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Purpose Facemask ventilation during the induction of general anesthesia in paediatric patients remains a challenge as it may result in hypoxic conditions and gastric insufflation with subsequent regurgitation and aspiration. So far, it is unclear if pressure-controlled or manual facemask ventilation is preferable in children. We hypothesized that pressure-controlled ventilation in apnoeic children results in lower peak airway pressure and flow rates compared to manual ventilation at comparable respiratory rates and tidal volumes. Methods Sixty-two lung-healthy children undergoing scheduled ear-nose-throat surgery were included in the study. After the induction of anesthesia, the patient's lungs were consecutively ventilated via a facemask in either manual or pressure-controlled mode, in randomized order. The primary outcome measure was peak airway pressure. Secondary outcome measures included positive end-expiratory pressure, airway compliance, tidal volume and airway flow. Results Data of 52 patients could be analyzed. Pressure-controlled ventilation resulted in a lower mean and peak inspiratory pressure (both p < 0.001), airway pressure amplitude (p = 0.01) and inspiratory peak flow rate (p = 0.005) compared to manual ventilation. The ratio of inspiration to expiration time was lower in pressure-controlled ventilation compared to manual ventilation (p < 0.001). Conclusion Pressure-controlled facemask ventilation during induction of anesthesia in pediatric patients results in lower airway pressure, and lower flow rates compared to manual ventilation, at comparable tidal and minute volumes., Author(s): Ulrich Goebel [sup.1] [sup.2] , Stefan Schumann [sup.1] [sup.2] , Steffen Wirth [sup.1] [sup.2] Author Affiliations: (Aff1) grid.5963.9, Department of Anesthesiology and Critical Care, Medical Center, University of Freiburg, [...]

Purpose To determine the influence of morbid obesity on the incidence of difficult mask ventilation and difficult intubation. Methods Over a 6-year period, all tracheal intubations in the operating room of a large tertiary teaching hospital were analyzed. A modified version of the intubation difficulty scale (mIDS) was used to define easy versus difficult intubation, where a score of two or greater was defined as difficult intubation. Difficult mask ventilation was defined as the use of one or more adjuncts to achieve successful mask ventilation. Results Of 45,447 analyzed cases, 1893 (4.2%) were classified as difficult intubations. Morbidly obese patients were not more likely to have difficult intubation [Odds Ratio (OR) = 1.131, 95% confidence interval (CI): 0.958, 1.334, p = 0.146]. Factors that were associated with difficult intubation included patient age > 46 years, male sex, Mallampati 3-4, thyromental distance < 6 cm, and the presence of intact dentition. Of 37,016 cases in which mask ventilation was attempted, 1069 (2.9%) were difficult. Morbidly obese patients were more likely to have difficult mask ventilation (OR = 3.785, 95% CI: 3.188, 4.493, p 46 years, male sex, Mallampati 3-4, and a history of obstructive sleep apnea. Having intact dentition decreased the likelihood of difficult mask ventilation. Conclusion Morbidly obese patients do not have a higher incidence of difficult intubation compared to non-morbidly obese patients. However, they have a significantly higher incidence of difficult mask ventilation. Other factors that are predictive of both difficult mask ventilation and difficult intubation include age > 46 years, male sex, and Mallampati 3-4., Author(s): Tiffany S. Moon [sup.1] , Pamela E. Fox [sup.1] , Alwin Somasundaram [sup.1] , Abu Minhajuddin [sup.1] , Michael X. Gonzales [sup.1] , Taylor J. Pak [sup.1] , Babatunde [...]

This study examined the effects of an external nasal dilator (END) on sedentary and aerobically trained women using the blood lactate threshold as a measure of aerobic performance. Three groups of women (sedentary, pre-season, in-season) participated in the study: nine sedentary college students (age 19 [+ or -] 1.0 y), eight pre-season college athletes (age 20 [+ or -] 2.3 y), and six in-season college rowers (age 20 [+ or -] 1.7 y). A two-way repeated-measures design was used with subjects in each group being exposed to both conditions (with END and without END). The first two groups performed two incremental exercise tests in random order on a cycle ergometer, and the third group performed the tests on a rowing ergometer. Participants in each group wore an END strip for only one of the tests. Venous blood was collected at rest, during the final 30 seconds of each stage, and 1 and 3 minutes into the recovery period for the determination of blood lactate concentration and identification of the blood lactate threshold. No significant differences (P = 0.05) were found in blood lactate concentration at the lactate threshold between conditions for either group (sedentary: with END 2.51 [+ or -] 1.18 mmol * [L.sup.-1], without END 2.56 [+ or -] 0.84 mmol * [L.sup.-1]; preseason: with END 2.93 [+ or -] 0.97 mmol * [L.sup.-1], without END 2.81 [+ or -] 1.15 mmol * [L.sup.-1]; and in-season: with END 3.93 [+ or -] 0.50 mmol * [L.sup.-1], without END 3.49 [+ or -] 0.387 mmol * [L.sup.-1]). We conclude that (a) the END did not improve the Lactate threshold in either sedentary or trained college-age women, and (b) the END did not result in lower blood lactate levels during moderate to high-intensity exercise in the three groups examined in this study. KEY WORDS lactate threshold, anaerobic threshold, rowing performance

Byline: Dwivedi. Deepak, Jinjil. Kavitha, Sheshadri. Kiran, Bhatnagar. Vidhu Sir, Incident reporting is a key factor in maintaining patient safety in the perioperative scenario. We report an incident of near [...]

Byline: Raj. Singh, Michell. Gulabani, Mohandeep. Kaur, Rajesh. Sood Background and Aims: Swapping of the endotracheal tube with laryngeal mask airway (LMA) before emergence from anaesthesia is one of the [...]

Many patients admitted to emergency departments (EDs) require therapy delivered by cannula. Mid-Western Regional Hospital, Tipperary, used to run a system in which many patients had to endure two invasive [...]

Byline: Mohd Saif. Ghaus Sir, An 80-year-old male, in-patient, known case of hypertension, insulin dependent diabetes mellitus, hemiplegia, chronic renal failure and bed ridden for 5 years, admitted with the [...]

Byline: Valter. Perilli, Paola. Aceto, Teresa. Sacco, Nunzia. Martella, Maria. Cazzato, Liliana. Sollazzi Background: The use of suction catheter (SC) has been shown to improve success rate during ProSeal laryngeal [...]

Byline: Teddy. Fabila, Shahani. Menghraj The advantages of video assisted thoracoscopic surgery (VATS) in children have led to its increased usage over the years. VATS, however, requires an efficient technique [...]

Byline: Moris. Topaz Regulated negative pressure-assisted wound therapy (RNPT) should be regarded as a state-of-the-art technology in wound treatment and the most important physical, nonpharmaceutical, platform technology developed and applied [...]

Byline: Bimla. Sharma, Chand. Sahai, Jayashree. Sood Sir, The ProSeal [sup]TM LMA (ProSeal [sup]TM laryngeal mask airway - PLMA) is expensive and has a shorter life span than the classic [...]

Byline: Anil. Ranganath, Deepak. Hanumanthaiah Cannulation of a peripheral artery in a patient allows for continuous blood pressure (BP) monitoring and facilitates frequent arterial blood gas (ABG) analysis. Complications include [...]

Byline: Rajeev. Sharma Sir, I read with great interest the article by Drs Sethi et al. describing the use of a paediatric face mask for mask ventilation in an adult [...]