Difficult airway management – a constant challenge

Point-of-care Ultrasound in Anaesthesia and Intensive Care Medicine

<abstract xmlns="http://www.w3.org/1999/xhtml">Study objective. Videolaryngoscopes can be fitted either with channeled or non-channeled blades, which may result in a different performance and success of tracheal intubation. We investigated the characteristics of the two different blade types of the commercially available KingVisionTMvideolaryngoscope. Design. A prospective, randomized, single center investigation study in a urological operation unit of a tertiary hospital. Subjects and Methods. Forty adult patients undergoing elective urological surgery in general anaesthesia with tracheal intubation were randomly allocated into group 1 (channeled videolaryngoscopy, n = 20) and group 2 (non-channeled videolaryngoscopy, n = 20). We measured the times from laryngoscope insertion to recognize the glottis and to conclude tracheal intubation. The number of laryngoscopy/intubation attempts and the degree of visual glottis exposure on a visual analog scale from 0 (glottis not visible) to 10 (glottis fully visible) was assessed. The lowest SpO2value during airway management was recorded. Results. There was no statistically significant difference in biometric data between the 2 groups. The time from the laryngoscope insertion to glottis recognition with the non-channeled blades was 5 (4-8) s as compared to the channeled ones with 11 (7-14) s (median and range; p = 0.01). Intubation duration was shorter with the channeled blades 17 (12-27) s vs. 29 (25-51) s (median and range; p &lt; 0.001). Number of laryngoscopy/intubation attempts, grades for glottis visibility, intubation difficulty were not different. The lowest SpO2was 98% in both groups. Conclusions. Videolaryngoscopic glottis recognition time was longer and the total time to secure the airway was shorter with the channeled blades.</abstract>

Tracheal intubation with channeled vs. non-channeled videolaryngoscope blades

<abstract xmlns="http://www.w3.org/1999/xhtml">Background and Aims: Manual bag mask ventilation is a life saving skill. An investigation was made to compare two different facemasks used in bag mask ventilation, the standard and the novel Tao face mask, and evaluate the ability of novices to achieve adequate tidal volume. Methods: The study design was a crossover trial, which randomized forty medical students with no previous airway experience to learn bag mask ventilation with the standard mask and the Tao face mask. Primary outcome measures were mean and median tidal volume per mask, and secondary measures were hand area, age, gender, and order of mask usage. Results: Medical students who used the Tao mask first achieved significantly more tidal volume than those who used the standard mask first (p = 0.002). However, when comparing face masks that were used second, the tidal volume did not differ significantly between the two masks (p = 1.000). Greater tidal volume was achieved on the second attempt relative to the first attempt with each mask. There was significantly more tidal volume achieved with greater hand size with the standard mask, whether it was used first or second (p &lt; 0.001 and p = 0.012 respectively). Greater hand size was associated with greater tidal volume in the Tao mask also, but only when used first (p &lt; 0.001). When first attempting bag mask ventilation, inexperienced students achieved greater tidal volume with the Tao Mask. The results also suggest that hand size matters less when using the Tao Mask. Conclusion: When first attempting bag mask ventilation inexperienced students achieved greater tidal volume with the Tao Mask. The results also suggest that hand size matters less when using the Tao mask.</abstract>

Advantages of the New Tao Mask for Bag Mask Ventilation: a randomized crossover trial

<abstract xmlns="http://www.w3.org/1999/xhtml">Background and Aims. Atrial fibrillation (AF) is the most common arrhythmia seen clinically. Due to the lack of literature and guidelines on maternal AF as a postoperative complication following cesarean delivery (CD), we undertook a study to characterize parturients who developed AF following CD and to evaluate arrhythmia management and outcomes in this patient population. Methods. After receiving ethics committee approval, a retrospective chart review was performed to determine the incidence, possible risk factors, treatment, and outcome of women who developed AF following CD performed between 2003 and 2012 at New York Methodist Hospital in Brooklyn, New York. Results. A total of 17,039 CDs were performed at New York Methodist Hospital from 2003 to 2012. Of these, seven parturients developed AF after CD. The incidence of AF following CD in this patient population was 1:2,434 (0.04%). The age range was 26-41 years, with a median of 33 years. All 7 parturients were at term or postterm. Two deliveries were elective and five were emergent. Two of the seven parturients had prior history of paroxysmal AF. One patient was identified as having mitral regurgitation. All seven had low levels of serum magnesium postoperatively. Out of the seven, two parturients had spontaneous conversion to normal sinus rhythm, one required electrical cardioversion and four required pharmacologic cardioversion. Conclusions. Postoperative AF (POAF) exists as a rare complication in women who undergo CD with an incidence of 0.04% in our patient population. All parturients in our study were noted to have hypomagnesemia in the postoperative period. Occurrence of AF increased length of hospital stay and utilization of hospital resources.</abstract>

Postoperative atrial fibrillation after cesarean delivery

<abstract xmlns="http://www.w3.org/1999/xhtml">Early allograft dysfunction (EAD) represents one of the most common and serious complications after liver transplantation (LT). Methods. One hundred sixty-four patients who underwent LT were prospectively included in the present study. Patient demographics, intraoperative blood loss and transfusion were recorded at the time of LT. Lactate levels were recorded during surgery and daily for the first 3 postoperative days. Standard and derived rotational thromboelastometry (ROTEM) parameters were recorded 24 hours after LT. EAD was diagnosed according to Nanashima criteria and post anaesthesia care unit length of stay was recorded. Results. Forty-seven patients (28.6%) developed EAD. Intraoperative blood loss (p = 0.01), packed red blood cells (p = 0.04) and fresh frozen plasma (p = 0.01) transfusion represented intraoperative risk factors for EAD. Lactate levels were significantly higher in patients with EAD at all time points. Patients with EAD demonstrated an increased clot formation time and decreased maximum clot firmness in both intrinsically (p &lt; 0.01) and extrinsically (p &lt; 0.01) activated assay, a decreased thrombin potential index (p &lt; 0.01), area under the curve (p &lt; 0.01) and clot elasticity (p &lt; 0.01) on ROTEM assay. Conclusion. Our results show that both standard and derived ROTEM parameters may indicate early signs of graft failure and can aid in the diagnosis of EAD.</abstract>

Rotational thromboelastometry (ROTEM) 24 hours post liver transplantation predicts early allograft dysfunction

<abstract xmlns="http://www.w3.org/1999/xhtml">Postpartum depression (PPD) is the main psychological status disorder and women suffering from postpartum depression often need long-term psychological and socio-economic rehabilitation. The study is dedicated to the evaluation of the role of labor pain management using epidural analgesia in natural delivery on stress level in labor and frequency of postnatal depression. Materials and methods: 210 women were investigated and divided into two groups. In the first group for labor pain management in natural delivery, patient-controlled epidural analgesia was used (bolus - 10.0 - 0.08% ropivacaine hydrochloride, lockout - 30 min, limit - 120 ml/6 h) with a background of continuousflow infusion of local anesthetic 0.08% ropivacaine hydrocluoride solution. Patients in the second group had no pain relief in delivery. The stress level was evaluated using blood plasma cortisol level in the early stages of labor, 6 hours and 3 days after delivery. The assessment of depression development was carried out step-by-step: Before the delivery, 6 hours after, 3 days and 6 weeks after the delivery. Results: The baby blues frequency 6 hours after the delivery in the group where the pain relief was conducted was 29.91%, with cortisol level below and equal to 2310.91 nmol/l. In the group with no pain relief 6 hours after delivery, baby blues was found in 15.53% of puerperas (p &lt; 0.05) and the cortisol level was 2673.82 nmol/l (p &lt; 0.05). Six weeks after the birth, postpartum depression was diagnosed in 4.67% of women who received epidural analgesia during delivery, in comparison to 6.79% with no pain relief during delivery. However, the difference was not statistically significant (p &lt; 0.05). Conclusions: The use of epidural analgesia leads to a significant reduction of pain syndrome and stress response during natural delivery, increases the risk of baby blues in the early postnatal period, but slightly influences the frequency of postpartum depression.</abstract>

The relationship between labor pain management, cortisol level and risk of postpartum depression development: a prospective nonrandomized observational monocentric trial

<abstract xmlns="http://www.w3.org/1999/xhtml"> Patients with pre-excitation abnormalities are at a high risk for life-threatening perioperative arrhythmias. In Wolff-Parkinson-White syndrome, the anaesthetics used for invasive diagnostic testing/ablation, should not affect cardiac electrophysiology; propofol, sevoflurane, fentanyl, sufentanil , alfentanil are suitable. In non-ablative surgery, propofol, sevoflurane, isoflurane, fentanyl, alfentanil, sufentanil have been used safely. Among neuromuscular blockers, cis-atracurium, rocuronium and vecuronium are good choices. Ketamine, pancuronium and pethidine should be avoided because of their sympathomimetic actions. Anticholinergic/ anticholinesterase combinations for neuromuscular block reversal should preferably be omitted, while sugammadex seems more attractive. In regional anaesthesia, addition of epinephrine and high sympathetic blocks should be avoided. Hypotension should be treated with pure alpha-adrenergic agonists. Other preexcitation abnormalities associated with different accessory pathways are the Mahaim Fiber and Lown- Ganong-Levine syndrome. Sympathetic activation should be avoided. Total intravenous anaesthesia with propofol probably represents the safest option. A careful anaesthetic plan and close cooperation with cardiologists are mandatory for successful management.</abstract>

Perioperative management of patients with pre-excitation syndromes

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Romanian Journal of Anaesthesia and Intensive Care

 The Romanian Journal of Anaesthesia and Intensive Care (Jurnalul Român de Anestezie Terapie Intensivă) is a biannual, in English, with abstracts in English and Romanian, ranked CNCS B+ and indexed Embase, PubMed and Scopus. This journal publishes papers reporting original clinical and experimental researches, reviews, case reports, editorials, guidelines, letters to Editor, book reviews as well as other materials considered adequate by the Editorial committee. In 2002, the Journal changed its name to “Jurnalul Român de Anestezie Terapie Intensivă” (ISSN 2344-2336) to better reflect its primary purpose. It continued to be published in Romanian, with abstracts in both Romanian and English, while 1-2 articles/issue were published in English only. We encouraged all Romanian authors to submit manuscripts written in English, and gradually the number of articles in English increased. The homepage has been written in English (www.jurnalul-anestezie.ro), and is accessible freely on-line; it was established in 2007 with the aim of widening its readership and promoting the Journal abroad. It contained: the Journal title, the title and abstracts of all published articles and the full text of articles in English. In 2008, the Journal benefited from the addition of an international editorial board of 8 members, which was subsequently enlarged to the current 22 members. The number of articles published in English increased, facilitating the inclusion of international experts tasked with reviewing the submitted manuscripts. The peer review enhanced the quality of the publications, stimulated additional original research, and eventually led to the indexing of the Journal in the Elsevier Bibliographic Database (EMBASE and SCOPUS) in 2009, and in the Romanian Ministry of Education CNCSIS B+ database. In 2014, in order to both increase the Journal’s readership internationally, and to attract a broader base of submissions, the Board decided to publish the Journal entirely in English, under the new name, “The Romanian Journal of Anaesthesia and Intensive Care” (ISSN 2392-7518). A native English-speaker editor has been recruited to assist non-native English-speaking authors with style and grammar, and a statistical editor was also added to the editorial process. In 2017 the Journal was accepted to be indexed in the PubMed Central database of the National Library of Medicine USA. The Romanian Journal of Anaesthesia and Intensive Care (Rom J Anaesth Int Care) is intended for anaesthesia and intensive care clinicians, and for specialists in emergency medical care, pain research and pain management. The principal aim is to stimulate and promote scientific discovery by publishing research papers and manuscripts accompanied by editorials written by experts in the field. The editorials seek to place the research findings in the appropriate clinical context, highlighting how the information is directly applicable to patient care and how it benefits the clinician and the patient. The Journal also seeks to inform and update anaesthesiologists about clinical and regulatory developments by publishing reviews and educational materials such as Clinical Guidelines of the European Society of Anaesthesiology and those of our Romanian National Society.  Archiving  Sciendo archives the contents of this journal in Portico - digital long-term preservation service of scholarly books, journals and collections.  Plagiarism Policy  The editorial board is participating in a growing community of Similarity Check System's users in order to ensure that the content published is original and trustworthy. Similarity Check is a medium that allows for comprehensive manuscripts screening, aimed to eliminate plagiarism and provide a high standard and quality peer-review process. 