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Background A tracheal tube stylet can be used to assist successful tracheal intubation, especially during videolaryngoscopic intubation because videolaryngoscopes with a Macintosh-type blade such as McGrath® MAC videolaryngoscope have more acute angle than conventional Macintosh laryngoscope. However, the use of a stylet during tracheal intubation can raise concerns about stylet-induced postoperative airway complications, such as sore throat, subglottic injury, and hoarseness. In this study, we compared the incidence of postoperative airway complications after McGrath® MAC videolaryngoscopic intubation with versus without a stylet in patients with a high Mallampati score. Methods In 104 patients with Mallampati score III or IV and who were scheduled for lumbar or thoracic spine surgery, McGrath® MAC videolaryngoscopic intubation was performed either with a stylet (group S, n = 52) or without a stylet (group N, n = 52). The primary outcome measure was the incidences of sore throat evaluated at 1 and 24 h postoperatively. Secondary outcome measures were the incidences of subglottic injury and postoperative hoarseness. Results The incidence of CL grade III in group S and N was 3.8 and 5.8%, respectively. No patient showed CL grade IV. The incidences of sore throat at 1 (26.9 vs 19.2%, P = 0.485) and 24 h (17.3 vs 13.5%, P = 0.786, respectively) postoperatively were not significantly different between the group S and N. However, the incidence of subglottic injury was significantly higher in the group S, compared with the group N (65.4 vs 42.3%, P = 0.030). The incidence of postoperative hoarseness did not differ significantly between the two groups. Conclusions The use of a stylet during McGrath® MAC videolaryngoscopic intubation did not have a significant impact on the incidence of postoperative sore throat in patients with a high Mallampati score. Avoiding the use of a stylet during intubation with McGrath® MAC videolaryngoscope may reduce the incidence of subglottic injury in such patients. Trial registration Clinical Research Information Service (identifier: KCT0002427, date of registration: June 12, 2017).

We sought to evaluate the association of postoperative acute kidney injury (AKI) adjusted for parenchymal mass reduction with long-term renal function in patients undergoing partial nephrectomy. A total of 629 patients undergoing partial nephrectomy were reviewed. Postoperative AKI was defined by the Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine criteria, by using either the unadjusted or adjusted baseline serum creatinine level, accounting for renal parenchymal mass reduction. Estimated glomerular filtration rates (eGFRs) were followed up to 61 months (median 28 months) after surgery. The primary outcome was the functional change ratio (FCR) of eGFR calculated by the ratio of the most recent follow-up value, at least 24 months after surgery, to eGFR at 3&ndash, 12 months after surgery. Multivariable linear regression analysis was performed to evaluate whether unadjusted or adjusted AKI was an independent predictor of FCR. As a sensitivity analysis, functional recovery at 3&ndash, 12 months after surgery compared to the preoperative baseline was analyzed. Median parenchymal mass reduction was 11%. Unadjusted AKI occurred in 16.5% (104/625) and adjusted AKI occurred in 8.6% (54/629). AKI using adjusted baseline creatinine was significantly associated with a long-term FCR (&beta, = &minus, 0.129 &plusmn, 0.026, p &lt, 0.001), while unadjusted AKI was not. Adjusted AKI was also a significant predictor of functional recovery (&beta, 0.243 &plusmn, 0.106, p = 0.023), while unadjusted AKI was not. AKI adjusted for the parenchymal mass reduction was significantly associated with a long-term functional decline after partial nephrectomy. A creatinine increase due to remaining parenchymal ischemic injury may be important in order to predict long-term renal functional outcomes after partial nephrectomy.

This is a supplemental material of the manuscript entitled with "Acute kidney injury adjusted for parenchymal mass reduction and long-term renal function after partial nephrectomy".&nbsp

Background In the present study, we compare the LMA-Protector™ and the i-gel™ in terms of adequacy of the airway seal, insertion time, ease and accuracy of insertion, and the incidence of postoperative sore throat. Methods In 110 anesthetized and paralyzed adult patients, the i-gel™ (n = 55) or the LMA-Protector™ (n = 55) was inserted. The primary outcome was airway leak pressure. The secondary outcomes included the first-attempt success rate, insertion time, ease and accuracy of the device insertion, ease of gastric tube placement, blood staining on the device after removal, and incidence and severity of postoperative sore throat. Results The airway leak pressure was higher with the LMA-Protector™ than with the i-gel™ (31 [7] cmH2O vs. 27 [6] cmH2O, respectively; P = 0.016). Insertion time was longer with the LMA-Protector™ than with the i-gel™ (27 [16] sec vs. 19 [16] sec, respectively, P

Tuffier line is a common landmark for spinal anesthesia. The 10th rib line has been suggested as a new landmark to predict the intervertebral levels. We evaluated the accuracy of these 2 anatomic landmarks for identifying the L4-L5 intervertebral space using ultrasonography in elderly patients with hip fracture.Seventy-nine elderly patients scheduled for hip fracture surgery under spinal anesthesia were included. In the lateral decubitus position with the fracture side up, the L4-L5 intervertebral space was identified alternately using Tuffier line, a line drawn between the highest points of both iliac crests, and the 10th rib line. The 10th rib line, an imaginary line that joints the 2 lowest points of the rib cage, passes through the L1-L2 intervertebral space or the body of L2. The L4-L5 intervertebral space was determined by the counting-down method from the 10th rib line. Then, the estimated intervertebral spaces were evaluated using ultrasonography.The L4-L5 intervertebral space was correctly identified in 47 (59%) patients with Tuffier line and 45 (57%) patients with the 10th rib line (P = .87). The estimation ratio related to the intervertebral levels was not different between the 2 landmarks (P = .40). The wrong identifications of intervertebral level with Tuffier line and the 10th rib line was observed in the following order: L3-L4 intervertebral space: 27% vs 24%, L5-S1 intervertebral space: 9% vs 16%, and L2-L3 intervertebral space: 5% vs 3%, respectively.Tuffier line and the 10th rib line may be unreliable to estimate the intervertebral space for spinal anesthesia in elderly patients with hip fracture.