Hemodynamic and humoral response to intubation with double-lumen endotracheal tubes versus single-lumen tubes combined with an endobronchial blocker: A randomized clinical trial

Introduction: Insertion of endotracheal tubes, especially large and relatively inflexible double-lumen tubes, provokes cardiovascular and humoral responses which can cause complications. Bronchial blockers, combined with conventional single-lumen tubes (SLT), serve as alternatives to double-lumen tubes (DLT) and may provoke less hemodynamic response. Methods: Forty adults scheduled for elective thoracic surgery requiring single-lung ventilation were randomly assigned to DLT or SLT combined with EZ-Blocker (EZ), a bronchial blocker. Heart rate and arterial blood pressure were recorded before induction of anesthesia, before laryngoscopy, after laryngoscopy, and one minute after intubation. Epinephrine, norepinephrine, and cortisol serum concentrations were assessed one minute after intubation. Results: Pre-laryngoscopy values were comparable in both groups. Mean arterial pressure significantly increased in both groups during intubation. The maximum value during intubation was significantly higher with DLT (121 ± 17 mmHg), compared to bronchial blocker (105 ± 18 mmHg, P=0.022). Heart rate increased significantly during intubation in both groups (DLT from 68 ± 9 to 86 ±11, P<0.001, bronchial blocker from 72 ±11 to 87 ± 16, P=0.002), but the increase did not differ between the groups (P=0.76). Epinephrine, norepinephrine, and cortisol serum concentrations did not increase significantly from baseline values and did not differ between the treatment groups. Conclusion: Insertion of DLT increases blood pressure more than placement of a SLT combined with bronchial blocker. However, the difference is probably not clinically important. Furthermore, there were no significant differences in heart rate or catecholamine concentrations. Clinicians should consider other factors when choosing between airway options for single-lung ventilation

Current concepts in locking plate fixation of proximal humerus fractures

Despite numerous available treatment strategies, the management of complex proximal humeral fractures remains demanding. Impaired bone quality and considerable comorbidities pose special challenges in the growing aging population. Complications after operative treatment are frequent, in particular loss of reduction with varus malalignment and subsequent screw cutout. Locking plate fixation has become a standard in stabilizing these fractures, but surgical revision rates of up to 25% stagnate at high levels. Therefore, it seems of utmost importance to select the right treatment for the right patient. This article provides an overview of available classification systems, indications for operative treatment, important pathoanatomic principles, and latest surgical strategies in locking plate fixation. The importance of correct reduction of the medial cortices, the use of calcar screws, augmentation with bone cement, double-plate fixation, and auxiliary intramedullary bone graft stabilization are discussed in detail

Swiss-wide multicentre evaluation and prediction of core outcomes in arthroscopic rotator cuff repair: protocol for the ARCR_Pred cohort study

Introduction In the field of arthroscopic rotator cuff repair (ARCR), reporting standards of published studies differ dramatically, notably concerning adverse events (AEs). In addition, prognostic studies are overall methodologically poor, based on small data sets and explore only limited numbers of influencing factors. We aim to develop prognostic models for individual ARCR patients, primarily for the patient-reported assessment of shoulder function (Oxford Shoulder Score (OSS)) and the occurrence of shoulder stiffness 6 months after surgery. We also aim to evaluate the use of a consensus core event set (CES) for AEs and validate a severity classification for these events, considering the patient’s perspective.Methods and analysis A cohort of 970 primary ARCR patients will be prospectively documented from several Swiss and German orthopaedic clinics up to 24 months postoperatively. Patient clinical examinations at 6 and 12 months will include shoulder range of motion and strength (Constant Score). Tendon repair integrity status will be assessed by ultrasound at 12 months. Patient-reported questionnaires at 6, 12 and 24 months will determine functional scores (subjective shoulder value, OSS), anxiety and depression scores, working status, sports activities, and quality of life (European Quality of Life 5 Dimensions 5 Level questionnaire). AEs will be documented according to a CES. Prognostic models will be developed using an internationally supported regression methodology. Multiple prognostic factors, including patient baseline demographics, psychological, socioeconomic and clinical factors, rotator cuff integrity, concomitant local findings, and (post)operative management factors, will be investigated.Ethics and dissemination This project contributes to the development of personalised risk predictions for supporting the surgical decision process in ARCR. The consensus CES may become an international reference for the reporting of complications in clinical studies and registries. Ethical approval was obtained on 1 April 2020 from the lead ethics committee (EKNZ, Basel, Switzerland; ID: 2019-02076). All participants will provide informed written consent before enrolment in the study.Trial registration number NCT04321005.Protocol version Version 2 (13 December 2019)