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Nong He, Fu-Shan Xue, Cheng-Wen Li Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of ChinaCorrespondence: Fu-Shan Xue, Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People’s Republic of China, Tel +86 13911177655, Fax +86 10-63138362, Email xuefushan@aliyun.com; fushanxue@outlook.com View the original paper by Prof. Dr. Kang and colleagues

Wen-Xuan Chen,1 Fu-Shan Xue,2 Cheng-Wen Li2 1Sixth Clinical Medical College and Beijing Anzhen Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of ChinaCorrespondence: Fu-Shan XueDepartment of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Road, Xi-Cheng District, Beijing 100050, People’s Republic of ChinaTel +86-13911177655Fax +86-10-63138362Email xuefushan@aliyun.com; fushanxue@outlook.com View the original paper by Dr Rao and colleagues

Lei Wan,1 Liu-Jia-Zi Shao,1 Yang Liu,2 Hai-Xia Wang,1 Fu-Shan Xue,1 Ming Tian11Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of ChinaPurpose: This study aimed to assess the effect of intravenous dexmedetomidine (DEX) on sevoflurane EC50 for supraglottic airway device (SAD) insertion in spontaneously breathing morbidly obese patients.Patients and methods: Thirty-eight morbidly obese patients with a body mass index 40–57 kg/m2, who were scheduled for bariatric surgery under general anesthesia requiring tracheal intubation were randomly allocated to two groups receiving the different treatments: group S, saline was given intravenously, and group D, a bolus dose of DEX 1 μg/kg was administered intravenously over 10 mins, followed by intravenous DEX infusion at a rate of 0.5 μg/kg/h. Five percent sevoflurane was initially inhaled for anesthesia induction and then end-tidal expiratory sevoflurane concentration (ETsev) was adjusted to a target value as to the modified Dixon’s up-and-down method. Patients’ response to SAD insertion was classified as “movement” or “no movement”. The average of the midpoints of all crossover points was defined as calculated sevoflurane EC50 for successful SAD insertion. Furthermore, the probit regression analysis was used to determine sevoflurane end-tidal concentrations where 50% (EC50) and 95% (EC95) insertions of SAD were successful. After the observation was completed, flexible bronchoscope-guided intubation was performed through the SAD.Results: The calculated sevoflurane EC50 for successful SAD insertion was significantly lower in group D than in group S (1.75±0.32% vs 2.92±0.26%, p

Hai-Jun Hou, Fu-Shan Xue, Rui-Juan Guo Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of ChinaIn a preliminary study, Gao et al1 assessed the preventive effect of transcutaneous electrical acupoint stimulation (TEAS) on postoperative delirium (POD) in geriatric patients with silent lacunar infarction. They showed that TEAS could reduce the development of POD and might be related to attenuated neuroinflammation by reducing the permeability of the blood–brain barrier. Given that POD is a common postoperative complication associated with adverse events and outcomes including functional decline, and increased risks of morbidity and mortality in elderly surgical patients, their findings have the potential implications. To differentiate the real effect of one factor on primary endpoint in a randomized trial, however, all of other factors must be standardized for avoidance of potential bias. Other than the limitations described in the discussion, we noted several issues in this study that were not addressed well.View original paper by Gao et al.

Jia Jiang,1 Da-Xu Ma,1 Bo Li,2 An-Shi Wu,1 Fu-Shan Xue31Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China; 2Beijing Hospital of Traditional Chinese Medicine, Affiliated to Capital Medical University, Beijing Institute of Traditional Chinese Medicine, Beijing 100010, China; 3Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China Background: Awake intubation with videolaryngoscopy (VL) is a novel method that is drawing more and more attention as an alternative to awake intubation with fiberoptic bronchoscope (FOB). This meta-analysis is designed to determine the performance of VL compared to the FOB for awake intubation.Methods: The Cochrane Central Register of Controlled Trials, PubMed, Embase, and Web of science were searched from database inception until October 30, 2017. Randomized controlled trials comparing VL and FOB for awake intubation were selected. The primary outcome was the overall success rate. Rev-Man 5.3 software was used to perform the pooled analysis and assess the risk of bias for each eligible study. The GRADE system was used to assess the quality of evidence for all outcomes.Results: Six studies (446 patients) were included in the review for data extraction. Pooled analysis did not show any difference in the overall success rate by using VL and FOB (relative risk [RR], 1.00; P=0.99; high-quality evidence). There was no heterogeneity among studies (I2=0). Subgroup analyses showed no differences between two groups through nasal (RR, 1.00; P=1.00; high-quality evidence) and oral intubations (RR, 1.00; P=0.98; high-quality evidence). The intubation time was shorter by using VL than by using FOB (mean difference, -40.4 seconds; P0.05).Conclusion: For awake intubation, VL with a shorter intubation time is as effective and safe as FOB. VL may be a useful alternative to FOB.Keywords: airway management, awake intubation, videolaryngoscopy, fiberoptic bronchoscopy, randomized controlled clinical trials, outcomes

Cheng-Wen Li, Fu-Shan Xue, Hai-Jun Hou Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of ChinaCorrespondence: Fu-Shan XueDepartment of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People’s Republic of ChinaTel + 86-13911177655Fax + 86-10-63138362Email xuefushan@aliyun.com View the original paper by Ren and colleagues

Fu-Shan Xue, Hui-Xian Li, Ya-Yang Liu, Gui-Zhen Yang Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China Abstract: The C-MAC videolaryngoscope is the first Macintosh-typed videolaryngoscope. Since the advent of its original version video Macintosh system in 1999, this device has been modified several times. A unique feature of C-MAC device is its ability to provide the 2 options of direct and video laryngoscopy with the same device. The available evidence shows that in patients with normal airways, C-MAC videolaryngoscope compared with direct laryngoscopy can provide comparable or better laryngeal views and exerts less force on maxillary incisors, but does not offer conclusive benefits with regard to intubation time, intubation success, number of intubation attempts, the use of adjuncts, and hemodynamic responses to intubation. In patients with predicted or known difficult airways, C-MAC videolaryngoscope can achieve a better laryngeal view, a higher intubation success rate and a shorter intubation time than direct laryngoscopy. Furthermore, the option to perform direct and video laryngoscopy with the same device makes C-MAC videolaryngoscope exceptionally useful for emergency intubation. In addition, the C-MAC videolaryngoscope is a very good tool for tracheal intubation teaching. However, tracheal intubation with C-MAC videolaryngoscope may occasionally fail and introduction of C-MAC videolaryngoscope in clinical practice must be accompanied by formal training programs in normal and difficult airway managements. Keywords: videolaryngoscopy, direct laryngoscopy, airway management, tracheal intubation, patient safety

Zhao-Jing Xue, Yi Cheng, Fu-Shan Xue Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of ChinaCorrespondence: Fu-Shan XueDepartment of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, NO. 95 Yong-An Road, Xi-Cheng District, Beijing 100050, People’s Republic of ChinaTel +86-13911177655Fax +86-10-63138362Email xuefushan@aliyun.com In the recent article of Chen et al1 determining the risk factors for postoperativedelirium (POD) in patients undergoing liver transplantation, the multivariate logisticregression analysis showed that preoperative ammonia ≥46 μmol/L, Model forEnd-Stage Liver Disease score ≥15, hepatic encephalopathy, anhepatic period, andaspartate aminotransferase at the first postoperative day were the independent riskfactors for POD. The findings of this study have potential clinical implications, butthere are several issues in methodology that need further clarification. View the original paper by Chen and colleagues &nbsp