Subcutaneous dissociative conscious sedation (sDCS) an alternative method for airway regional blocks: a new approach

<p>Abstract</p> <p>Background</p> <p>Predicted difficult airway is a definite indication for awake intubation and spontaneous ventilation. Airway regional blocks which are commonly used to facilitate awake intubation are sometimes impossible or forbidden. On the other hand deep sedation could be life threatening in the case of compromised airway.</p> <p>The aim of this study is evaluating "Subcutaneous Dissociative Conscious Sedation" (sDCS) as an alternative method to airway regional blocks for awake intubation.</p> <p>Methods</p> <p>In this prospective, non-randomized study, 30 patients with predicted difficult airway (laryngeal tumors), who were scheduled for direct laryngoscopic biopsy (DLB), underwent "Subcutaneous Dissociative Conscious Sedation" (sDCS) exerted by intravenous fentanyl 3-4ug/kg and subcutaneous ketamine 0.6-0.7 mg/kg. The tongue and pharynx were anesthetized with lidocaine spray (4%<b>)</b>. 10 minutes after a subcutaneous injection of ketamine direct laryngoscopy was performed. Extra doses of fentanyl 50-100 ug were administered if the patient wasn't cooperative enough for laryngoscopy.</p> <p>Patients were evaluated for hemodynamic stability (heart rate and blood pressure), oxygen saturation (Spo₂), patient cooperation (obedient to open the mouth for laryngoscopy and the number of tries for laryngoscopy), patient comfort (remaining moveless), hallucination, nystagmus and salivation (need for aspiration before laryngoscopy).</p> <p>Results</p> <p>Direct laryngoscopy was performed successfully in all patients. One patient needed extra fentanyl and then laryngoscopy was performed successfully on the second try. All patients were cooperative enough during laryngoscopy. Hemodynamic changes more than 20% occurred in just one patient. Oxygen desaturation (spo₂< 90%) didn't occur in any patient.</p> <p>Conclusions</p> <p>Subcutaneous Dissociative Conscious Sedation (sDCS) as a new approach to airway is an acceptable and safe method for awake intubation and it can be suggested as a noninvasive substitute of low complication rate for regional airway blocks.</p> <p>Registration ID in IRCT</p> <p>IRCT201012075333N1</p

Synthesis, molecular structure and palladium(II) and platinum(II) complex chemistry of 3-(ferrocen-1-yl)-1-(pyridin-2-yl)pyrazole

Treatment of the potassium salt of 3(5)-(ferrocen-1-yl)pyrazole L1 with 2-bromopyridine in diglyme (2,5,8-trioxononane) at 130 °C for 3 d, followed by an aqueous quench, yielded the compound 3-(ferrocen-1-yl)-1-(pyridin-2-yl)pyrazole L2 in 37% recrystallised yield. A single-crystal structure determination of L2 confirmed the proposed 1,3-disubstitution pattern at the pyrazole ring, the substituted cyclopentadienyl and two heterocyclic rings being approximately coplanar. Treatment of L2 with a stoichiometric amount of [{MCl(C3H5)}x](M = Pd, x= 2; M = Pt, x= 4) and NH4PF6 gave [M(η3-C3H5)(L2)]PF6(M = Pd 1 or Pt 2) while a similar reaction with [PdCl2(NCPh)2] afforded [PdCl2(L2)]3. Treatment of 3 with 1 molar equivalent of K2C2O4, Na2(cat) or Na(acac)–NH4PF6 yielded [Pd(L)L2][L = C2O42–4 or catecholate (cat)5] and [Pd(acac)(L2)]PF66(acac = acetylacetonate) as analytically pure solids. The 1H NMR behaviour of 4–6 is complex and suggestive of extensive ligand dissociation in solution; molecular models imply that this may reflect steric interactions between the pendant ferrocenyl moiety and metal-bound anionic chelate O-donors. The UV/VIS and electrochemical data show that the ferrocenyl group becomes significantly electron-poorer upon co-ordination of L2, reflecting an inductive interaction with the co-ordinated M2+(M = Pd or Pt) electrophiles

Digital video assessment (dva) as catalyst for skill transfer in the road and airport visual condition survey environment in rsa

Government clients require that 30% of work be done by Exempt Micro Enterprise (EME) and Qualifying Small Enterprise (QSE) sub-consultants and can be difficult to achieve in high technology environments such as specialist pavement condition assessment. Tender requirements for experience with a proven track record as pre-qualification qualification work against such capacity-building objectives. Multi-Functional-Vehicles (MFV’s) used for instrument surveys typically already have accurate Geographic Positioning Systems (GPSs). The addition of high definition video cameras enables a technology coupling innovation approach to the normal manual visual survey methodology. The Digital Video Assessment (DVA) software system was developed with pre-calibrated camera settings to enable accurate measurements of grabbed photos at pre-set length intervals. The TMH 9 for Visual Condition Index (VCI) and also the American Society Test Method (ASTM) for Pavement Condition Index (PCI) survey templates are used to record the various forms of distress in terms of degree and extent. The survey data is analysed by the DVA software in the safety and comfort of an office environment. Surveys can thus be done with initially inexperienced EME and QSE sub-consultants. The DVA allows “on the job training” as their surveys can be checked by a qualified experienced visual surveyor numerous times with no additional travel and stay cost until they are trained and quality ensured. A recent comparative study using manual visual surveys versus this DVA survey methodology found that this DVA survey is not only more accurate and better quantifiable but can provide more detail with geo-referenced image records than what is required at project-level investigations. This DVA software and survey approach offer tremendous opportunity for capacity building of new entrants to this specialized field of visual survey with accuracy in a safe survey mode.Papers presented virtually at the 39th International Southern African Transport Conference on 05 -07 July 202

Large predators can mitigate nutrient losses associated with off‐site removal of animals from a wildlife reserve

Please read abstract in the article.National Aeronautics and Space Administration, a Google Earth Engine research and the Royal Society Newton International Fellowship.http://wileyonlinelibrary.com/journal/jpehj2022Mammal Research InstitutePlant Production and Soil Scienc