The King Vision™ video laryngoscope for awake intubation: series of cases and literature review

Ewelina Gaszynska, Tomasz GaszynskiDepartment of Emergency Medicine and Disaster Medicine, Medical University of Lodz, Lodz, PolandAbstract: Intubation of patients with a supraglottic mass causing obstruction of the glottis remains a difficult problem for the experienced anesthesiologist. Awake fiberscopic endotracheal intubation is the recommended approach in such cases; however, use of a video laryngoscope for awake intubation can be an alternative to a fiberscope. Here we present two cases of awake intubation using a King Vision™ video laryngoscope in patients with a supraglottic mass, and a literature review on use of video laryngoscopes for awake intubation. After topical anesthesia and sedation with opioids, the patients were successfully intubated.Keywords: airway management, difficult airway, awake intubation, video laryngoscop

Dexmedetomidine for awake intubation and an opioid-free general anesthesia in a superobese patient with suspected difficult intubation

Tomasz Gaszynski,1 Ewelina Gaszynska,2 Tomasz Szewczyk31Department of Anesthesiology and Intensive Therapy, 2Department of Hygiene and Health Promotion, 3Department of Gastroenterology, Oncology, and General Surgery, Barlicki University Hospital, Medical University of Lodz, PolandAbstract: Super-obese patients (body mass index [BMI] >50 kg/m2) are at a particularly high risk of anesthesia-related complications during postoperative period, eg, critical respiratory events including respiratory arrest, and over-sedation leading to problems with maintaining airway open, hypoxia and hypercapnia. In this paper authors present a case of a 39-year-old super-obese (BMI 62.3 kg/m2) female patient who was admitted for surgical treatment of obesity. Preanesthesia evaluation revealed hypertension and type 2 diabetes mellitus (DM) as comorbidities as well as potential for a difficult intubation– neck circumference of 46 cm, reduced neck mobility and DM type 2. Patient was intubated using "awake intubation" method using topical anesthesia and dexmedetomidine infusion. General anesthesia was maintained with sevoflurane and dexmedetomidine infusion instead of opioid administration in "opioid-free anesthesia method".Keywords: morbid obesity, non-opioid anesthesia, dexmedetomidin

Oral health status, dental treatment needs, and barriers to dental care of elderly care home residents in Lodz, Poland

Ewelina Gaszynska,1 Franciszek Szatko,1 Malgorzata Godala,2 Tomasz Gaszynski3 1Department of Hygiene and Health Promotion, Medical University of Lodz, Lodz, Poland; 2Department of Nutrition and Epidemiology, Medical University of Lodz, Lodz, Poland; 3Department of Emergency Medicine and Disaster Medicine, Medical University of Lodz, Lodz, Poland Objectives: To determine oral health status, dental treatment needs, and to identify barriers that prevent easy access to dental care by elderly care home residents in Lodz.Background: Studies in many countries show that oral health status of elderly care home residents is poor and there is an urgent need to improve it.Methods: The study included 259 care home residents, aged 65 years and older. The oral examination was performed. In face-to-face interviews, subjects were asked about frequency of cleaning teeth and/or dentures, whether they needed assistance, and whether the assistance was available; they were also asked about the perceived dental needs, and about the time since their last visit to a dentist and the purpose of the visit. If they had not visited the dentist in the past 12 months, they were asked about reasons for failing to visit the dentist.Results: Forty-six percent of the subjects were edentulous. Only 5.8% of all participants had a sufficient number of functional natural teeth. Dental treatment was found to be necessary in 59.8% of the respondents. One in four subjects reported reduced ability of correctly cleaning teeth and dentures themselves, of whom only one-third were helped by others. An insufficient level of hygiene was found in every other subject. About 42% of residents had not visited a dentist for over 5 years, mainly due to organizational reasons.Conclusion: Expanding the current scope of medical care for the elderly care home residents to include dental care would improve their currently poor oral health status. Keywords: dental care, institutionalized elderly, treatment needs, oral behavior

Thirty years of evolution of oral health behaviours and dental caries in urban and rural areas in Poland

[b]Introduction and objective[/b]. 34 years ago, children living in rural areas had almost 2 more teeth affected by decay than those living in cities. Environmental differences are being reduced along with Poland’s civilization development. The aim of the study is to assess the extent to which the differences in the intensity of caries and oral health behaviours between the urban rural environment have been reduced have been reduced in the past 3 decades. [b]Materials and methods[/b]. The data from 9 national surveys of 14,338 children aged 12 years and 5,425 adults aged 35–44 who lived in the city and in the countryside were analysed. Mean number of decayed (D), missing (M) and filled (F) teeth (DMFT) was determined during the examination, as well as oral health behaviours. [b]Results[/b]. During the past 3 decades, in the statistical 12-year-old Polish child, tooth decay has been reduced from 7.3 to 3.6 teeth, and the environmental difference between the town and village children is now almost 5 times smaller. A similar trend is observed in children’s dental behaviours. Improving the oral health status and levelling of the environmental differences in the population aged 35–44 is much slower than in children. [b]Conclusions[/b]. In the last three decades, the level of tooth decay has been reduced by half, but it is still 3 times higher than in other European countries. Environmental differences have been reduced particularly in children. Both the oral health status and urban/rural environment differences in the intensity of tooth decay may be regarded as one of the many measures of Poland’s social and civilization development. However, the analysed process is not monotonic; instead, it has some turning points

Masseter muscle tension, chewing ability, and selected parameters of physical fitness in elderly care home residents in Lodz, Poland

Ewelina Gaszynska,1 Malgorzata Godala,2 Franciszek Szatko,1 Tomasz Gaszynski3 1Department of Hygiene and Health Promotion, Medical University of Lodz, Poland; 2Department of Nutrition and Epidemiology, Medical University of Lodz, Poland; 3Department of Emergency Medicine and Disaster Medicine, Medical University of Lodz, Poland Background: Maintaining good physical fitness and oral function in old age is an important element of good quality of life. Disability-related impairment of oral function contributes to a deterioration of the diet of older people and to the reduction of their social activity.Objectives: Investigate the association between masseter muscle tension, dental status, and physical fitness parameters.Materials and methods: Two hundred fifty-nine elderly care home residents (97 men, 162 women; mean age, 75.3±8.9 years) were involved in this cross-sectional study. Their chewing ability was evaluated by masseter muscle tension palpation, differences of masseter muscle thickness, self-reported chewing ability, number of present and functional teeth, and number of posterior tooth pairs. Masseter muscle thickness was measured by ultrasonography. To assess physical fitness, hand grip strength and the timed up-and-go test were performed. Nutritional status was assessed using body mass index and body cell mass index (BCMI), calculated on the basis of electrical bioimpedance measurements. Medical records were used to collect information on systemic diseases and the number of prescribed medications. Subjects were also evaluated for their ability to perform ten activities of daily living.Results: Ninety-seven percent of the subjects suffered from systemic diseases. The three most prevalent illnesses were cardiac/circulatory 64.5%, musculoskeletal 37.3%, and endocrine/metabolic/nutritional 29.3%. Of the participants, 1.5% were underweight and more than one third (34.4%) were overweight. Malnutrition (BCMI below normal) was found in almost half (45.2%) of the subjects. Only 5.8% had a sufficient number of functional natural teeth. Statistically significant correlations were found between palpation of masseter muscle tension and perceived chewing ability, number of present teeth, number of functional teeth, number of posterior tooth pairs, timed up-and-go, hand grip strength, body mass index, BCMI, and activities of daily living. In a multivariate model, after adjusting for age, sex, and education, subjects with higher BCMI, higher hand grip strength, and more present teeth had a significantly higher chance of strong masseter muscle tension.Conclusion: There is a relationship between chewing ability and physical fitness in elderly people. Efficiency of masseter muscles is related to physical fitness in the elderly. Masseter muscle tension examined by palpation can be used in public dentistry as one of the indicators of quality of life. Keywords: physical fitness, chewing ability, masseter muscle tensio

Electromyographic activity of masticatory muscles in elderly women – a pilot study

Ewelina Gaszynska,1 Karolina Kopacz,2 Magdalena Fronczek-Wojciechowska,2 Gianluca Padula,2 Franciszek Szatko1 1Department of Hygiene and Health Promotion, 2Academic Laboratory of Movement and Human Physical Performance “DynamoLab”, Medical University of Lodz, Lodz, PolandObjectives: To evaluate the effect of age and chosen factors related to aging such as dentition, muscle strength, and nutrition on masticatory muscles electromyographic activity during chewing in healthy elderly women.Background: With longer lifespan there is a need for maintaining optimal quality of life and health in older age. Skeletal muscle strength deteriorates in older age. This deterioration is also observed within masticatory muscles.Methods: A total of 30 women, aged 68–92 years, were included in the study: 10 indivi­duals had natural functional dentition, 10 were missing posterior teeth in the upper and lower jaw reconstructed with removable partial dentures, and 10 were edontoulous, using complete removable dentures. Surface electromyography was performed to evaluate masticatory muscles activity. Afterwards, measurement of masseter thickness with ultrasound imaging was performed, body mass index and body cell mass index were calculated, and isometric handgrip strength was measured.Results: Isometric maximal voluntary contraction decreased in active masseters with increasing age and in active and passive temporalis muscles with increasing age and increasing body mass index. In active masseter, mean electromyographic activity during the sequence (time from the start of chewing till the end when the test food became ready to swallow) decreased with increasing age and during the cycle (single bite time) decreased with increasing age and increasing body mass index. In active and passive temporalis muscles, mean electromyographic activity during the sequence and the cycle decreased with increasing age, increasing body mass index, and loss of natural dentition. Individuals with natural dentition had significantly higher mean muscle activity during sequence and cycle in active temporalis muscles than those wearing full dentures and higher maximal activity during cycle in individuals with active and passive temporalis muscles than in complete denture wearers.Conclusion: Decrease in electromyographic activity of masticatory muscles in elderly women is related to age, deterioration of dental status, and body mass index.Keywords: electromyographic activity, masseters, temporalis muscles, masticatory muscles, mastication, elderly wome