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Pre-selection of primary intubation technique is associated with a low incidence of difficult intubation in patients with a BMI of 35 kg/m2 or higher

Abstract

Background: The incidence of difficult intubation (DI) in obese patients may reach a two-digit figure. No studies have assessed the effect of primary use of special intubation devices on lowering the incidence of DI. We assessed the effect of primary selection of special intubation techniques on the incidence of DI in patients with a BMI of 35 kg/m2 or higher. Patients and methods: Data from 546 patients with a BMI of 35 kg/m2 or higher who underwent bariatric surgery at Wolfson Medical Center from 2010 through 2014 was retrospectively extracted and analyzed for demographics, predictors of DI and intubation techniques employed. Difficult intubation was defined as the presence of at least one of the followings: laryngoscopy grade 3 or 4, need for >1 laryngoscopy or intubation attempt, need for changing the blade size, failed direct laryngoscopy (DL), difficult or failed videolaryngoscopy (VL-Glidescope), difficult or failed awake fiberoptic intubation (AFOI) and using VL or awake AFOI as rescue airway techniques. Primary intubation techniques were direct DL, VL and AFOI. We correlated the predictors of DI with the actual incidence of DI and with the choice of intubation technique employed. Results: The overall incidence of DI was 1.6% (1.5% with DL vs. 2.2 with VL + AFOI, p = 0.61). With logistic regression analysis, age was the only significant predictor of DI. Predictors of DI that affected the selection of VL or AFOI as primary intubation tools were Mallampati class 3 or 4, limited neck movement, age, male gender, body mass index and obstructive sleep apnea syndrome. Conclusion: The lower incidence of DI in our study group may stem from the primary use of special intubation devices, based on the presence of predictors of DI.

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Toxic Megacolon – A Three Case Presentation

difficile ribotype 027: relationship to age, detectability of toxins A or B in stool with rapid testing, severe infection, and mortality. Clin Infect Dis. 2015;61(2):233-41. 22. Dubberke ER, Sadhu J, Gatti R, et al. Severity of Clostridium difficile-associated disease (CDAD) in allogeneic stem cell transplant recipients: evaluation of a CDAD severity grading system. Infect Control Hosp Epidemiol. 2007;28:208–11. 23. Henrich TJ, Krakower D, Bitton A, Yokoe DS. Clinical Risk Factors for Severe Clostridium difficile–associated Disease. Emerg Infect Dis. 2009

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Extracorporeal Life Support and New Therapeutic Strategies for Cardiac Arrest Caused by Acute Myocardial Infarction - a Critical Approach for a Critical Condition

.0012. 3. Gyongyosi M, Hemetsberger R, Posa A, et al. Hypoxia-inducible Factor 1-Alp[ha Release After Intracoronary versus Intramyocardial Stem Cell Therapy in Myocardial Infarction. J Cardiovasc Translational Res. 2010;3:114-21. doi: 10.1007/s12265-009-9154-1. 4. Benedek I, Gyongyosi M, Benedek T. A prospective regional registry of ST-elevation myocardial infarction in central Romania. Impact of the Stent for Life initiative recommendations on patient outcomes. Am Heart J. 2013;166:457-65. doi: 10.1016/j.ahj.2013.03.033. 5. Avalli L, Maggioni E, Formica F

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