Acute vision impairment: does it affect an anesthesiologist's ability to intubate the trachea?

The result of impaired vision on an anesthesiologist's ability to intubate the trachea is unknown. We studied 12 attending staff anesthesiologists as they intubated 2 anesthesia mannequins (A and B) under 6 conditions. The conditions were: 1) usual vision, 2) central-vision loss with 20/500 bilaterally and a 24 degrees central scotoma, 3) peripheral-field loss with 20/20 bilaterally and a 7 degrees visual field, 4) peripheral-field loss with 20/20 bilaterally and a 3.5 degrees visual field, 5) central-vision loss with 20/200 bilaterally and a 12 degrees central scotoma, and 6) right eye ocular media opacity and 20/70 left eye usual acuity. The time to intubation was recorded by stopwatch from gripping the laryngoscope until the anesthesiologist signaled that the endotracheal tube was properly placed in the trachea. The mean +/- SD times to intubation for Mannequins A and B were 16.0 +/- 3.3, 31.9 +/- 10.4, 26.4 +/- 9.0, 26.4 +/- 7.7, 22.4 +/- 5.1, 25.5 +/- 16.9 and 16.6 +/- 6.6, 26.9 +/- 10.0, 21.4 +/- 9.2, 21.4 +/- 5.8, 21.5 +/- 7.7, 17.7 +/- 5.1 s for the 6 conditions, respectively. Multiple analysis of variance revealed a highly significant difference for the time to successful intubation between the anesthesiologists' usual vision and the vision-impaired conditions. There was a significant improvement in time to successful intubation from the first to subsequent intubation attempts. There were also more esophageal intubations in the vision-impaired conditions. This implies that anesthesiologists who develop acute severe vision impairment might have more difficulty intubating the trachea, which could initiate more critical incidents. The results of this study cannot be applied to anesthesiologists with chronic vision impairment. IMPLICATIONS: We found that acute severe vision impairment adversely affects the anesthesiologist's ability to intubate the trachea. This implies that anesthesiologists with acute onset of severe visual handicaps might have more difficulty intubating the trachea, which could initiate more critical incidents.     

Increased level of polymerase Ⅲ transcribed Alu RNA in hepatocellular carcinoma tissue

There have been extensive observations that RNA containing repetitive elements accumulates in transformed cells and tumor tissues. In the present study, we first obtained result consistent with previous observations by in situ hybridization.     

Is the tono-pen accurate for measuring intraocular pressure in young children with congenital glaucoma?

PURPOSE: We sought to compare intraocular pressure (IOP) measurements by Perkins tonometer and Tono-Pen in young children with primary congenital glaucoma (PCG). METHODS: This was a retrospective comparative case series. We reviewed the clinical records of all children with primary congenital glaucoma who underwent examinations under general anesthesia at Soroka University Medical Center between January 1999 and July 2002. Our main outcome measures were IOP with Perkins hand-held tonometer and Tono-Pen tonometer. RESULTS: A total of 28 eyes of 16 children were examined under general anesthesia. The mean IOP was 18 +/- 6 mm Hg with the Perkins tonometer and 22 +/- 8 mm Hg with the Tono-Pen. In 18 eyes, IOP was less than 21 mm Hg with the Perkins tonometer; these eyes had already undergone surgical procedures. The other 10 eyes with IOP greater than 21 mm Hg with the Perkins tonometer underwent surgery at the end of the examination under anesthesia. In eyes with IOP greater than 16 mm Hg (Group A, n = 18), a significant difference (P < 0.001) was found between the Perkins and Tono-Pen measurements, even although the values were strongly correlated (r = 0.60). In contrast, in eyes with IOP less than 16 mm Hg (Group B, n = 10) no statistically significant difference (P = 0.28) and good correlation (r = 0.78) were obtained. A difference of 5.8 +/- 3.8 mm Hg and 0.6 +/- 1.7 mm Hg between Perkins and Tono-Pen readings, respectively, was found in Groups A and B. CONCLUSIONS: Tono-Pen readings disagree with Perkins tonometer measurements for measuring IOP in children with PCG who present with IOP greater than 16 mm Hg and tends to overestimate IOP. A further study with a similar population is necessary to confirm these results.     

Motor performance and functional ability in preschool- and early school-aged children with Juvenile Idiopathic Arthritis: a cross-sectional study

Objective  

To describe the level of motor performance and functional skills in young children with JIA.     

Geospatial patterns of access to self-care resources for obesity among endometrial cancer survivors in a high poverty urban community

Objective

To examine endometrial cancer survivors' access to recommended obesity-related self-care resources.

Sciatic nerve transection produces death of dorsal root ganglion cells and reversible loss of substance P in spinal cord

Sciatic nerve section has been shown to reduce substance P (SP) in the dorsal horn of the spinal cord, but the mechanism which underlies the reduction is not understood. Whether SP levels subsequently recover as they do after dorsal rhizotomy has also been unknown. To test the hypothesis that transganglionic degeneration of primary afferents contributes to the reduction of SP, we have studied the changes in SP which result from section of the cat sciatic nerve and determined the extent of dorsal root ganglion (DRG) cell death. Sciatic nerve section resulted in DRG cell death, but the amount was variable and not seen in all animals. Reduction in dorsal horn and DRG SP was seen in all animals, and in the spinal cord it was followed by recovery. These sequelae resemble the changes which follow dorsal rhizotomy. After sciatic nerve section, the reduction in dorsal horn SP is small than after rhizotomy, the recovery more complete, and both the reduction and the recovery proceed more slowly. Evidence is presented that similar mechanisms may contribute to depletion of intraspinal SP after sciatic nerve section and after dorsal rhizotomy. The mechanisms contributing to recovery of spinal cord SP after sciatic nerve section may resemble known mechanisms of recovery that occur when the lesion is central.     

Stabilization of hog cholera virus by dimethyl sulfoxide.

The stability of hog cholera virus through five freeze-thaw cycles in the presence and absence of dimethyl sulfoxide was studied. In the absence of dimethyl sulfoxide the hog cholera virus titer was reduced 52% to 91% following successive freezing and thawing cycles. However, when dimethyl sulfoxide was added to the viral suspension the virus titer appeared to remain the same after the same number of freezing and thawing cycles.