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A letter to the editor is presented in response to the article "Nasotracheal intubation of a patient with restricted mouth opening using a McGrath MAC X-Blade and Magill forceps," by Z. İ. Arslan and colleagues.

A letter to the editor is presented in response to the article "Face-to-face tracheal intubation in adult patients: A comparison of the Airtraq, Glidescope and Fastrach devices," by Z.I. by Arslan et al., published in a previous issue of the journal.

A letter to the editor is presented in response to the article "Does topical lidocaine before tracheal intubation attenuate airway responses in children? An observational audit," by N. D. Hamilton and colleagues in an issue in 2012.

A letter to the editor is presented in response to an article regarding the intraoral fixation method in fixing endotracheal tube (ETT) during craniomaxillofacial surgery.

Re: Intermittent peri-tubal instillation of dexamethasone and ropivacaine on postoperative analgesia after percutaneous nephrolithotomy: A prospective randomized controlled trial In a prospective double-blinded randomized controlled trial including 64 patients who underwent percutaneous nephrolithotomy, Ahuja et al.1 assessed the effect of additional dexamethasone on the efficacy of intermittent peri-tubal ropivacaine infiltration for postoperative pain control and showed that the addition of dexamethasone to local anesthetic can significantly prolong the duration of analgesia. Indeed, the NRS scores at 4, 6, 12, 48, and 60 h postoperatively were significantly increased in patients receiving ropivacaine alone compared to patients receiving dexamethasone and ropivacaine. [Extracted from the article]

The available evidence indicates that preoperative pain is common among patients undergoing arthroscopic shoulder surgery and both preoperative pain severity and opioid use are the strongest independent risk factors of postoperative pain [[2]]. Keywords: Remifentanil; Shoulder arthroplasty; Postoperative analgesia; Analgesic consumption EN Remifentanil Shoulder arthroplasty Postoperative analgesia Analgesic consumption 665 666 2 09/30/22 20221001 NES 221001 This comment refers to the article available online at https://doi.org/10.1007/s00540-022-03085-0. [Extracted from the article]

A letter to the editor in response to the article "Changes in mortality patterns following total hip or knee arthroplasty over the past two decades: a nationwide cohort study" in the February 2014 issue is presented.

As adequate movement pain control is very important for postoperative functional recovery in patients undergoing AKT, we were very interested in knowing why designed goal of postoperative pain control was not achieved in some time points, especially for patients receiving ACB alone. Keywords: iPACK; Adductor canal block; Periarticular block; Postoperative analgesia; Total knee arthroplasty EN iPACK Adductor canal block Periarticular block Postoperative analgesia Total knee arthroplasty 447 448 2 06/03/22 20220601 NES 220601 This comment refers to the article available online at https://doi.org/10.1007/s00540-022-03047-6. Adductor canal block, Postoperative analgesia, Total knee arthroplasty, iPACK, Periarticular block. [Extracted from the article]

What is already known and objective: Sedation is routinely provided for patients undergoing gastrointestinal endoscopy. Remimazolam tosilate is a novel and short‐acting sedative agent that has been used for sedation during endoscopic procedures. The optimal dose of remimazolam in gastrointestinal endoscopy for patients with liver cirrhosis has not been elucidated. Background: To determine the effective dose of remimazolam tosilate with adjuvant sufentanil for sedation in patients with liver cirrhosis undergoing oesophagogastric varices screening endoscopy. Material and Methods: Patients aged 18–65 years with liver cirrhosis undergoing screening endoscopy for oesophagogastric varices were recruited. Sufentanil 0.15 μg/kg was given intravenously at 2 min before administration of remimazolam tosilate. The initial dose of remimazolam was 0.1 mg/kg and adjusted by 0.025 mg/kg as a step size, based on the Dixon and Massay up‐and‐down sequential method. Inclusion of patients was stopped after eight crossovers and the calculated median effective dose (ED50) of remimazolam for successful endoscopy was obtained by calculating the mean of midpoint of all crossovers. Furthermore, a probit regression was applied to establish the dose–response curve of remimazolam and further assess the 95% effective dose (ED95) of remimazolam. Results: The calculated ED50 of remimazolam for successful endoscopy using the mean of midpoint of all crossovers was 0.097 mg/kg (95% CI, 0.004–0.099 mg/kg). Using the probit regression analysis, the ED50 and ED95 of remimazolam for successful endoscopy was 0.097 mg/kg (95% CI, 0.004–0.099 mg/kg) and 0.107 mg/kg (95% CI, 0.103–0.336 mg/kg), respectively. No adverse events were observed throughout the study period. Conclusions: This pilot study suggests that the ED50 and ED95 of remimazolam tosilate with adjuvant sufentanil for sedation in liver cirrhosis patients undergoing oesophagogastric varices screening endoscopy was 0.097 and 0.107 mg/kg, respectively. [ABSTRACT FROM AUTHOR]

Background: Oxygen-desaturation episodes, blood pressure drops, and involuntary body movement are common problems that occur in propofol-based sedation in the procedure of painless gastrointestinal (GI) endoscopy. As a widely used analgesic adjuvant, intravenous lidocaine can reduce the consumption of propofol during ERCP or colonoscopy. However, it is still unknown how lidocaine affects the incidence of oxygen-desaturation episodes and cardiovascular events, and involuntary movement during painless GI endoscopy. Therefore, we aimed to assess the effectiveness and safety of intravenous lidocaine in propofol-based sedation for GI endoscopy.Methods: We will conduct a single-center, prospective, randomized, double-blind, saline-controlled trial. A total number of 300 patients undergoing painless GI procedures will be enrolled and randomly divided into the lidocaine group (Group L) and the control group (Group C). After midazolam and sufentanil intravenous injection, a bolus of 1.5 mg/kg lidocaine was immediately injected and followed by a continuous infusion of 4 mg/kg/h in the lidocaine group, whereas the same volumes of saline solution in the control group. Then, propofol was titrated to produce unconsciousness during the procedure. The primary outcome will be the incidence of oxygen-desaturation episodes. Secondary outcomes will be the incidence of involuntary body movement, discomfort symptoms, propofol consumption, endoscopist, and patient satisfaction.Discussion: Propofol-based deep sedation without intubation is widely used in painless GI endoscopy. However, adverse events such as hypoxemia often occur clinically. We expect to assess the effect of lidocaine on reducing the incidence of oxygen-desaturation episodes, cardiovascular events, and involuntary body movement. We believe that the results of this trial will provide an effective and safe method for painless GI endoscopy.Trial Registration: Chinese Clinical Trial Registry ChiCTR2100053818. Registered on 30 November 2021. [ABSTRACT FROM AUTHOR]

Background Both morphine and limb remote ischemic perconditioning (RIPer) can protect against myocardial ischemia/reperfusion injury (IRI). This experiment was designed to assess whether combined morphine and limb RIPer could provide and enhanced protection against myocardial IRI in an in vivo rat model. Methods One hundred male Sprague–Dawley rats were randomly allocated to six groups: sham, ischemia/reperfusion (IR), ischemic preconditioning, RIPer, morphine (M), and combined morphine and remote ischemic perconditioning (M + RIPer). Ventricular arrhythmias that occurred during ischemia and early reperfusion were scored, and serum creatine kinase isoenzyme and cardiac troponin I levels were assayed. The infarct size was determined by Evans blue and triphenyl tetrazolium chloride staining. The apoptosis in the myocardial ischemic core, ischemic border, and nonischemic areas was assessed through real-time polymerase chain reaction for Bax and Bcl-2 and with the transferase-mediated deoxyuridine triphosphate-biotin nick end labeling assay. Results The infarct size, serum cardiac troponin I level, incidence, and score of the arrhythmias during the initial reperfusion were significantly reduced in the M + RIPer group compared with the IR group but did not differ significantly between the ischemic preconditioning and M + RIPer groups. Transferase-mediated deoxyuridine triphosphate-biotin nick end labeling–positive cells were significantly decreased, and the Bcl-2/Bax ratio was significantly increased in the M + RIPer group compared with the IR group. Conclusions This experiment demonstrates that combined morphine and limb RIPer provides an enhanced protection against myocardial IRI by the Bcl-2-linked apoptotic signaling pathway. [ABSTRACT FROM AUTHOR]

Within the airway management field, simulation has been used as a tool of training for over 40 years. Simulation training offers a chance of active involvement for the trainees. It can effectively enhance and upgrade the knowledge and skills of the trainees in airway management, and subsequently decrease medical errors and improve patients' outcomes and safety through a variety of airway management training modalities, such as common airway skills, difficult airway management strategies, and crisis management skills. To perform simulation-based airway management training effectively, not only are task trainers and high-fidelity simulators required but also instructors with rich experience in airway management simulation training and optimal curriculum design are essential. [ABSTRACT FROM AUTHOR]

Various combined interventions to acquire enhanced cardioprotection are prevalent focuses of current research. This randomized experiment assessed whether combined vagal stimulation perconditioning (VSPerC) and limb remote ischemic perconditioning (LRIPerC) improved cardioprotection compared to the use of either treatment alone in an in vivo rat model of myocardial ischemia/reperfusion injury. A total of 100 male Sprague Dawley rats were randomly allocated into five groups: sham group, ischemia/reperfusion (IR) group, VSPerC group, LRIPerC group, and combined VSPerC and LRIPerC (COMPerC) group. Serum enzymatic markers, inflammatory cytokines, myocardial inflammatory cytokines, and infarct size were assessed. Infarct size decreased significantly in the COMPerC group compared to the VSPerC and LRIPerC groups. Serum intercellular adhesion molecule 1 (ICAM-1) level at 120 min of reperfusion, myocardial interleukin-1 (IL-1), ICAM-1, and tumor necrosis factor α (TNF-α) levels in the ischemic region decreased significantly in the COMPerC group compared to the VSPerC group, but myocardial IL-10 levels in the nonischemic region increased markedly in the COMPerC group. Serum TNF-α levels at 30, 60, and 120 min of reperfusion; serum IL-1, IL-6, ICAM-1, and high mobility group box-1 protein (HMGB-1) levels at 120 min of reperfusion; and myocardial IL-1, IL-6, ICAM-1, and TNF-α levels in the ischemic region decreased significantly in the COMPerC group compared to the LRIPerC group. However, myocardial IL-10 levels in both ischemic and nonischemic regions were evidently higher in the COMPerC group. This study concludes that combined VSPerC and LRIPerC enhances cardioprotection compared to either treatment alone. This result is likely attributable to a more potent regulation of inflammation. [ABSTRACT FROM AUTHOR]

Background: The combination of various interventions to obtain enhanced cardioprotection is always an important area of research focus. This randomized experiment was designed to assess whether combined fentanyl and limb remote ischemic postconditioning produced enhanced protection against myocardial ischemia/reperfusion injury in an in vivo rat model, and to determine if κ-opioid receptors were implicated in the cardioprotection of these interventions. Methods: Seventy-two rats were exposed to a 30-min myocardial ischemia followed by a 180-min reperfusion. Half of the rats (36) were randomized into four different groups receiving control treatment, fentanyl postconditioning, limb remote ischemic postconditioning, and combined fentanyl and limb remote ischemic postconditioning. The remaining 36 rats were also randomized into four groups receiving the same interventions as the above groups following the intravenous administration of a κ-opioid receptor antagonist, nor-binaltorphimine, before myocardial ischemia. At the end of reperfusion, both serum cardiac troponin I and infarct size were determined. Results: Both fentanyl postconditioning and limb remote ischemic postconditioning significantly decreased the infarct size and serum cardiac troponin I level, and combined fentanyl and limb remote ischemic postconditioning produced enhanced cardioprotection on the infarct size-sparing effect. The use of nor-binaltorphimin to block κ-opioid receptors eliminated cardioprotection by fentanyl postconditioning and enhanced cardioprotection by combined fentanyl and limb remote ischemic postconditioning, but did not change cardioprotection by limb remote ischemic postconditioning. Conclusions: Combined fentanyl and limb remote ischemic postconditioning produced enhanced protection against myocardial ischemia/reperfusion injury. κ-Opioid receptors are essential for cardioprotection by fentanyl postconditioning and enhanced cardioprotection by combined fentanyl and limb remote ischemic postconditioning; however, they do not play a pivotal role in cardioprotection by limb remote ischemic postconditioning. [ABSTRACT FROM AUTHOR]

Background: Available literature indicates that long-term drinkers demand a higher dose of propofol for induction of anesthesia than non-drinkers. However, there is no study having assessed the influence of long-term high-risk drinking (LTHRD) on the effective doses of propofol for successful insertion of gastroscope with sedation. This study was designed to compare the effective doses of propofol for successful insertion of gastroscope between LTHRD and non-drinking (ND) Chinese male patients. Methods: Thirty-one LTHRD patients and 29 ND male patients undergoing elective gastroscopy with propofol sedation were enrolled. The modified Dixon's up-and-down method was applied to determine the calculated median effective dose (ED50) of propofol for successful insertion of gastroscope. Furthermore, the isotonic regression analysis was used to establish the dose–response curve of propofol and assess the effective doses of propofol where 50% (ED50) and 95% (ED95) of gastroscope insertions were successful. Results: The calculated ED50 of propofol for successful insertion of gastroscope was 1.55 ± 0.10 mg/kg and 1.44 ± 0.11 mg/kg in the LTHRD and ND patients. The isotonic regression analysis further showed that ED50 and ED95 of propofol for successful insertion of gastroscope was 1.50 mg/kg (95%CI, 1.40–1.63) and 1.80 mg/kg (95%CI, 1.74–1.90) in the LTHRD patients, respectively; 1.40 mg/kg (95% CI, 1.27–1.57) and 1.60 mg/kg (95%CI, 1.56–1.65) in the ND patients. The ED50 of propofol for successful insertion of gastroscope was not significantly different between LTHRD and ND patients. Conclusions: This study demonstrates that the difference in the estimated ED50 of propofol for successful insertion of gastroscope between LTHRD and ND Chinese male patients was not statistically significant. Trial registration: The study was registered on November 28, 2020 (ChiCTR2000040382) in the Chinese Clinical Trial Registry. [ABSTRACT FROM AUTHOR]

Anaesthesia 1996; 51: 114 - 8. 4 Mahawongkajit P, Talalak N, Soonthornkes N. Comparison of lidocaine spray and lidocaine ice popsicle in patients undergoing unsedated esophagogastroduodenoscopy: A single center prospective randomized controlled trial. We read with interest the recent article by Martín-Marcos I et al i .1 evaluating the effectiveness of pharyngeal lidocaine anesthesia for esophagogastroduodenoscopy. First, topical lidocaine increased the proportion of procedures where endoscopists rated patient tolerance as good, but all procedures in the control group were successfully completed. [Extracted from the article]

Objective: To determine the optimal intervention time of the vagal stimulation (VS) attenuating myocardial ischemia/reperfusion injury (IRI). Methods: One hundred and twenty male SD rats were randomly allocated into six groups: sham group, IRI group, the VS performed at 15 min of ischemia (VSI15) group, the VS performed immediately before reperfusion (VSR0) group, the VS performed at 30 min of reperfusion (VSR30) group, and the VS performed at 60 min of reperfusion (VSR60) group. Rats in each group were further allocated into subgroups A and B. In each group, the hemodynamics and ventricular arrhythmias were continuously observed. In the subgroup A, serum inflammatory cytokine levels were tested, and infarct size was assessed. In the subgroup B, myocardial inflammatory cytokine levels in both ischemic and non-ischemic regions were assayed. Results: As compared to the IRI, VSR0, VSR30 and VSR60 groups, infarct size, serum HMGB-1 and ICAM-1 levels at 120 min of reperfusion, myocardial HMGB-1, IL-1 and IL-6 levels in non-ischemic region, myocardial ICAM-1 level in ischemic region were all significantly decreased in the VSI15 group. Compared with the IRI group, myocardial IL-10 levels in both ischemic and non-ischemic regions were significantly increased in the VSI15 group. Compared to the IRI, VSR0, VSR30 and VSR60 groups, incidence and score of ventricular arrhythmia during initial reperfusion were significantly decreased in the VSI15 group. Conclusions: The VS performed at 15 min of ischemia provides the best protection against myocardial IRI. Also, early modulation on inflammatory responses caused by myocardial IRI may contribute to this best cardioprotection. [ABSTRACT FROM AUTHOR]

Early postoperative fluid overload precedes acute kidney injury and is associated with higher morbidity in pediatric cardiac surgery patients. Effects of intraoperative dexmedetomidine on the incidence of acute kidney injury in pediatric cardiac surgery patients: a randomized controlled trial. Keywords: acute kidney injury; cardiac surgery; dexmedetomidine; pediatric patients EN acute kidney injury cardiac surgery dexmedetomidine pediatric patients 506 507 2 03/30/21 20210401 NES 210401 B SIR b - By a randomized controlled trial, Kim et al1 assessed effect of intraoperative dexmedetomidine on the incidence of acute kidney injury (AKI) after pediatric cardiac surgery and showed that this intervention could not significantly reduce incidence of AKI. [Extracted from the article]

This letter to the editor has made several comments regarding possible statistical issues in recent article by Wang et al. determining the risk factors of continuous renal replacement treatment after emergency surgery for type A acute aortic dissection, which is published in Journal of Cardiothoracic Surgery. 2020; 15(1):100. Our comments were involved in the issues of using the propensity score matched cohorts to adjust the covariates that can potentially confound the primary outcomes, process of establishing multivariate model and application of Kaplan-Meier curve analysis in this retrospective study. We would like to remind readers to pay special attention to these issues and invite the authors to comment on these. [ABSTRACT FROM AUTHOR]

Reference 1 Panghal R, Mitra S, Singh J, Sarna R, Goel B. Oral acetaminophen as an adjunct to continuous epidural infusion and patient-controlled epidural analgesia in laboring parturients: a randomized controlled trial. Given that labor pain is an acute pain and oral acetaminophen has a slow onset time, we argue that appropriate time of oral acetaminophen administration should be an important part of study design for achieving best effect of combined PCELA. Keywords: Acetaminophen; Patient-controlled epidural analgesia; Labor pain EN Acetaminophen Patient-controlled epidural analgesia Labor pain 328 328 1 04/01/22 20220401 NES 220401 This comment refers to the article available online at https://doi.org/10.1007/s00540-021-02975-z. [Extracted from the article]

Anesthetic strategy for obese patients during gastroscopy: deep sedation or conscious sedation? To the Editor: In recent article of Kang et al. [[1]] comparing deep sedation versus conscious sedation for gastroscopy in obese patients, patients' positions during gastroscopy were not provided. Keywords: Sedation; Gastroscopy; Obese patients EN Sedation Gastroscopy Obese patients 327 327 1 04/01/22 20220401 NES 220401 This comment refers to the article available online at https://doi.org/10.1007/s00540-021-02951-7. [Extracted from the article]

Comparison of single minimum dose administration of dexmedetomidine and midazolam for prevention of emergence delirium in children: a randomized controlled trial. Keywords: Emergence delirium; Emergence agitation; Children EN Emergence delirium Emergence agitation Children 156 156 1 02/02/22 20220201 NES 220201 Cho EA, et al. As postoperative pain is a known precipitating factor for ED in children, we were concerned that unbalanced postoperative pain treatments would have biased their findings. [Extracted from the article]

Objective: To assess effects of postconditioning with the vagal stimulation (VS) on the local and systematic inflammatory responses to acute myocardial ischemia reperfusion injury (IRI). Methods: Sixty male Sprague-Dawley rats were randomly allocated into three groups: sham group, ischemia reperfusion group (IR group), and postconditioning with the VS group (POVS group). Serum levels of inflammatory cytokines during reperfusion and myocardial levels of inflammatory cytokines in both ischemic and non-ischemic regions at the end of the experiment were assayed. The infarct size was assessed by Evans blue and triphenyltetrazolium chloride staining. Results: The infarct size was significantly reduced in the POVS group compared to the IR group. Serum levels of TNF-α at 30, 60, and 120 min of reperfusion and serum levels of HMGB-1, ICAM-1, IL-1, and IL-6 at 120 min of reperfusion were significantly lower in the POVS group than in the IR group. Myocardial levels of TNF-α, HMGB-1, ICAM-1, IL-1, and IL-6 in both ischemic and non-ischemic regions were also significantly reduced in the POVS group compared with the IR group. Conclusions: Postconditioning with the VS can significantly attenuate the local and systemic inflammatory responses to myocardial IRI, and provide an obvious cardioprotection. [ABSTRACT FROM AUTHOR]

The inflammatory response plays a major role in ischemia-reperfusion injury (IRI). Considering that cholinergic stimulation can inhibit inflammatory response through the cholinergic anti-inflammatory pathway (CAP) and the α subunit-containing nicotinic acetylcholine receptor(α7nAChR) expressed by immune cells is an important component of CAP, we assessed the effect of postconditioning with α7nAChR agonist on systemic inflammatory response during the myocardial ischemia-reperfusion process in an in vivo rat model. Thirty Sprague Dawley rats were randomly divided into three groups: sham group, control group, and postconditioning with α7nAChR agonist group (PP group). In the groups other than the sham group, the left anterior descending coronary artery was ligated for 30 min followed by a 180-min reperfusion. At the end of the experiment, the serum levels of troponin I, tumor necrosis factor α, interleukin-6, and high-mobility group box 1 were assayed, and the infarct size was assessed. The results showed that postconditioning with α7nAChR agonist significantly attenuated the systemic inflammatory response to myocardial IRI, as evidenced by decreased serum levels of tumor necrosis factor α and high-mobility group box 1. Also, this treatment protected against myocardial IRI, as shown by reduced infarct size and serum troponin I level. [ABSTRACT FROM AUTHOR]

Background: The incidence of postoperative pulmonary complications (PPCs) is higher in obese patients undergoing general anesthesia and mechanical ventilation due to the reduction of oxygen reserve, functional residual capacity, and lung compliance. Individualized positive end-expiratory pressure (iPEEP) along with other lung-protective strategies is effective in alleviating postoperative atelectasis. Here, we compared the best static lung compliance (Cstat) titration of iPEEP with electrical impedance tomography (EIT) titration to observe their effects on postoperative atelectasis in obese patients undergoing laparoscopic surgery.Methods: A total number of 140 obese patients with BMI ≥ 32.5kg/m2 undergoing elective laparoscopic gastric volume reduction and at moderate to high risk of developing PPCs will be enrolled and randomized into the optimal static lung compliance-directed iPEEP group and EIT titration iPEEP group. The primary endpoint will be pulmonary atelectasis measured and calculated by EIT immediately after extubation and 2 h after surgery. Secondary endpoints will be intraoperative oxygenation index, organ dysfunction, incidence of PPCs, hospital expenses, and length of hospital stay.Discussion: Many iPEEP titration methods effective for normal weight patients may not be appropriate for obese patients. Although EIT-guided iPEEP titration is effective in obese patients, its high price and complexity limit its application in many clinical facilities. This trial will test the efficacy of iPEEP via the optimal static lung compliance-guided titration procedure by comparing it with EIT-guided PEEP titration. The results of this trial will provide a feasible and convenient method for anesthesiologists to set individualized PEEP for obese patients during laparoscopic surgery.Trial Registration: ClinicalTrials.gov ChiCTR2000039144 . Registered on October 19, 2020. [ABSTRACT FROM AUTHOR]

Keywords: Prediction; Risk factors; Difficult intubation EN Prediction Risk factors Difficult intubation 630 630 1 07/25/20 20200801 NES 200801 This comment refers to the article available at 10.1007/s00540-019-02721-6. In multivariate analysis, odds ratios of LNE for difficult laryngoscopy and intubation were significantly greater than those of low thyromental height test and high modified Mallampati test, but LNE was not identified as a risk factor. Second, difficult laryngoscopy is a main determinant of successful intubation with direct laryngoscopy, but incidence of difficult laryngoscopy (12%) in this study was lower than incidence of difficult intubation was 17%. [Extracted from the article]

Sir - With great interest, we read the recent article by Koylu et al1 assessing the effect of placing a folded towel under the shoulders on laryngeal visualization and intubation with a C-MAC Miller videolaryngoscope in pediatric patients younger than 2 years of age. Did you assess the overall ease of use with this device after completion of intubation (ie, including both laryngeal visualization and intubation), or only at the time of laryngeal visualization before intubation? Footnotes 1 Re: Koylu Gencay Z, Begec Z, Ozgul U, Colak C. The effect of placement of a support under the shoulders on laryngeal visualization with a C-MAC Miller Video Laryngoscope in children younger than 2 years of age. [Extracted from the article]

Purpose: 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<0.001). By the probit regression analysis, EC50 and EC95 of sevoflurane for successful SAD insertion were 1.59% (95% CI, 1.22-1.90%) and 2.15% (95% CI, 1.86-3.84%) in group D, respectively, and 2.81% (95% CI, 2.35-3.29%) and 3.32% (3.02-6.74%) in group S. Conclusion: When sevoflurane inhalational induction is performed in spontaneous breathing morbidly obese patients, intravenous DEX can reduce sevoflurane EC50 for successful SAD insertion by about 40%. Chinese Clinical Trial Registry: No. ChiCTR1800016868. [ABSTRACT FROM AUTHOR]

Study Objective: Nasotracheal intubation (NTI) is a common practice in the oral and maxillofacial surgeries. A systematic review and meta-analysis was performed to determine whether videolaryngoscopy (VL) compared with direct laryngoscopy (DL) can lead to better outcomes for NTI in adult surgical patients.Measurements: Only randomised controlled trials comparing VL and DL for NTI were included. The primary outcome was overall success rate and the second outcomes were first-attempt success rate, intubation time, rate of Cormack and Lehane classification 1, rate of Magill Forceps used, rate of postoperative sore throat, and ease of intubation.Main Results: Fourteen studies with 20 comparisons (n = 1052) were included in quantitative synthesis. The overall success rate was similar between two groups (RR, 1.03; p = 0.14; moderate-quality evidence). VL was associated with a higher first-attempt success rate (RR 1.09; p = 0.04; low-quality evidence), a shorten intubation time (MD-6.72 s; p = 0.0001; low-quality evidence), a higher rate of Cormack and Lehane classification 1 (RR, 2.11; p < 0.01; high-quality evidence), a less use of the Magill forceps (RR, 0.11; p < 0.01; high-quality evidence) and a lower incidence of postoperative sore throat (RR, 0.50; p = 0.03; high-quality evidence). Subgroup analysis based on whether with a difficult airway showed higher overall success (p < 0.01) and first-attempt success rates with VL (p = 0.04) in patients with difficult airways; however, these benefits was not shown in patients with a normal airway (p > 0.05); Subgroup analysis based on operators' experience showed that success rate did not differ between groups (p > 0.05), but intubation time was shortened by more than 50s by non-experienced operators (p < 0.05). Subgroup analysis based on different devices used showed that only non-integrated VL led to a shorter intubation time (p < 0.05).Conclusions: The use of VL does not increase the overall success rate of NTI in adult patients with general anesthesia, but it improves the first-attempt success rate and laryngeal visualization, and shortens the intubation time. VL is particularly beneficial for patients with difficult airways. [ABSTRACT FROM AUTHOR]

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; P<0.01; low-quality evidence). There were no differences between groups for other outcomes (P>0.05).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. [ABSTRACT FROM AUTHOR]

Background: Pain is often observed in pediatric patients after craniotomy procedures, which could lead to some serious postoperative complications. However, the optimal formula for postoperative analgesia for pediatric neurosurgery has not been well established. This study aimed to explore the optimal options and formulas for postoperative analgesia in pediatric neurosurgery. Methods: Three hundred and twenty patients aged 1 to 12-years old who underwent craniotomy were randomly assigned to receive 4 different regimens of patient-controlled analgesia. The formulas used were as follows: Control group included normal saline 100 ml, with a background infusion of 2 ml/h, bolus 0.5 ml; Fentanyl group was used with a background infusion of 0.1–0.2 μg/k·h, bolus 0.1–0.2 μg/kg; Morphine group was used with a background infusion of 10–20 μg/kg·h, bolus 10–20 μg/kg; while Tramadol group was used with a background infusion of 100–400 μg/kg·h, bolus 100–200 μg/kg. Postoperative pain scores and analgesia-related complication were recorded respectively. Comparative analysis was performed between the four groups. Results: In comparison of all groups with each other, lower pain scores were shown at 1 h and 8 h after surgery in Morphine group versus Tramadol, Fentanyl and Control groups (P < 0.05). Both Tramadol and Fentanyl groups showed lower pain scores in comparison to Control group (P < 0.05). Nausea and vomiting were observed more in Tramadol group in comparison to all other groups during the 48 h of PCIA usage after operation (P = 0.020). Much more rescue medicines including ibuprofen and morphine were used in Control group (CI = 0.000–0.019). Changes in consciousness and respiratory depression were not observed in study groups. Moderate-to-severe pain was observed in a total of 56 (17.5%) of the study population. Multiple regression analysis for identifying risk factors for moderate-to-severe pain revealed that, younger children (OR = 1.161, 1.027–1.312, P = 0.017), occipital craniotomy (OR = 0.374, 0.155–0.905, P = 0.029), and morphine treatment (OR = 0.077, 0.021–0.281, P < 0.001) are the relevant factors. Conclusions: Compared with other analgesic projects, PCIA or NCIA analgesia with morphine appears to be the safest and most effective postoperative analgesia program for pediatric patients who underwent neurosurgical operations. Trial registration: Chinese Clinical Trial Registry. No: ChiCTR-IOC-15007676. Prospective registration. http://www.chictr.org.cn/index.aspx. [ABSTRACT FROM AUTHOR]

Given the fact that the bilateral TTMPB only improved pain control analgesic within 24 h following surgery and the mean length of hospital stay was 152-195 h, however, we consider that these clinical benefits cannot be completely attributable to improved postoperative analgesia by the bilateral TTMPB. By a randomized, double-blind controlled trial, Zhang et al.1 assessed the perioperative benefits of bilateral transversus thoracis muscle plane block (TTMPB) in patients undergoing open cardiac surgery and showed that bilateral TTMPB decreased intraoperative and postoperative sufentanil consumption, improved postoperative pain control and sleep quality, and enhanced recovery after surgery. [Extracted from the article]