at high risk for undernutrition and intestinal parasitic infections (IPIs). We assessed the nutritional status and its association with IPIs in 500 children <5 years of age in a clustered cross‐sectional study in Adadle district, ESRS. Stool samples were microscopically examined for IPIs and biomarkers for iron and vitamin A status, anthropometry, and food variety score (FVS) were assessed. Median (interquartile range [IQR]) FVS was 2.0 (2.0, 4.0), and 35% of children were exclusively breastfed up to age 6 months. Prevalence of stunting, wasting, underweight and mid‐upper arm circumference (MUAC) <12.5 cm was 30, 34, 40, and 16%, respectively. Median (IQR) haemoglobin, ferritin, and retinol‐binding protein concentrations were 9.5 g dL^‐1 (8.2, 10.9), 6.2 μg L^‐1 (4.0, 10.2), and 0.8 μmol L^?1 (0.67, 0.91), respectively. Prevalence of anaemia, iron, and vitamin A deficiency was 75, 91, and 30%, respectively. IPIs' prevalence was 47%; the most prevalent IPIs were Giardia lamblia (22%) and Ascaris lumbricoides (15%). Giardial infections but not A. lumbricoides increased the risk for MUAC <12.5 cm (adjusted odds ratio [aOR]: 3.50, 95% confidence interval [CI] [2.21, 5.54]). The odds for anaemia were 97% (aOR: 0.03, 95% CI [0.03, 0.07]) and 89% (aOR: 0.11, 95% CI [0.11, 0.23]) less for children with FVS >2 or with exclusive breastfeeding up to 6 months, respectively. Undernutrition and IPIs are alarmingly high in <5 years of age children in ESRS. Giardial infections and low nutritional adequacy of the diet seem to be major contributing factors to the precarious nutritional status and should be addressed by appropriate interventions.     

Self-reported oral health perceptions of Somali adults in Minnesota: a pilot study

Abstract: Objective: To assess self‐reported oral health perceptions and associated factors in an adult Somali population living in Minnesota, USA. Methods: We analysed data from a cross‐sectional study of Somali adults aged 18 to 65+ years attending a dental school clinic for care. A comprehensive oral examination was performed by the dental school outreach team on all patients who attended a 2‐week designated Somali dental clinic. Adults who consented were given an oral health questionnaire to collect information on sociodemographics, marital status, language preference and self‐rated oral and general health. We performed summary statistics and differences between proportions using Fisher’s exact test and a comparison of means using one‐way anova or a two‐sample t‐test. Results: The sample consisted of 53 adults, 75% of whom were females. About 49% of subjects reported poor/fair oral health and 38% reported poor/fair general health. Seventy‐four percent rated their access to dental care as poor/fair and 83% reported that they did not have a regular source of dental care. Self‐rated oral health was significantly associated with marital status (P < 0.05) and self‐rated general health (P < 0.01) using Fisher’s exact test. Conclusion: A substantial proportion of Somali adults rated their oral health and access to dental care as poor/fair. These findings suggest that this population would benefit from improved access to oral health care and culturally appropriate oral health education and promotion programs.     

A Compressible Conserved Discrete Unified Gas-Kinetic Scheme with Unstructured Discrete Velocity Space for Multi-Scale Jet Flow Expanding into Vacuum Environment

The mechanism of jet flow expanding into vacuum environment (or extremely low density environment) is important for the propulsion unit of micro-electro-mechanical systems (MEMS), the thruster of spacecraft, the attitude control system of satellite, etc.. Since its flow field is often composed of local continuum region and local rarefied region, the jet flow into vacuum has noteworthy multi-scale transportation behaviors. Therefore, the numerical study of such flows needs the multi-scale schemes which are valid for both continuum and rarefied flows. In the past few years, a series of unified methods for whole flow regime (from continuum regime to rarefied regime) have been developed from the perspective of the direct modeling, and have been verified by sufficient test cases. In this paper, the compressible conserved discrete unified gas-kinetic scheme is further developed and is utilized for predicting the jet flows into vacuum environment. In order to cover the working conditions of both aerospace and MEMS applications, the jet flows with a wide range of inlet Knudsen (Kn) numbers (from 1E-4 to 100) are considered. The evolution of flow field during the entire startup and shutdown process with Kn number 100 is predicted by the present method, and it matches well with the result of analytical collisionless Boltzmann equation. For Kn numbers from 1E-4 to 10, the flow field properties such as density, momentum, and pressure are investigated, and the results are provided in details, since the published results are not sufficient at the present stage. The extent and intensity of the jet flow influence are especially investigated, because they are strongly related to the plume contamination and momentum impact on objects facing the jet, such as the solar paddles which face the attitude control thruster during the docking process.     

Prolonged high-frequency jet ventilation in a patient with bronchopleural fistula. An alternative mode of ventilation

We report a case of bronchopleural fistula (BPF) in a patient submitted to conventional mechanical ventilation in which high frequency jet ventilation (HFJV) was applied during five consecutive days. Gas exchange was adequate, the bronchial secretions could easily be cleared and the patient adapted comfortably to HFJV. In spite of PEEP levels between 4 and 8 mm Hg, the leak through the BPF ceased completely.     

主动按压减压结合高频通气对心肺复苏犬的循环效应影响

目的　比较标准心肺复苏、主动按压减压心肺复苏、主动按压减压结合高频通气心肺复苏三种复苏法对心肺复苏循环效应影响 ;评价主动按压减压结合高频通气用于心肺复苏的可行性。方法　将9条犬经电击致颤制成心搏骤停模型 ,每只犬先后实施三种复苏法 ,①标准心肺复苏 ;②主动按压减压心肺复苏 ;③主动按压减压结合高频通气心肺复苏 ,实验顺序由随机法确定 ,每种复苏方法进行 5min ,待循环动力学稳定后记录收缩压、舒张压、心输出量。结果　收缩压、舒张压、心输出量均为主动按压减压结合高频通气模式大于主动按压减压心肺复苏模式 (P <0 0 1) ;主动按压减压心肺复苏模式大于标准心肺复苏模式 (P <0 0 1)。标准心肺复苏模式和主动按压减压心肺复苏模式胸外按压停顿期血压降至零 ,而主动按压减压结合高频通气心肺复苏模式血压持续稳定。结论　主动按压减压心肺复苏优于标准心肺复苏模式。主动按压减压结合高频通气心肺复苏模式既可产生较高的动脉血压、心输出量 ,又可提供充分的气体交换 ,值得进一步研究和推广应用     

高频部分液体通气对吸入性损伤犬呼吸功的影响

目的　观察高频喷射通气结合小剂量氟碳 (3ml/kg)液体通气对吸入性损伤犬呼吸的功影响。方法　将 16条犬经蒸气吸入造成吸入性损伤模型 ,并随机分为两组 ,即对照组和治疗组。两组动物致伤后均行高频喷射通气 ,但治疗组动物同时经气管导管将氟碳液体 (3ml/kg)缓慢注入肺内 ,在 90min内测机械通气功 (WOBvent)。结果　治疗组在给予小剂量氟碳后的WOBvent与致伤后比较差异无显著意义 (P >0 0 5 ) ,对照组治疗后的WOBvent与致伤后比较差异亦无显著意义 (P >0 0 5 ) ,治疗组与对照组各时间点的WOBvent比较差异均无显著意义 (P >0 0 5 )。结论　高频喷射通气合并小剂量氟碳 (3ml/kg)部分液体通气并不增加动物的呼吸功。     

Anesthesia with sevoflurane and remifentanil under spontaneous respiration assisted with high‐frequency jet ventilation for tracheobronchial foreign body removal in 586 children

Background: Foreign body aspiration is a common life‐threatening event in young children. Tracheobronchial foreign body removal is usually performed by rigid tracheobronchoscopy under general anesthesia. Anesthetic and ventilation techniques vary greatly among anesthesiologists and institutions. In the present retrospective study, we report our anesthetic experience over 5 years. We describe complications and outcomes and analyze the clinical characteristics of anesthesia and ventilation. Methods: We retrospectively reviewed relevant clinical findings of 586 pediatric patients treated with rigid tracheobronchoscopy under general anesthesia. All procedures were performed under inhaled sevoflurane anesthesia combined with remifentanil infusion, with spontaneous respiration assisted by high‐frequency jet ventilation (HFJV) and topical airway anesthesia. Results: Among 586 patients, the foreign body was successfully removed by rigid tracheobronchoscopy in 558 patients, and no foreign body was found in 28 patients. Laryngospasm was observed during the procedure in five patients. Hypoxemia was observed in 15 patients (2.6%). No severe complications or deaths occurred. The mean operation time was 22 min and the average hospital stay was 2 days. Conclusion: Inhaled sevoflurane anesthesia combined with remifentanil infusion, with spontaneous respiration assisted by HFJV and topical airway anesthesia, is safe and effective for tracheobronchial foreign body removal.