Difficult intubation and extubation in adult anaesthesia.

To provide an update to French guidelines about "Difficult intubation and extubation in adult anaesthesia 2006". A consensus committee of 13 experts was convened. A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independent of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. Few recommendations were ungraded. The panel focused on 6 questions: 1) Why must oxygen desaturation be avoided during intubation and what preoxygenation and oxygenation techniques should be used to prevent it? 2) Should videolaryngoscopes be used instead of standard laryngoscopy with or without a long stylet to achieve a better success rate of intubation after the first attempt during anticipated difficult intubation off fiberoptic intubation? 3) Should TCI or target controlled inhalation anaesthesia (TCIA) be used instead of bolus sedation for airway control in the event of suspected or proven difficulty in a patient spontaneously breathing? 4) What mode of anaesthesia should be performed in patients with difficult intubation criteria and potentially difficult mask ventilation? 5) In surgical patients, what criteria predict difficulties encountered during postoperative tracheal extubation? 6) Should decision trees and algorithms be employed to direct decision-making for the management of difficult intubation, whether foreseen or not? (based on the information from the preceding five issues). Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. The analysis of the literature and the recommendations were then conducted according to the GRADE <sup>®</sup> methodology. The SFAR Guideline panel provided 13 statements on difficult intubation and extubation in adult anaesthesia. After two rounds of discussion and various amendments, a strong agreement was reached for 99% of recommendations. Of these recommendations, five have a high level of evidence (Grade 1±), 8 have a low level of evidence (Grade 2±). No recommendation was provided for one question. Substantial agreement exists among experts regarding many strong recommendations for the best care of patients with difficult intubation and extubation in adult anaesthesia

Técnicas de análise multivariada na avaliação de injúrias pelo frio em mangas cv. Tommy Atkins

Este trabalho objetivou identificar as variáveis que se associam às injúrias pelo frio e determinar as diferenças nos parâmetros de qualidade que melhor caracterizam mangas 'Tommy Atkins' submetidas à condição de injúria pelo frio, utilizando-se da análise de fatores em componentes principais e a análise de agrupamentos. Frutos colhidos no estádio "de vez" foram cuidadosamente transportados, selecionados, padronizados quanto a coloração, tamanho e ausência de injúrias, e tratados com fungicida antes de serem armazenados a 2 ºC (74,8% UR), 5 °C (75,4% UR) e 12 °C (76,4% UR), por até 28 dias. Os frutos foram avaliados semanalmente quanto à ocorrência de danos pelo frio, coloração da casca e da polpa, firmeza da polpa, teores de sólidos solúveis, acidez titulável, açúcares solúveis e redutores, ácido ascórbico e atividade das enzimas peroxidase, polifenoloxidase e fenilalanina amônia-liase. A análise estatística multivariada dos fatores em componentes principais e agrupamentos permitiram melhor compreensão do efeito do armazenamento, sob condição de chilling, no metabolismo de mangas 'Tommy Atkins' e indicaram que o dano está intimamente relacionado com a casca e que a resposta da polpa ao estresse ocorre de forma tardia