Awake fiberoptic intubation in patients with stenosis of the upper airways. Utility of the laryngeal nerve block

Awake fiberoptic intubation (AFOI) is mandatory to manage difficult airways. Superior laryngeal nerve block (SLNB) could reduce risks and improve patient comfort. The aim of this study is to assess the procedural comfort of SLNB during AFOI in a population of patients undergoing upper airway oncological surgery. Forty patients were randomized into two groups and were treated with continuous infusion of remifentanil, topic anesthesia and intercricoid block. In the study group (=20), SLNB was performed with lidocaine (L-SLNB); in the control group (n=20) SLNB was performed using saline (S-SLNB). AFOI was more comfortable in the L-SLNB group compared to S-SLNB patients [FOICS ≤ 1 in 18 patients (90%) L-SLNB; 2 (10%) S-SLNB (P<0.001)]. Intubation was faster in L-SLNB (47.45 ±15.38 sec) than S-SLNB (80.15 ±37.91 sec) (p<0.001). The SLNB procedure during AFOI is a safe and comfortable procedure in a population of patients undergoing upper airways surgery. Time to intubation was shorter in L-SLNB than in S-SLNB

Obstructive sleep apnea syndrome in the pediatric age: the role of the anesthesiologist

– OBJECTIVE: Childhood obstructive sleep disordered breathing (SDB) is a sleep-related upper airway obstruction that degrades sleep quality, ventilation and/or oxygenation; obstructive sleep apnea syndrome (OSAS) is one of the most common causes of SDB in children. The aim of this review is to evaluate the role of the anesthesiologist in pediatric OSAS. MATERIALS AND METHODS: A literature review has been performed on the following topics: clinical aspects of pediatric OSAS, preoperative investigations including questionnaires, clinical parameters, laboratory polysomnography and home sleep apnea testing, anesthesiologic preoperative management, anesthesiologic perioperative management, anesthesiologic postoperative management including postoperative analgesia, postoperative nausea and vomiting (PONV), and post‐tonsillectomy bleeding. RESULTS: OSAS in children is a distinct disorder from the condition that occurs in adults; adenoidectomy and tonsillectomy are the first line of therapy in these patients. Even if these surgical procedures are frequently performed, they represent a great challenge for surgeons and anesthesiologists and are associated with a substantially increased risk of morbidity and mortality. CONCLUSIONS: The role of the anesthesiologist is pediatric OSAS is crucial before, during and after surgery, as pediatric patients are at higher risk of preoperative, perioperative and postoperative adverse events including airway obstruction, PONV, and bleeding

La falsificazione epigrafica. Questioni di metodo e casi di studio

This paper aims to reconsider the manuscript by Jacopo Valvasone (1499-1570), formerly owned by the Earl of Leicester (now British Library, Additional MS 49369), which Theodor Mommsen borrowed and inspected in 1876, just before the publication of the second part of CIL V. In the letter that he wrote to thank the Vicar and Librarian of Halkham Hall, Mommsen declared that Valvasone joined \u201cthe the long list of forgers\u201d. The analysis of forgeries in Valvasone\u2019s manuscript could show whether Mommsen was right in his opinion

Shrub Invasion Decreases Diversity and Alters Community Stability in Northern Chihuahuan Desert Plant Communities

BACKGROUND:Global climate change is rapidly altering species range distributions and interactions within communities. As ranges expand, invading species change interactions in communities which may reduce stability, a mechanism known to affect biodiversity. In aridland ecosystems worldwide, the range of native shrubs is expanding as they invade and replace native grassland vegetation with significant consequences for biodiversity and ecosystem functioning. METHODOLOGY:We used two long-term data sets to determine the effects of shrub encroachment by Larrea tridentata on subdominant community composition and stability in formerly native perennial grassland dominated by Bouteloua eriopoda in New Mexico, USA. PRINCIPAL FINDINGS:Our results indicated that Larrea invasion decreased species richness during the last 100 years. We also found that over shorter temporal scales species-poor subdominant communities in areas invaded by Larrea were less stable (more variable in time) compared to species rich communities in grass-dominated vegetation. Compositional stability increased as cover of Bouteloua increased and decreased as cover of Larrea increased. SIGNIFICANCE:Changes in community stability due to altered interspecific interactions may be one mechanism by which biodiversity declines in grasslands following shrub invasion. As global warming increases, shrub encroachment into native grasslands worldwide will continue to alter species interactions and community stability both of which may lead to a decline in biodiversity

Extracorporeal shockwave lithotripsy vs ureteroscopy as first-line therapy for patients with single, distal ureteric stones: a prospective randomized study

The distal ureter is the location of the great majority of ureteric stones . Stones with a diameter of < 5 mm have a high chance of spontaneous expulsion ranging from 71% to 98% [2]. By contrast, active intervention is often required for distal stones of > 5 mm [2]. To date, open surgery is still required in a few patients, while extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy (URS) have emerged as valid, minimally invasive alternatives for the treatment of distal ureteric stones [3]. However, the best first-line treatment remains a controversial issue. The reported advantages of ESWL include: less invasiveness, short hospitalization, and a lower complication rate. However, ESWL is not available in many centres and often requires multiple treatment sessions. URS shares the advantages of a more rapid stone clearance but often requires anaesthesia, longer hospitalization, and it is often associated with a higher incidence of complications [4]. In recent years, the development of new generation lithotripters using electromagnetic energy has increased the efficacy of ESWL for the treatment of ureteric stones located in the mid and distal ureter without the need for any type of anaesthesia [5]. On the other hand, the development of new endoscopic techniques has led some authors to consider URS a more appropriate first-line treatment for distal ureteric stones, mainly due to its cost-effective benefits [6]. Consequently, the choice between ESWL and URS depends on multiple factors, e.g. the number of treatments required to obtain a stone-free status, the duration of the hospital stay, the need for anaesthesia and for auxiliary procedures, the experience and equipment of the centre. The aim of the present study was to compare ESWL and URS as first-line treatments for patients with solitary, monolateral, distal ureteric stones

Ultrasound as a new tool in the assessment of airway difficulties: An observational study.

BACKGROUND: Prediction of difficult mask ventilation (DMV) is as challenging as difficult laryngoscopy. Ultrasound could be a helpful tool in the prediction of these difficulties. OBJECTIVES: The purpose of this study was to evaluate the ability of pre-operative ultrasound assessment of neck anatomy in predicting DMV and difficult laryngoscopy in patients undergoing during elective surgery requiring tracheal intubation. DESIGN: Prospective, single blind, observational study. SETTING: Operating theatre of a teaching hospital in Italy from April 2018 to July 2018. PATIENTS: A total of 194 patients aged more than 18 years, without neck masses, previous thyroid surgery or tracheotomy undergoing general anaesthesia and tracheal intubation for elective ear, nose and throat-surgery were included in the study. OUTCOME MEASURES: Ultrasound distances were recorded with a linear 6 to 13 MHz ultrasound transducer: measurements included the minimum distance from the thyroid isthmus to skin surface, the minimum distance from the hyoid bone to skin surface (DSHB), the minimum distance from skin to anterior commissure of the vocal cords, the minimum distance from skin to trachea at the level of the jugular notch and the distance from skin to epiglottis midway. The degree of DMV and difficult laryngoscopy was quantified. RESULTS: The mean (SD) of DSHB was 0.88 (0.3) cm in the easy mask ventilation group, 1.4 (0.19) cm in DMV group. The mean of DSHB and of the other ultrasound distances increased according to the DMV and difficult laryngoscopy level. The DSHB was correlated with an increase in the risk for DMV (0.61 [IQR 0.5 to 0.69]). DMV groups were associated with a greater ultrasound-measured DSHB. CONCLUSION: The prospective observational study confirms the relationship between ultrasound assessment of the anterior soft tissues of the neck and difficult laryngoscopy and DMV. DSHB and the other distances extend the available evidence, not only for difficult laryngoscopy but also for DMV