Search

Objectives: Simulation-based technical skills training is now ubiquitous in medicine, particularly for high acuity, low occurrence (HALO) procedures. Mastery learning and deliberate practice (ML + DP) are potentially valuable educational methods, however, they are resource intensive. We sought to compare the effect of deliberate practice and mastery learning versus self-guided practice on skill performance of the rare, life-saving procedure, a bougie-assisted cricothyroidotomy (BAC)., Methods: We conducted a multi-center, randomized study at five North American emergency medicine (EM) residency programs. We randomly assigned 176 EM residents to either the ML + DP or self-guided practice groups. Three blinded airway experts independently evaluated BAC skill performance by video review before (pre-test), after (post-test) and 6-12 months (retention) after the training session. The primary outcome was post-test skill performance using a global rating score (GRS). Secondary outcomes included performance time and skill performance at the retention test., Results: Immediately following training, GRS scores were significantly higher as mean performance improved from pre-test, (22, 95% CI = 21-23) to post-test (27, 95% CI = 26-28), (p < 0.001) for all participants. However, there was no difference between the groups on GRS scores (p = 0.2) at the post-test or at the retention test (p = 0.2). At the retention test, participants in the ML + DP group had faster performance times (66 s, 95% CI = 57-74) compared to the self-guided group (77 s, 95% CI = 67-86), (p < 0.01)., Conclusions: There was no significant difference in skill performance between groups. Residents who received deliberate practice and mastery learning demonstrated an improvement in skill performance time., (© 2023. The Author(s), under exclusive licence to Canadian Association of Emergency Physicians (CAEP)/ Association Canadienne de Médecine d'Urgence (ACMU).)

Abstract Background Improvement is needed in the remedies used to control Th2 polarization. Bioengineering approaches have modified immune cells that have immunosuppressive functions. This study aims to generate modified eosinophils (Meos) in vivo and use Meos to balance Th2 polarization and reduce airway allergy. Methods A cell editor was constructed. The editor contained a peptide carrier, an anti-siglec F antibody, MHC II, ovalbumin, and LgDNA (DNA extracted from a probiotic, Lactobacillus rhamnosus GG). Which was designated as Cedit. Meos are eosinophils modified using Cedits. An airway Th2 polarization mouse model was established used to test the effect of Meos on suppressing airway allergy. Results The Cedits remained physically and chemically stable in solution (pH7.2) for at least 96 h. Cedits specifically bound to eosinophils, which are designated as Meos. Meos produced programmed death ligand-1 (PD-L1); the latter induced antigen specific CD4+ T cell apoptosis. Administration of Cedits through nasal instillations generated Meos in vivo, which significantly reduced the frequency of antigen specific CD4+ T cells in the airways, and mitigated airway Th2 polarization. Conclusions We constructed Cedit, which could edit eosinophils into Meos in vivo. Meos could induce antigen specific CD4+ T cell apoptosis, and reconcile airway Th2 polarization.

A 4.1 kg male neonate with a diagnosis of double-inlet left ventricle with dextro-transposition of the great arteries was intubated shortly after birth due to respiratory insufficiency. The initial management consisted of a successful Stage I hybrid procedure. Persistent respiratory insufficiency led to cross-sectional imaging and bronchoscopy that demonstrated severe airway compression from a dilated main pulmonary artery. A Norwood procedure with Blalock–Thomas–Taussig shunt was performed at 1 month of age to relieve the airway obstruction. The patient was discharged home on room air at 2 months of age. This case highlights a unique single-ventricle anatomic variant with airway compression, which was successfully managed with deferred Norwood palliation.

Background Ambient fine particulate matter (PM2.5) exposure adversely impacts child airway health; however, research on prenatal PM2.5 exposure, and child lung function is limited. We investigated these associations in the ECHO-PATHWAYS Consortium, focusing on the role of exposure timing during different phases of fetal lung development.Methods We included 675 children in the CANDLE cohort born between 2007 and 2011 in Memphis, TN, USA. Prenatal exposure to ambient PM2.5 was estimated using a spatiotemporal model based on maternal residential history and averaged over established prenatal periods of lung development. Forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) were measured by spirometry at age 8–9 years. We used linear regression and Bayesian Distributed Lag Interaction Models (BDLIM) to estimate associations between exposure and lung function z-scores, adjusting for maternal/child characteristics, prenatal/postnatal tobacco exposure, and birth year/season, and evaluating effect modification by child sex and allergic sensitization.Results The average ambient concentration of PM2.5 during pregnancy was 11.1 µg/m3 (standard deviation:1.0 µg/m3). In the adjusted linear regression and BDLIM models, adverse, but not statistically significant, associations were observed between exposure during the pseudoglandular (5–16 weeks of gestation) and saccular (24–36 weeks) phases of lung development and FEV1 and FVC. The strongest association was between a 2 μg/m3 higher concentration of PM2.5 during the saccular phase and FEV1 z-score (−0.176, 95% Confidence Interval [CI]: −0.361, 0.010). The FEV1/FVC ratio was not associated with PM2.5 in any exposure window. No effect modification by child sex or allergic sensitization was observed.Conclusions We did not find strong evidence of associations between prenatal ambient PM2.5 exposure and child lung function in a large, well-characterized study sample. However, there was a suggested adverse association between FEV1 and exposure during late pregnancy. The saccular phase of lung development might be an important window for exposure to PM2.5.

Abstract Background Airway management is a crucial skill for many clinicians. Besides mastering the technical skills of establishing a patent airway, human factors including leadership and team collaboration are essential. Teaching these human factors is often challenging for instructors who lack dedicated training. Therefore, the European Airway Management Society (EAMS) developed the Teach-the-Airway-Teacher (TAT) course. Methods This online post-course survey of TAT-course participants 2013–2021 investigated the impact of the TAT-course and the status of airway management teaching in Europe. Twenty-eight questions e-mailed to participants (using SurveyMonkey) assessed the courses’ strengths and possible improvements. It covered participants’ and workplace details; after TAT-course considerations; and specifics of local airway teaching. Data were assessed using Excel and R. Results Fifty-six percent (119/213) of TAT-participants answered the survey. Most were anaesthetists (84%), working in university level hospitals (76%). Seventy-five percent changed their airway teaching in some way, but 20% changed it entirely. The major identified limitation to airway teaching in their departments was “lack of dedicated resources” (63%), and the most important educational topic was “Teaching non-technical skills” (70%). “Lecturing “ was considered less important (37%). Most surveyed anaesthesia departments lack a standardized airway teaching rotation. Twenty-one percent of TAT-participants rated their departmental level of airway teaching overall as inadequate. Conclusions This survey shows that the TAT-course purpose was successfully fulfilled, as most TAT-course participants changed their airway teaching approach and did obtain the EAMS-certificate. The feedback provided will guide future TAT-course improvements to advance and promote a comprehensive approach to teaching airway management.

Introduction: Newer second-generation Supraglottic Airway Devices (SADs) are easy to insert and provide a smooth induction of anaesthesia with minimal haemodynamic pressor response. The paediatric I-gel and Ambu AuraGain are newer SADs that are increasingly being used as alternatives to endotracheal intubation in the paediatric population. Aim: To compare the clinical performance of I-gel and Ambu AuraGain in children undergoing general anaesthesia with respect to ease of insertion, haemodynamic changes, and the frequency and severity of postoperative sore throat. Materials and Methods: This randomised clinical study included 100 children aged 2 to 10 years, belonging to American Society of Anaesthesiologists (ASA) Grade I and II, scheduled for elective surgery under general anaesthesia. They were randomly allocated to Group I (I-gel) and Group A (Ambu AuraGain), comprising 50 patients each. The time taken for SAD placement, the number of attempts, ease of insertion, and the requirement of additional airway manipulations during insertion were observed. Haemodynamic Parameters Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP), SpO2 , and End-tidal Carbon Dioxide [ (EtCO2 ) ]) during the procedure were observed. The frequency and severity of postoperative sore throat were assessed between both groups. Descriptive statistics were applied to all data and reported in terms of mean, Standard Deviation (SD), and percentages, and appropriate statistical tests of comparison were applied. Results: In this study, the demographic data of patients, such as age, weight, gender, and ASA status, were comparable in both groups. There was no statistically significant difference in the time taken for successful SAD placement and the number of attempts required to do the same. Ambu AuraGain was easier to insert than I-gel (p-value

Background: Microgravity in space causes changes in the physiology of human body and as a result makes them susceptible to various pathology. As a result astronauts suffer from health disorders which includes otorhinolaryngological disorders Aim: To gather information about the various otorhinolaryngological manifestations occuring in microgravity by compiling the available scattered data existing in literature Methods: This is a narrative review article. Using keywords a search was made on the internet, various databases such as googlescholar, pubmed to find out the description of various otorhinolaryngological manifestation in microgravity environment of space. A few proposals or initiatives are given at the end of the discussion so that more research can be conducted on this aspect of otorhinolaryngology Results: Studies have revealed that the microgravity environment leads to mastoid effusion, predisposes tosinusitis, causes cytoskeletal changes and altered gene expression in thyroid cancer cells, decreases salivary secretion,causes difficulty in airway management, affects temporomandibular joint function, causes impairment of balance. Regarding sleep some studies revealed that microgravity improves sleep whileother studies revealed that microgravity causes increase in sleep disturbances. Important future initiatives include establishment of world class health and research facility, National Health Programme forastronauts, Fellowship courses by NBEMS etc. Conclusion: Microgravity has a significant impact on mastoid, sinuses, sleep, thyroid cancer cells, salivation, airway, temporomandibular joint and balance. More research needs to be conducted on this topic.

Abstract Background Systemic and local profiles have each been associated with asthma, but parsing causal relationships between system-wide and airway-specific processes can be challenging. We sought to investigate systemic and airway processes in asthma and their causal relationships. Methods Three hundred forty-one participants with persistent asthma and non-asthmatic controls were recruited and underwent peripheral blood mononuclear cell (PBMC) collection and nasal brushing. Transcriptome-wide RNA sequencing of the PBMC and nasal samples and a series of analyses were then performed using a discovery and independent test set approach at each step to ensure rigor. Analytic steps included differential expression analyses, coexpression and probabilistic causal (Bayesian) network constructions, key driver analyses, and causal mediation models. Results Among the 341 participants, the median age was 13 years (IQR = 10–16), 164 (48%) were female, and 200 (58.7%) had persistent asthma with mean Asthma Control Test (ACT) score 16.6 (SD = 4.2). PBMC genes associated with asthma were enriched in co-expression modules for NK cell-mediated cytotoxicity (fold enrichment = 4.5, FDR = 6.47 × 10−32) and interleukin production (fold enrichment = 2.0, FDR = 1.01 × 10−15). Probabilistic causal network and key driver analyses identified NK cell granule protein (NKG7, fold change = 22.7, FDR = 1.02 × 10−31) and perforin (PRF1, fold change = 14.9, FDR = 1.31 × 10−22) as key drivers predicted to causally regulate PBMC asthma modules. Nasal genes associated with asthma were enriched in the tricarboxylic acid (TCA) cycle module (fold enrichment = 7.5 FDR = 5.09 × 10−107), with network analyses identifying G3BP stress granule assembly factor 1 (G3BP1, fold change = 9.1 FDR = 2.77 × 10−5) and InaD-like protein (INADL, fold change = 5.3 FDR = 2.98 × 10−9) as nasal key drivers. Causal mediation analyses revealed that associations between PBMC key drivers and asthma are causally mediated by nasal key drivers (FDR = 0.0076 to 0.015). Conclusions Integrated study of the systemic and airway transcriptomes in a well-phenotyped asthma cohort identified causal key drivers of asthma among PBMC and nasal transcripts. Associations between PBMC key drivers and asthma are causally mediated by nasal key drivers.

Background: Supraglottic airway devices (SGD) are indispensable for airway management. The successful placement of the laryngeal mask airway (LMA) supreme largely depends on the right size selection. Aims and Objectives: The study was undertaken to compare three LMA supreme insertion methods in short elective surgeries under general anesthesia. Materials and Methods: Atotal of 90 American Society of Anesthesiologists I and II patients (either gender, 18–55 years, Mallampati grade I and II) undergoing short surgeries were randomized into three equal groups (n=30 in each). Insertion of LMA was done after an adequate depth of anesthesia for jaw relaxation (Young’s criteria). The efficacy of controlled ventilation through LMA by each method, success rate, ease of insertion, insertion time, additional induction dose (propofol) required during insertion, hemodynamic stability (baseline vitals and 10 min after insertion), and adverse events after LMA removal were evaluated between groups. Results: Better ventilation (tidal volume at 10 cmH2O) was observed in the thyromental group (448±35) than in tongue width (440±46) and weight-based (409±33) groups. Minimum additional propofol requirement during insertion was in thyromental distance group. Thyromental distance group had the most easy LMA insertions (70%) with minimum insertion time (10±4) and minimum additional propofol requirement during insertion (P

Abstract Background Cricothyrotomy is a procedure performed to establish an airway in critical airway events. It is performed only rarely and anesthesiologists are often unprepared when called upon to perform it. This study aimed to simulate cricothyrotomy using pig larynx and trachea models to help anesthesiologists master cricothyrotomy and improve the ability to establish cricothyrotomy quickly. Methods The porcine larynx and trachea were dissected and covered with pigskin to simulate the structure of the anterior neck of a human patient. An animal model of cricothyrotomy was established. Forty anesthesiologists were randomly divided into four groups. Each physician performed three rounds of cricothyrotomy, and recorded the time to accomplish each successful operation. After training the cricothyrotomy procedure, a questionnaire survey was conducted for the participating residents using a Likert scale. The participants were asked to score the utility of the training course on a scale of 1 ((minimum) to 5 ((maximum). Results Through repeated practice, compared with the time spent in the first round of the operation (67 ± 29 s), the time spent in the second round of the operation (47 ± 21 s) and the time spent in the third round of the operation (36 ± 11 s) were significantly shortened (P

Background: Training is required to achieve proficiency in airway management. Simulators are of utmost importance not only for the purpose of training novices, but also for evaluating newer airway devices and techniques. Growing evidence supports inadequate anatomic airway reproduction in adult and pediatric manikins. Methods: We conducted an observational study comparing 17 radiological anatomic airway measurements obtained via the computed tomography of three commercially available manikins with the same measurements obtained from a population of newborns/infant (range: 0–3 months) undergoing magnetic resonance imaging for diagnostic purposes. According to the reference (mean and standard deviation (SD) of the pediatric population), each manikin measurement was defined as adequate, partially adequate or inadequate (difference between means: ≤±1, 1.0–1.96 or >1.96 SD, respectively). The primary outcome was the number of measurements with an adequate reproduction of airways. Results: We included 27 pediatric patients (21 ± 19 days, 48% males, 46.6 ± 3.5 cm, 2.7 ± 0.5 Kg and 12.6 ± 2.9 kg/m2). All manikins had n = 11/17 measurements with inadequate airway anatomic reproduction. The three measurements with more adequate reproduction were the height of the soft palate, retropalatal airspace volume and tongue volume (adequate in two manikins, and partially adequate in the remaining one). Conclusions: In three manikins commonly used for training in pediatric airways, static dimensions do not seem anatomically correct in relation to those of pediatric patients. Such inaccuracies may introduce biases in airway device development as well as in training.

Prevention of arterial oxygen desaturation during anaesthesia with high-flow nasal oxygen (HFNO) has gained greater acceptance for a widening range of procedures. However, during HFNO use there remains the potential for development of significant anaesthesia-associated apnoea or hypoventilation and the possibility of hypercarbia, with harmful cardiovascular or neurological sequelae. The aim of this study was to determine whether any HFNO-related hypercarbia adverse incidents had been reported on webAIRS, an online database of adverse anaesthesia-related incidents. Two relevant reports were identified of complications due to marked hypercarbia during HFNO use to maintain oxygenation. In both reports, HFNO and total intravenous anaesthesia were used during endoscopic procedures through the upper airway. In both, the extent of hypoventilation went undetected during HFNO use. An ensuing cardiac arrest was reported in one report, ascribed to acute hypercarbia-induced exacerbation of the patient's pre-existing pulmonary hypertension. In the other report, hypercarbia led to a prolonged duration of decreased level of consciousness post procedure, requiring ventilatory support. During the search, an additional 11 reports of postoperative hypercarbia-associated sedation were identified, unrelated to HFNO. In these additional reports an extended duration of severe acute hypercarbia led to sedation or loss of consciousness, consistent with the known effects of hypercarbia on consciousness. These 13 reports highlight the potential dangers of unrecognised and untreated hypercarbia, even if adequate oxygenation is maintained. [ABSTRACT FROM AUTHOR]

Introduction:This study aims to evaluate bronchoscopy’s indications and clinical results in patients who underwent bronchoscopy during their stay in the pediatric intensive care unit (PICU).Methods:This study was carried out retrospectively in PICU between April 2019, and October 2021. The diagnoses of the patients, the reasons for bronchoscopy, where and by whom bronchoscopy was performed, complications related to bronchoscopy, and the contribution of bronchoscopy to diagnosis and treatment were determined.Results:Thirty-seven patients underwent bronchoscopy. The median age was 20 (7-126) months. The children comprised 17 females (45.9%). We performed bronchoscopy in 17 (45.9%) patients in the PICU and in 20 (54.1%) patients in the operating room. Pediatric intensive care physicians, 13 (35.1%) performed fifteen (40.5%) of bronchoscopy procedures pediatric pulmonologists and 9 (24.3%) pediatric surgeons. Nine patients underwent rigid bronchoscopy, 28 patients underwent flexible bronchoscopy. The median bronchoscopy time was 10 minutes (7.5-15). Bronchomalacia was found in 5 of the patients and tracheomalacia in 2 of them. Three patients (8.1%) had extraluminal airway compression. Bronchoscopy was performed in six patients due to foreign body aspiration. In 13 patients, peak inspiratory pressure and positive end-expiratory pressure of mechanical ventilation were decreased after the bronchoscopy procedure. During the bronchoscopy procedure, desaturation showed in 19 patients, bleeding in 4 patients, bradycardia in 4 patients, and short-term cardiac arrest in 3 patients. Three patients with cardiac arrest were patients who underwent rigid bronchoscopy. The median PICU length of stay was 52 days. There were no bronchoscopy-related deaths, but 9 patients died due to their primary disease.Conclusion:Bronchoscopy is a method that can be performed in PICU, both at the bedside and the operating room, to identify pathological changes in the airway in critical patients and to remove foreign bodies and life-threatening plugs in the airway. Its use for emergency or diagnostic purposes is increasing in PICUs.

Abstract Background Ultrasound assessment of the airway recently integrates the point-of-care approach to patient evaluation since ultrasound measurements can predict a difficult laryngoscopy and tracheal intubation. Because ultrasonography is performer-dependent, a proper training and assessment tool is needed to increase diagnostic accuracy. An objective, structured assessment ultrasound skill (OSAUS) scale was recently developed to guide training and assess competence. This work aims to study the psychometric properties of OSAUS Scale when used to evaluate competence in ultrasound hyomental distance (HMD) measurement. Methods: Prospective and experimental study. Volunteers were recruited and enrolled in groups with different expertise. Each participant performed three ultrasonographic HMD evaluation. The performance was videorecorded and anonymized. Five assessors blindly rated participants’ performance using OSAUS scale and a Global Rating Scale (GRS). A psychometric study of OSAUS scale as assessment tool for ultrasound HMD competence was done. Results: Fifteen voluntaries participated on the study. Psychometric analysis of OSAUS showed strong internal consistency (Cronbach’s alpha 0.916) and inter-rater reliability (ICC 0.720; p

Bovine respiratory disease (BRD) is the leading cause of mortality and antimicrobial drug (AMD) use in weaned dairy heifers. Limited information is available regarding antimicrobial resistance (AMR) in respiratory bacteria in this population. This study determined AMR gene presence in 326 respiratory isolates (Pasteurella multocida, Mannheimia haemolytica, and Histophilus somni) from weaned dairy heifers using whole genome sequencing. Concordance between AMR genotype and phenotype was determined. Twenty-six AMR genes for 8 broad classes of AMD were identified. The most prevalent, medically important AMD classes used in calf rearing, to which these genes predict AMR among study isolates were tetracycline (95%), aminoglycoside (94%), sulfonamide (94%), beta-lactam (77%), phenicol (50%), and macrolide (44%). The co-occurrence of AMR genes within an isolate was common; the largest cluster of gene co-occurrence encodes AMR to phenicol, macrolide, elfamycin, β-lactam (cephalosporin, penam cephamycin), aminoglycoside, tetracycline, and sulfonamide class AMD. Concordance between genotype and phenotype varied (Matthew’s Correlation Coefficient ranged from −0.57 to 1) by bacterial species, gene, and AMD tested, and was particularly poor for fluoroquinolones (no AMR genes detected) and ceftiofur (no phenotypic AMR classified while AMR genes present). These findings suggest a high genetic potential for AMR in weaned dairy heifers; preventing BRD and decreasing AMD reliance may be important in this population.

Background and Objective: Knowledge of airway dimensions is important in the process of diagnosing and planning the treatment of orthodontic patients. Therefore, this study was conducted with the aim of performing cephalometric anlysis of airway dimensions in patients with different vertical jaw relations in the specialized clinic of Babol Dental School. Methods: This cross-sectional study was conducted on 150 lateral cephalometric radiographs taken from patients aged 18 to 25 before orthodontic treatment. Based on the FMA angle and Jarabak index, the patients were divided into three groups of 50 according to the vertical skeletal pattern. The width of the upper (UP) and lower (LP) airways was measured in millimeters using McNamara's analysis. Moreover, the width of the nasopharynx (PNS-UPW), oropharynx (U-MPW) and hypopharynx (V-LPW) was recorded in millimeters and compared in three groups. Findings: The studied population included 43 men and 107 women with a mean age of 20.39±2.50 years. The results showed a significant relationship in the dimensions of the upper airway, nasopharynx, and oropharynx between the vertical groups (p=0.001, p=0.001, and p=0.015, respectively). All these parameters in the Hyperdivergent group were significantly lower than the other two groups, and no significant relationship was found between the Hypodivergent and Normodivergent groups. The mean upper airway in Normodivergent group was 13.62±3.05. In addition, the dimensions of the lower airway and hypopharynx were not significantly different between the vertical groups. Conclusion: The results of the study showed that hyperdivergent patients have a narrower upper airway. However, lower airway dimensions are not affected by vertical growth pattern factors.

Velopharyngeal insufficiency is a disorder where the soft palate directs the air through the nose. It is often present in patients with previous cleft or short palate, but also in many other conditions. Symptoms are primarily to be found in speech, with very distinct nasal sound. After clinical evaluation and nasal endoscopy, surgery is considered. Several surgical techniques are in use, with posterior pharyngeal flap pharyngoplasty being most widely used. This method leaves the base of the posterior pharyngeal flap attached to the posterior pharyngeal wall, with two lateral ports on each side of the flap. Permanent nasopharyngeal obstruction is a very challenging pathology for anesthesiologists in case of mandatory nasal intubation since it is a relative contraindication for nasal intubation. Patients with previous palatoplasty will regularly appear in our routine anesthetic practice, in all surgical segments. The high risk of damage to the flap with possible bleeding can put the anesthesiologist in a very unpleasant situation if not aware of the permanent effect of this surgery. During preanesthetic assessment, if there is information on a previous pharyngoplasty, one should consider alternative options for nasotracheal intubation. All nasal insertion procedures must be either avoided or carried out with great caution, under fiberoptic visual control.

SCIWOCTET is a cervical spine injury (CSI) with objective signs of myelopathy, due to trauma, without evidence of ligament injury or bone fractures on x-ray and computed tomography (CT) images. It is rare, found in about 3% of patients with CSI. Perioperative manipulation of these patients may cause secondary spinal cord injury. The challenge for the anesthesiologist is to manage an airway with as little movement of the patient’s head and neck as possible. A patient is presented after a fall from a motorbike. At hospital admission, he had neurological deficit in the innervation area of the cervical spinal cord. Multi-slice CT of the head and cervical spine was without signs of acute bone trauma. Magnetic resonance imaging was performed and the diagnosis met the criteria defining SCIWOCTET. Elective cervical spine surgery under general anesthesia was performed, the patient was intubated with a rigid bronchoscope using manual in-line immobilization. The selection of instruments and procedures is emphasized. Other procedures, techniques and instruments that can be used for airway management and their influence on the movement of the patient’s head and neck are listed. It is concluded that rigid bronchoscopy with the application of manual in-line immobilization is suitable for emergency and elective intubation of patients with cervical spine pathology.

Physiological changes in pregnancy as part of biohumoral and morphological changes (hyperemia, edema, hypersecretion) influence the possible problems in obstetric anesthesia. These changes by themselves, and particularly aggravated by acute or chronic gestational or non-gestational comorbidity, increase the risk of aspiration of gastric contents, failed intubation, esophageal intubation, inadequate ventilation, and respiratory failure. The types of premedication, anesthesia and techniques of anesthesia are evident from medical historiography. Almost obligatory promethazine and atropine was given intravenously either in the delivery room or on the operating table immediately before the induction of anesthesia in a dose of 0.5 mg in partuients of average body weight. Atropine has been a favorite premedicant for decades, given its pharmacological properties, especially its antisialogenic effect and absence of a depressant effect on the fetoplacental unit, but today it is rarely used. Nasal decongestants before surgery are not recommended but in cases of severe rhinitis, atropine, promethazine, or topical decongestants may be used.

Background: Securing airway and adequate ventilation after induction of anesthesia is the utmost priority of anesthesiologists, failure of that can lead to hypoxic brain injury and death in a few minutes. Aims and Objectives: The aims of this study were to ascertain the role of ultrasonography in predicting difficult intubation by comparing different ultrasonographic parameters. Materials and Methods: One hundred patients posted for elective surgery under general anesthesia were studied. The study was carried out in two phases. The first phase – during the pre-anesthetic checkup, ultrasonographic measurements of Anterior neck soft-tissue thickness at the level of hyoid (ANS-Hyoid), anterior neck soft tissue thickness at the level of vocal cords (ANS-VC), pre-epiglottic space (Pre-E), distance from the epiglottis to the mid-point of the distance between the vocal cords (EVL), and the ratio of both (PES/EVL) was also done. In the second phase, Cormack–Lehane (CL) grade was noted during intubation. A Chi-square test was applied to correlate ultrasonographic parameters and CL grade. Sensitivity, specificity, an area under the receiver operating characteristic (ROC) curve, negative predictive value, and positive predictive value were calculated for various parameters. Results: In this study among the studied parameter, only ANS–VC was statistically significant in predicting difficult intubation (P0.32 cm was 93.3% sensitive and 84.7% specific and had Area under the ROC curve of 85% in predicting CL grade 3 and 4 (difficult intubation). Conclusion: USG is a useful tool in predicting difficult intubation. ANS-VC >0.32 cm is a highly sensitive and specific predictor of difficult intubation, while other USG parameters are not indicative of difficult intubation.

Introduction: In-hospital advanced life support and acute airway management is critically time sensitive and requires the immediate availability of key equipment. While most acute airway emergencies present to emergency centres, clinical deterioration may occur at any point during a patient's care process. Thus, all areas of the hospital should be equipped to provide acute airway management. The aim of this study was to audit the availability and functioning of emergency airway equipment and drugs at a large academic Johannesburg hospital. Methods: A prospective, observational, cross-sectional spot audit was conducted at nineteen patient care units at Chris Hani Baragwanath Academic Hospital (CHBAH), Johannesburg, SA from January to March 2018. Using a modified list of equipment and drugs derived from the EMSSA Practice Guideline of Rapid Sequence Intubation, each unit's emergency trolley was spot audited by a single Investigator, assessing both availability and if the equipment was in good working order. A selection of drugs was assessed for availability and location. Results: Overall, approximately two thirds (67%) of the listed equipment were available and in working order in the audited units. Almost a third (31%) of the listed equipment was not available at all, while 2% of the equipment was available but not working. The Intensive Care Unit, Medical Emergency Unit and Trauma Unit had the highest (≥80%) of available and working equipment, with the Psychiatry Ward and the Labour Ward having the lowest percentage (≤45%). Conclusion: This audit highlights specific deficiencies in emergency airway management equipment within this institution, as well as the need for improved strategies to address equipment shortages. The causes for these shortages were not explored. Recommendations following this audit include further qualitative research to explore and address the barriers to well stocked emergency trolleys, the standardization of equipment checklists and to provide regular staff training in resuscitation.

Introduction: Intended for use by prehospital first responders, the Lubo TM cervical collar is an adjustable, radiolucent, single-use device that incorporates a mechanical jaw thrust mechanism. The combination enables non-invasive airway management in cases of trauma where cervical motion restriction is necessary. The potential benefits include use as an airway adjuvant maintaining upper airway patency, reducing provider task loading. The limited research on the device efficacy and safety requires further investigation.Methods: A randomized, crossover, interventional study was performed to compare mean differences in airway patency at the level of the uvula, epiglottis, tongue and soft palate with and without the Lubo collar in awake volunteers using magnetic resonance imaging (MRI). Fourteen participants each underwent two MRI scans of the upper airway: A control scan with no Lubo collar, and an intervention scan with the Lubo collar applied and jaw thrust mechanism activated. Two independent radiologists measured anterior-posterior diameter of the airway at four anatomical levels on the resulting MRI images.Results: There was no significant difference in mean airway diameter between the control and intervention measurements at any level. Mean (SD; 95% CI: p-value) differences were 0.9 mm (-2.38; 2.3 to 0.5; p=0.17) at the epiglottis, 0.5 mm (1.6; -0.5 to 1.4; p=0.29) at the soft palate, 0.2 mm (2.86; -1.4 to 1.9; p = 0.78) at the tongue, 0.4 mm (4.04; -1.9 to 2.7; p = 0.72) at the uvula.Conclusion: The Lubo TM airway collar did not show a significant change in upper airway patency at four anatomical levels measured in awake adult participants. Further research is required to investigate its clinical use in patients that are unable to maintain upper airway tone. Groups of interest would include trauma, obstructive sleep apnoea, obesity and patients under general anaesthesia.

The respiratory tract, the first-line defense, is constantly exposed to inhaled allergens, pollutants, and pathogens such as respiratory viruses. Emerging evidence has demonstrated that the coordination of innate and adaptive immune responses in the respiratory tract plays a crucial role in the protection against invading respiratory pathogens. Therefore, a better understanding of mucosal immunity in the airways is critical for the development of novel therapeutics and next-generation vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other respiratory viruses. Since the coronavirus disease 2019 pandemic, our knowledge of mucosal immune responses in the airways has expanded. In this review, we describe the latest knowledge regarding the key components of the mucosal immune system in the respiratory tract. In addition, we summarize the host immune responses in the upper and lower airways following SARS-CoV-2 infection and vaccination, and discuss the impact of allergic airway inflammation on mucosal immune responses against SARS-CoV-2.

The aim of this study is to investigate the protective effects of glaucocalyxin A (GLA) on airways in mouse models of asthma, concerning the inflammatory mediators, Th1/Th2 subgroup imbalance, and Toll-like receptor 4 (TLR4)/NF-κB signaling pathway. Hematoxylin and eosin/periodic acid–Schiff staining was used to observe the pathological changes in lung tissues. Inflammatory cytokine contents in the bronchoalveolar lavage fluid were detected by enzyme-linked immunosorbent assay. Protein expression levels were detected with Western blot, immunohistochemistry, and immunofluorescence. In vivo studies showed that, in ovalbumin (OVA)-induced asthmatic mouse models, the GLA treatments reduced the airway hyperresponsiveness and the secretion of inflammatory cells, declined the proliferation of goblet cells, decreased the levels of IL-4, IL-5, and IL-13, and increased the contents of interferon-γ and IL-12. Moreover, GLA inhibited the protein expression levels of TLR4, MyD88, TRAF6, and NF-κB in OVA-induced asthmatic mouse models. Further in vitro studies showed that GLA inhibited the expression of NF-κB, p-IκBα, tumor necrosis factor-α, IL-6, and IL-1β and blocked the nuclear transfer of NF-κB in lipopolysaccharide-stimulated RAW264.7 macrophages. Conclusively, GLA can inhibit the inflammatory responses in OVA-induced asthmatic mice and inhibit the release of inflammatory factors in LPS-induced RAW264.7 macrophages, which may be related to the inhibition of TLR4/NF-κB signaling pathway.

Objective: Airway complications in obese patients are a major concern during surgical operation. This study aimed to determine the incidence of airway- and respiratory-related anesthetic complications for obese (including maternal) patients undergoing general anesthesia. Materials and Methods: This multicenter, retrospective, observational study evaluated obese female patients (BMI≥ 30 kg/m2), both non-pregnant and pregnant, undergoing general anesthesia in 5 hospitals across Thailand during May 2013 - August 2016. The primary observation was anesthesia-related airway complications (difficult and failed intubations, aspiration, desaturation, and airway injuries) detected during anesthesia. An analysis was performed to compare the incidents of the adverse events and to determine the risk factors for airway-related adverse events in both groups. Results: There were 1,347 obese patients enrolled (777 non-pregnant and 570 pregnant). The overall incidence of airway and respiratory complications was observed in 129 patients (9.6%), with a higher rate in pregnant patients (12.5% vs. 7.5%; p

This study aims to investigate the association between adenoid hypertrophy and facial development. A total of 388 children aged 1–13 years old who had undergone head MRI in Foshan Maternal and Child Health Hospital were collected, including 196 hypertrophic cases and 192 normal cases. The maxillofacial soft tissue indicators were measured and compared. The A/N ratio and adenoid thickness consistently increased with age in the hypertrophic group and the A/N ratio reached a maximum value three years earlier than the normal group. The pharyngeal airway space, vallecula of epiglottis to anterior plane distance of the third/fourth cervical vertebrae, angle of convexity, total angle of convexity, and the nasolabial angle in the hypertrophy group were smaller than those in the control group (p < 0.05). The thickness of adenoids, palate height, palate length, and tongue length in the hypertrophy group exceeded that of the control group (p < 0.05). To conclude, adenoid hypertrophy was associated with craniofacial features such as a convex facial profile, a narrowed nasopharyngeal airway, an elongated and heightened palate, a lengthened tongue or a lower tongue position. These findings emphasize the importance of early intervention for children with adenoid hypertrophy to mitigate potential adverse effects on maxillofacial development.

In this study, we aimed to compare supraglottic airway devices (Supreme and i-gel laryngeal mask) with tracheal tube with respect to airway control and efficiency in ventilation and oxygenation. The study included 325 patients of ASA I-II who underwent laparoscopic cholecystectomy. In group 1, the airway was secured using endotracheal intubation (115 patients). In group 2 (103 patients), LMA Supreme was applied, whereas i-gel mask was used for airway management in group 3 (107 patients). Monitoring parameters were recorded and compared using t-test, analysis of variance (ANOVA), Tukey’s test and χ2-test. The following parameters were monitored: insertion time, number of attempts for device placement, oropharyngeal seal pressure, etc. Insertion time was longest in group 1 (14.7±1.65 s) as compared to group 2 (15.5±1.05 s) and group 3 (14.1±1.27 s); ANOVA test yielded a statistically significant difference (p

Background: Aspiration of an open safety pin in the airway is an extremely rare and critical condition that needs immediate and safe removal of the foreign body (FB). An open safety pin in the airway of the pediatric patient requires urgent recognition. Imaging will confirm the exact site of the open safety pin in the airway. Rigid bronchoscopy with optical forceps or grasping forceps is an ideal tool for the removal of the open safety pin from the airway. Objective: This study aims to evaluate the clinical details, management, and outcome of pediatric patients with an inhaled open safety pin in the laryngotracheal airway. Materials and Methods: This is a retrospective descriptive study done between November 2016 and December 2021. There were six children with inhaled open safety pins in the laryngotracheal airway. The diagnosis was done through proper history taking, clinical examination, and the X-ray of the neck and chest of the children. All children underwent rigid bronchoscopy with optical forceps to remove the open safety pin. Results: Out of the six children, four were boys and two were girls. Out of the six cases, four were in the proximal part of the airway and two were seen in the distal airway. The most common clinical presentation was coughing. In this study, open safety pins of the pediatric airway were removed successfully under general anesthesia with the help of a rigid bronchoscope. Conclusion: Open safety pin is rarely found in the laryngotracheal airway. Open safety pin may cause a life-threatening complication. During the removal of the open safety pin, the surgeon should maintain maximum care to not injure the surrounding structures by the sharp end of the open safety pin.

BACKGROUND: Tracheostomy in pediatric patients is considered a surgery of significant morbidity and mortality. However, the airway management with tracheostomy in the pediatric age group has changed over time with respect to indication and outcome. OBJECTIVE: The objective of this study is to evaluate the indications and complications of pediatric tracheostomies. MATERIALS AND METHODS: This is a prospective study done on pediatric tracheostomies at a tertiary care teaching hospital. The study period was from September 2011 to October 2021. The data on age, gender, indications, and complications over 10 years were analyzed. In this study, pediatric tracheostomy was classified into prolonged intubation, obstruction in the upper airway, anomalies in the craniofacial region, neurological disorders, and vocal fold paralysis. If a child required ventilator assistance, they were placed in the prolonged intubation group. RESULTS: There were 162 pediatric tracheostomies performed during the study time. Of 162 children, 98 (60.49%) were male and 64 (39.50%) were female, with a male-to-female ratio of 1.5:1. Of 162 children, 112 (69.13%) underwent tracheostomy for prolonged ventilation and 50 (30.86%) underwent tracheostomy for upper airway obstruction. Intraoperative complications were seen in 9 (5.55%) cases of pediatric tracheostomy. There were 28 (17.28%) pediatric patients with a tracheostomy who presented with postoperative complications. CONCLUSION: Standardization of the pediatric tracheostomy, the timing of the procedure, and appropriate indications of pediatric tracheostomy are helpful to minimize morbidity and mortality in pediatric patients.

Background Spirometry is a simple diagnostic tool for pulmonary diseases, as obstructive pulmonary disorders, especially in obese. Obesity is an increasing worldwide public health concern that contributes to many respiratory problems that affect both large and small airways. The traditional use of forced expiratory volume in the first second (FEV1) and FEV1/forced vital capacity (FVC) in defining large-airflow obstruction may be confined not only by the limitation of FVC maneuver, but also by the long time to reach plateau flow rate in geriatrics and in patients with moderate-to-severe airflow obstruction. FEV3 and its derivatives FEV1/FEV3 and FEV3/FVC are used for better diagnosis of obstruction, especially in deteriorated patients who cannot blow for more than or equal to 6 s even after their best trials. Regarding small-airway obstruction, FEV3/FEV6 abnormality may be used to diagnose it in the early stages, especially with obesity. Aim To compare the accuracy of FEV3, FEV1/FEV3, and FEV3/FEV6 with that of FVC, FEV1/FVC, and forced expiratory flow (FEF) 25–75% as indices for large-airway and small-airway obstruction in obese persons, in order to replace the ordinary spirometric maneuvers that are easier to perform. Patients and methods In this study, 95 patients were enrolled. All participants were classified according to BMI into normal, overweight, and obese groups. FEV1, FEV3, FEV6, FVC, FEV1/FVC%, FEV1/FEV3%, FEV3/FVC%, and FEV3/FEV6% were determined. Results Fifty participants were males, 52.63%, and 45 were females, 47.37%. Acceptable accuracy of FEV1/FEV3 test for diagnosis of large-airway obstruction, if compared with FEV1/FVC. While FEV3/FVC test showed less-satisfied accuracy. FEV3/FEV6 failed to show an acceptable accuracy for diagnosis of small-airway obstruction when compared with FEF25–75%. Regarding the effect of BMI on spirometric values, FEV1/FVC (P = 0.027), FEV1/FEV3 (P = 0.029), and FEF25–75% (P = 0.002) were more significant in obese patients than overweight patients or normal participants. No differences in FEV3/FVC and FEV3/FEV6 were found among the various groups studied. Conclusion Targeting obese persons, FEV3 and its derivatives as FEV1/FEV3 and to a lesser extent FEV3/FVC can be used as substitutes for FVC and FEV1/FVC, respectively, for evaluation of large-airway obstruction, while FEV3/FEV6 cannot identify people with small-airflow obstruction.

Tracheal intubation using a Macintosh laryngoscope can save lives. However, because intubation is a difficult procedure to master, failures can have disastrous results. A more recent intubation tool than the Macintosh is the Airtraq optical laryngoscope, which offers glottic plane visualization without requiring correct tracheal, pharyngeal and oral axes alignment. Airtraq can improve the incidence of failed first intubations and the time required to manage an airway, especially in patients who have had cervical spine trauma which requires manual stabilization of the cervical spine. With no differences in hemodynamics or intubation duration, the Airtraq laryngoscope offered patients a better laryngeal vision than the Macintosh laryngoscope by providing shorter laryngoscopy and intubation time, and easier intubation. The aim of this literature review was to compare these two laryngoscopes with respect to endotracheal intubation. This review article was put together after a comprehensive study of the literature using the electronic databases PubMed, Medline, Embase and Google. Airtraq laryngoscope was found to be superior to Macintosh laryngoscope as it provides a better view of the glottic region with more ease and less intubation time than the conventional Macintosh laryngoscope.

Abstract We describe an unusual presentation of a suspected pediatric foreign body (FB) aspiration which was found to be an occlusive inflammatory myofibroblastic tumor (IMT) of the distal trachea. These are rarely reported entities, with the potential for significant airway bleeds. Multidisciplinary discussion and involvement allowed for a safe patient outcome.

Background: Although the most common age for foreign body (FB) aspiration (FBA) is considered from 1 to 4 years old, it can even happen earlier. Aim: The purpose of this study is to evaluate the occurrence of FBA in 6-month infants and younger. Material and methods: This study is a retrospective analysis of all the cases of FBA in infants under 6 months admitted to Namazi Hospital in Shiraz, Iran, and who underwent flexible fiberoptic bronchoscopy from September 2017 to March 2019. Results: Medical records of 38 infants under 6 months of age who underwent flexible fiberoptic bronchoscopy with a diagnosis of FBA were reviewed retrospectively. 71.1% of the infants were male. History regarding prematurity was positive in 63.2% of the neonates. 55.3% had different degrees of tooth eruption. Sudden-onset cough (97.4%), noisy breathing (92.1%), and cyanotic spells (52.6%) were the 3 most common reported symptoms before hospitalization. Most (73.7%) aspirations occurred in the presence of parents or caregivers. 7.9% of the infants had normal radiographic results. Only 21.1% of the patients were diagnosed and managed within 24 hours after the aspiration. The most common aspirated FBs were organic objects. Conclusion: Although FBA is more common in older children, it can also occur in infants younger than 6 months. Families, and especially physicians, should be fully informed of the possibility of aspiration at an early age, which can reduce the occurrence of FBA and its irreversible effects.

Summary: Background: Age-related comorbidities such as chronic obstructive pulmonary disease (COPD) are common in people living with human immunodeficiency virus (PLWH). We investigated the relationship between COPD and the epigenetic age of the airway epithelium and peripheral blood of PLWH. Methods: Airway epithelial brushings from 34 PLWH enrolled in the St. Paul's Hospital HIV Bronchoscopy cohort and peripheral blood from 378 PLWH enrolled in The Strategic Timing of Antiretroviral Treatment (START) study were profiled for DNA methylation. The DNA methylation biomarker of age and healthspan, GrimAge, was calculated in both tissue compartments. We tested the association of GrimAge with COPD in the airway epithelium and airflow obstruction as defined by an FEV1/FVC

Background: We designed this prospective observational study in order to evaluate whether conventional predictors of “Difficult airway” truly predict difficult airway in patients who present for cleft surgeries at Cleft Centre Peradeniya. Methods: One hundred and two babies between the ages of 2 months to 18 months who underwent cleft lip or palate repairs at Cleft centre, Peradeniya August 2015 to April 2016 were included in the study. For each of the patients, we gave a grade for the degree of mouth opening and the laryngoscopic view prior to surgery. Results: Out of the 102 participants, 9.8% of patients had difficult laryngoscopy. At least one out of seventeen studied “predictors of difficult airway,” was found in seven patients out of the 10 in whom laryngoscopy was difficult. There was a significant association of difficult laryngoscopy with reduced mouth opening. Furthermore, factors such as the presence of microstomia, micrognathia, retrognathia, and short neck were significantly associated with difficult laryngoscopy in Cleft Lip and Cleft palate patients who underwent surgical repair.

OBJECTIVE: To find out any noticeable size difference in the superior airway at the end of premolar extraction treatment and to find out the effects of extraction on axial inclinations of anterior teeth. METHODOLOGY: It was a retrospective quasi-experimental study that consisted of 30 orthodontic patients in which all four first premolars were extracted. The orthodontic treatment of the participants was done at Department of Orthodontics, Jinnah Medical and Dental College, Karachi. The data was collected from January 2020 to March 2020. Sampling technique selected was consecutive which is a non- probability type of sampling. The cases included in this study were skeletal and dental class I having class I molar relationship with crowding that required all four first premolar extractions. Patients having syndromes or in need of orthognathic surgery were excluded from this study. The analysis was done on Lateral Cephalometric radiograph which was captured in the beginning and another one once treatment was completed. On these radiographs, changes in the soft palate and upper airway widths were measured. RESULTS: No appreciable alterations observed in the superior airway and soft palate widths. The difference observed in the upper incisors inclination was significant when compared to their pretreatment values. CONCLUSION: No appreciable change has been noted in the airway dimensions after extraction of premolars. The extractions done as a part of orthodontic treatment results in a great improvement in the correction of proclinations of anterior teeth and reduction of lip procumbency.

Introduction: Repositioning of the maxilla is usually a part of the treatment of skeletal deformities. Lefort I osteotomy is a surgical technique introduced to perform these movements. Since the introduction of this technique, surgeons have found its inevitable effects on the form and function of the nasal cavity. Some researchers have examined these changes by measuring nasal airflow and. Therefore, the present study aimed to evaluate the differences in nasal airflow and resistance after maxillary movement surgeries. Materials and Methods: The current study was conducted on 21 patients referred to the Oral and Maxillofacial Surgery Department, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran. All of these patients needed Lefort I and were divided into three groups, namely anterior displacement, upper displacement, and upper-posterior displacement. To perform the necessary examinations, anterior rhinomanometry test and lateral cephalometric radiographs were carried out 1 week pre-operationally and 3 months post-operationally. Result: According to results of the rhinomanometric and radiographic assessment, the most and the least improvements in nasal function occurred in the upper and anterior maxillary displacement groups, respectively. Regardless of the group, the mean scores of airflow and air passage resistance increased and decreased after the surgery, respectively; however, none of these changes were statistically significant. Conclusion: If the maxillary surgery is performed with the correct technique, it will not cause breathing problems.

Abstract Fractured tracheostomy tube is a rare, late complication. It typically occurs at the junction of metallic tube. We report an atypical case with laceration of the main trunk of a silastic tube after short period of use (10 days).

BACKGROUND AND OBJECTIVE: Damage to the endotracheal tube cuff during general anesthesia can cause ventilatory failure for the patient. The aim of this study is to report structural defect and herniation of the endotracheal tube cuff in a patient undergoing lumbar discectomy in the prone position. CASE REPORT: The patient was a 77-year-old woman who was a candidate for Lumbar discectomy who referred to Kowsar Hospital in Sanandaj for surgery. The patient underwent general anesthesia with a spiral endotracheal tube in the prone position. After 30 minutes of surgery, there were symptoms of increased airway pressure, decreased saturation, and increased carbon dioxide. Postoperative examinations revealed that the patient's endotracheal tube cuff had a hernia which blocked the airway; the problem was resolved and surgery continued. Diagnosis and treatment of this case have important and significant points that are mentioned below. CONCLUSION: Structural defects in the endotracheal tube and its cuff may cause insufficient ventilation of the patient and reduce the delivery of anesthetic gases to the patient. The definitive solution to endotracheal tube cuff defect is replacement, but conservative measures may be used as a temporary solution in some clinical situations. The anesthesia team should be prepared with adequate equipment, programs, and personnel to follow “​Guidelines for Management of the Difficult Airway” developed by the American Society of Anesthesiologists (ASA) in the case of loss of air exchange in the patient.

BACKGROUND AND OBJECTIVE: Tracheostomy is one of the most common surgeries in patients with upper airway defects. Tracheostomy is a surgical procedure to open a side passage through the neck into the trachea to stabilize the airway. The complications of this operation are very important, common and at the same time preventable. The purpose of this article is to report a case of a fractured fragment of tracheostomy tube entering the left bronchus. CASE REPORT: The patient was a 34-year-old man diagnosed with amyotrophic lateral sclerosis and quadriplegia, who has had a tracheostomy tube for 7 years, who referred with complaint of shortness of breath following a tracheostomy tube fracture. The patient had 60% saturation and significant respiratory distress. After confirming the fracture of the tracheostomy tube with a CT scan of the lung, the fractured fragment was removed with rigid bronchoscopy and the tracheostomy tube was re-inserted for the patient. The patient was discharged from the hospital two days after tracheostomy. CONCLUSION: In case of shortness of breath and decreased saturation, tracheostomy tube fracture should be considered. Proper cleaning and planned replacement of the tracheostomy tube may prevent this complication.

Endotracheal intubation is the gold standard in inpatient treatment of cardiac arrest patients; however, there are conflicting research results in out-of-hospital conditions. This prospective study included 92 patients with confirmed cardiac arrest occurring outside a hospital facility, who fulfilled the inclusion criteria and whom the emergency ambulance team reached within 20 minutes from the event. Medical data on each patient (age, gender, cause of arrest, estimated time of arrest, time to arrival of the ambulance team, resuscitation commenced prior to arrival of the ambulance team, initial electrocardiographic rhythm, method of airway management, and success of resuscitation) were recorded. The airway maintenance techniques applied in the patients were endotracheal intubation and I-gel laryngeal mask (LMA). The rate of spontaneous circulation recovery resulting from different techniques of airway management and the incidence of spontaneous circulation recovery between the defibrillation rhythm and non-defibrillable rhythm groups were recorded for each patient. Forty-seven patients received endotracheal tube and the rest of 45 patients I-gel LMA treatment. The ratio of achieving spontaneous circulation with intubation versus I-gel LMA was 13 (28%) to 11 (24%) (p=0.725). The best return of spontaneous circulation results was recorded in patients suffering from ventricular fibrillation; however, there was no statistically significant difference between the intubation and I-gel LMA treatments (8 (47%) vs. 7 (41%); p=0.916). No statistically significant difference was observed between the outcomes of patients resuscitated by endotracheal intubation and I-gel LMA methods either.

Rhino-orbital-cerebral mucormycosis (ROCM) is an aggressive, lethal, angioinvasive fungal infection that has presented as an opportunistic infection in the backdrop of a highly infectious and severe second coronavirus disease 2019 (COVID-19) wave in India. The dominant delta strain during the second wave led to an unprecedented rise in hospital admissions with moderate to severe COVID-19 illness. A working staging system is helpful in triaging these patients to prioritize surgical debridement and liposomal amphotericin B induction therapy. The evaluation and optimization of post-COVID-19 sequelae becomes a cornerstone in achieving a favorable perioperative outcome. As anesthesiologists, we share our experience in managing this novel subset of patients. Post-COVID-19 sequelae with a prothrombotic state and multisystem involvement, challenging and shared airway, and amphotericin B-related complications are being the key concerns.

Introduction: Mucormycosis, an aggressive fungal infection may result in a difficult airway owing to its inflammation. King Vision Video Laryngoscope (KVVL) is a useful addition to a difficult airway armamentarium. McCoy laryngoscope with hinged tip is well-known equipment of difficult airway cart. Conventional Macintosh laryngoscope dominates in anaesthesia practice. Standard, existing and contemporary devices were compared in difficult airways resulting from mucormycosis. Aim: To compare the relative performance of KVVL, McCoy, and Macintosh laryngoscopes based on the ease of intubation and haemodynamic response in patients with mucormycosis. Materials and Methods: The present study was a randomised clinical trial, conducted in a tertiary care government hospital, during June-August 2021 on 90 consenting patients of 18-65 years age, belonging to either sex with microbiologically confirmed mucormycosis undergoing debridement surgery. Group A was intubated with a non channeled KVVL, while group B had McCoy and group C had Macintosh laryngoscope. Primary outcome parameters were Cormack Lehane (CL) grade, time from laryngoscopy to successful intubation, number of attempts, any adjuncts or optimisation maneuvers, and any mucosal injury. Secondary outcome parameters were Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Blood Pressure (MBP) measured on arrival, before induction, after induction, and at 1, 2, 3, 5, and 7 minutes after intubation. Comparison of quantitative variables not normally distributed were analysed using Kruskal-Wallis test. Post-hoc analysis by Dunn’s multiple pairwise comparison test. Friedman test followed by pairwise comparison was done to compare haemodynamic parameters within each group. Chi-square test was used for qualitative variables. The p-value ≤0.05 was considered to be statistically significant. Results: The CL grade was lowest in group B (1.83±0.38) against group A (1.93±0.25), group C (2.13±0.35) with p-value of 0.029. Time from laryngoscopy to successful intubation was the least in group B (19.5±3.98 seconds) against group A (26.07±9.8 seconds), group C (21.33±3.74 seconds) with p-value of 0.002. No significant difference was there in the number of attempts, airway adjuncts/optimisation maneuvers, mucosal injury. Haemodynamic variables were comparable. Conclusion: McCoy laryngoscope was found to perform best in difficult airways resulting from mucormycosis. It was most effective for glottic visualisation, with the shortest time to successful intubation and, haemodynamic parameters were comparable to KVVL and macintosh laryngoscopes.

Introduction: The Airtraq is a new intubation device that has been developed to facilitate tracheal intubation in patients with normal or difficult airway. The available paediatric sizes are 0, 1 and 2 and are of grey, purple, green colour. These can insert endotracheal tube of size 2.0-3.5/4-5.5/6-7.5, respectively. Aim: To evaluate the clinical efficacy of Airtraq laryngoscope in comparison with Macintosh by experienced Anaesthesiologist for intubation in paediatric patients. Materials and Methods: The randomised controlled trial was conducted at Sarojini Naidu Medical College, Agra, Uttar Pradesh, India, from December 2015 to August 2017. Fifty healthy children, aged 2-10 years of American Society of Anesthesiologists (ASA) grades I/II, presenting for elective surgery were randomly allocated in two equal groups. Endotracheal intubation was done either using Airtraq or Macintosh laryngoscope. Duration of intubation (primary variable), number of attempts, ease of intubation, oesophageal intubation, optimisation maneuvers, Percentage Of Glottic Opening (POGO) scoring and haemodynamic parameters were compared between two groups. Patients’ demographic data, intubation time, haemodynamic variables were analysed by Unpaired t-test. While number of attempts for intubation, ease of intubation, optimisation maneuvers and POGO scoring were analysed by Fisher’s-exact test. Data was presented as mean±SD with categorical data presented as frequency (n) and percentages (%). The p-value of

Background: External laryngeal trauma is rare. It has a population incidence of 1 in 137,000 in adults. In developing countries blunt trauma is more common than penetrating trauma. Blunt trauma may occur due to accidents, sports injuries or hanging. Laryngeal trauma manifests as a spectrum of symptoms and signs ranging from cardiopulmonary arrest to subtle changes in voice quality. The most common presenting feature of laryngeal trauma is hoarseness, followed by dysphagia and pain. Although blunt laryngeal trauma is rare, but it can be life threatening. So, its early and proper management will remarkably affect the immediate probability of patient’s survival and their long term quality of life. Methods: In this cross-sectional and descriptive study, medical records of 30 patients with blunt laryngeal trauma, who were admitted in ENT ward of Imam Reza hospital over a 10-year period, were evaluated. Results: 30 patients, including 27 (90%) males and 3 (10%) women were studied. Mean age of patients was 36.13±10.53 years. The most common cause of blunt laryngeal trauma was vehicle accidents. The most common presenting symptoms were neck pain and tenderness. Subcutaneous emphysema was the most common radiological finding. The most common laryngoscope findings were swelling and hematoma of true vocal cords. Treatment modalities were supportive therapy performed on 26(86.7%) patients, tracheotomy on 3(10%) patients and open surgery on 1(3.3%) patients. Also 2 (6.7%) patients required intubation. Conclusion: In most patients suffering from mild trauma, conservative therapy is mostly administered. Any delay in early and proper diagnosis and treatment may be life threatening. So in such situations the patient's airway should be evaluated by skillful experts and emergency procedures have to be applied. Also any changes in patient's signs should be monitored frequently and the required diagnostic and therapeutic procedures must be applied.

Background and purpose: Airway assessment is very important in anesthesia. The aim of this study was to determine the diagnostic value of Mallampati test indicators in supine and sitting positions with and without phonation in anesthesia candidate patients. Materials and methods: This cross-sectional descriptive study (diagnostic approach) was done in 200 adult patients ≥16 years, undergoing surgery in hospitals affiliated with Mazandaran University of Medical Sciences, 2018-2019. Diagnostic indicators of Mallampati test, including accuracy, sensitivity, specificity, and positive and negative predictive values, in sitting and supine positions with and without phonation were determined before induction of anesthesia. Correlation between different Mallampati test methods was determined applying standard Cormac Lehane test. Results: Based on Cormack-lehane scoring, laryngoscopy was very difficult in 5.5% (n=11) and difficult in 12% (n= 24), respectively. The correlation coefficients between Cormack Lehane test and Mallampati test in sitting and supine positions with phonation were 0.332 and 0.284, respectively. The highest sensitivity (82.9%) and specificity (80%) were found in supine position without phonation and sitting position with phonation, respectively. In supine position with phonation, the sensitivity and specificity were 65.7 % and 67.9%, respectively. The accuracy of the sitting position with phonation was 77.4%. Conclusion: The highest correlation between Malapmati test and Cormac Lehane test was in sitting position with phonation. Also, Malapmati test in supine position with phonation, has high sensitivity and specificity and is recommended as a suitable alternative for airway assessment.

Background and purpose: Respiratory function of patients is a major part of orthodontic diagnosis and treatment planning. It is affected by the dimensions of the pharyngeal airway. In this study, these dimensions were compared in patients with different skeletal patterns. Materials and methods: This cross-sectional descriptive-analytical study was performed studying the cephalograms of patients attending the Orthodontic Clinic affiliated with Mazandaran University of Medical Sciences 2016-17. After tracing, 144 cephalograms were divided into three groups: class I, II, and III (n= 48 per group) based on the ANB angle. The nasopharyngeal, oropharyngeal, and hypopharyngeal dimensions were measured. Data were analyzed using SPSS V24. Results: The highest mean dimensions amongst nasopharyngeal, oropharyngeal, and hypopharyngeal spaces were found in class I (21.25mm), III (10.49mm), and III (15.89mm), respectively. There was no significant difference between class I and II in the nasopharyngeal space (P=0.108). There were significant differences in the mean dimensions of all three spaces studied between class I and III and class II and III (P

Background: The prevalence of asthma in prepuberty women is more common than in puberty men. Even after puberty, to a certain age, women dominate more. It is still unclear whether sex hormones affect the histological structure of male and female airways. Objective: This study objective was to examine the effect of sex difference on the histological structure of bronchial and nasal cavity of mice model (Mus musculus) with ovalbumin exposure. Materials and Methods: This study used 24 mice in four groups (male control, female control, male asthma model, and female asthma model). At the sensitization phase in days 0 and 14, the mice were injected intraperitoneally with 100 μl of a mixture of 50 μl ovalbumin (200 μl/ml) and 50 μl alum. At the exposure phase in days 21 to 23, the mice were exposed to 1% ovalbumin (aerosol, 30 minutes/per day). The mice were sacrificed 48 hours after the last exposure. The data taken included four variables, bronchial epithelial thickness, bronchial smooth muscle thickness, nasal cavity goblet cells number, and nasal cavity mucosal thickness. Then, Shapiro-Wilk normality test and parametric t-test were conducted. Results: In animal asthma models, mice with male and female exposure did not cause differences in epithelial thickness and smooth muscle thickness in bronchus compared to the control group. However, there were significant differences in the number of goblet cells and mucosal thickness in nasal cavity of male and female mice compared to the control group (respectively, p= 0.002; p= 0.006 and p= 0.003; p = 0.005). There were no significant differences between groups of male and female mice on all variables. Conclusion: In animal asthma models of mice, ovalbumin exposure did not cause differences in the values of all variables between male and female groups.

Spinal cord injury (SCI) is a devastating neurological disorder that is estimated to affect approximately 1000 patients each year in the Republic of Turkey. With this review, we aim to update the recent evidence related to the acute management of patients with SCI in out-of-hospital and emergency department settings. We performed a literature review of publications in the English language and indexed in PubMed, ScienceDirect and Scopus using the following search terms: “spinal cord injury” and “acute management”, “spinal cord injury” and “immobilisation”, “spinal cord injury” and “transfer”, “spinal cord injury” and “transport”, “spinal cord injury” and “airway management”, “spinal cord injury” and “haemodynamic management”, “spinal cord injury” and “steroid”. We also reviewed the recent international guidelines. This review reports the immobilisation of patients with SCI and management strategies relevant to their transfer, airway management in cervical SCI, haemodynamic management and methylprednisolone use. The patient’s spinal alignment should be maintained with appropriate techniques for sufficient immobilisation to ease safe extrication and transport. Patients with acute SCI should be promptly and carefully transported from the place of injury to the nearest specialist SCI facility.

Managing the airway of patient with postburn contracture at the neck is often challenging for otolaryngologists and anesthesiologists. It affects the oro-pharyngo-laryngeal airway axes because of anatomical and functional deformities because of the long-standing contracture in the face and neck region. We present a case of extensive neck postburn contractures distorting anatomy, whose airway was assessed and managed using a video fiberoptic bronchoscope (FOB) (Ambu® aScope™). Our experience of the utility of FOB mirrors the experience and literature in the management of difficult airway.