Failed obstetric tracheal intubation and postoperative respiratory support with the ProSeal laryngeal mask airway

The ProSeal laryngeal mask airway (ProSeal LMA) provides a better seal and probably better airway protection than the classic laryngeal mask airway (classic LMA). We report the use of the ProSeal LMA in a 26-yr-old female with HELLP syndrome for failed obstetric intubation and postoperative respiratory support. Both laryngoscope-guided tracheal intubation and face mask ventilation failed, but a size 4 ProSeal LMA was easily inserted and high tidal volumes obtained. A gastric tube was inserted through the ProSeal LMA drain tube and 300 mL of clear fluid was removed from the stomach. There were no hemodynamic changes during ProSeal LMA insertion. Postoperatively, the patient was transferred to the intensive care unit, where she was ventilated via the ProSeal LMA for 8 h until the platelet count had increased and she was hemodynamically stable. Weaning and ProSeal LMA removal were uneventful. There is anecdotal evidence supporting the use of the LMA devices for failed obstetric intubation (19 cases) and for postoperative respiratory support (8 cases). In principle, the ProSeal LMA may offer some advantages over the classic LMA in both these situations. IMPLICATIONS: We report the successful use of the ProSeal laryngeal mask airway for failed obstetric intubation and postoperative respiratory support in a patient with HELLP syndrom

Airway management during spaceflight: A comparison of four airway devices in simulated microgravity

Background: The authors compared airway management in normogravity and simulated microgravity with and without restraints for laryngoscope-guided tracheal intubation, the cuffed oropharyngeal airway, the standard laryngeal mask airway, and the intubating laryngeal mask airway. Methods: Four trained anesthesiologist-divers participated in the study. Simulated microgravity during spaceflight was obtained using a submerged, full-scale model of the International Space Station Life Support Module and neutrally buoyant equipment and personnel. Customized, full-torso manikins were used for performing airway management. Each anesthesiologist-diver attempted airway management on 10 occasions with each device in three experimental conditions: (1) with the manikin at the poolside (poolside); (2) with the submerged manikin floating free (free-floating); and (3) with the submerged manikin fixed to the floor using a restraint (restrained). Airway management failure was defined as failed insertion after three attempts or inadequate device placement after insertion. Results: For the laryngoscope-guided tracheal intubation, airway management failure occurred more frequently in the free- floating (85%) condition than the restrained (8%) and poolside (0%) conditions (both, P 90%), and for the cuffed oropharyngeal airway, laryngeal mask airway, and intubating laryngeal mask airway, it was always a result of inadequate placement. Conclusion: The emphasis placed on the use of restraints for conventional tracheal intubation in microgravity is appropriate. Extratracheal airway devices may be useful when restraints cannot be applied or intubation is difficult

Les protéines de pathogenèse PR-10 des végétaux

peer reviewedThe PR-10 protein family contains proteins related to pathogenesis and allergenic proteins. They are acidic proteins, with an intracellular localization, usually members of a multigene family and ubiquitous among plant kingdom. They contain a highly conserved motif, identified as a phosphate binding site. Even if the biological function of these proteins is still unknown, many indicators seem to favour the hypothesis of an RNAse activity. Moreover, one of them seems to be a cytokinin specific binding protein. Besides, PR-10 protein expression induction under cytokinin treatment was observed with the Catharanthus roseus CrPR-10a protein. Here, we present the evidence of a significative increase of endogenous cytokinin contents in leaves of transgenic Tobacco plants over-expressing the CrPR-10a protein.Les protéines PR-10 regroupent à la fois des protéines de pathogenèse et des protéines allergènes. Ce sont des protéines acides, à localisation intracellulaire, généralement membres d’une famille multigénique et ubiquitaires à travers le règne végétal. Elles contiennent un motif hautement conservé, identifié comme un site de fixation de groupements phosphates. Même si la fonction biologique de ces protéines est encore mal définie, plusieurs indications semblent être favorables à l’hypothèse d’une activité RNAse. De plus, l’une d’entre elles serait dotée de la faculté de former des complexes spécifiques avec des cytokinines. En outre, une induction de l’expression des protéines PR-10 sous l’action de traitement par des cytokinines a été observée dans le cas de la protéine CrPR-10a chez Catharanthus roseus. La sur-expression de cette protéine PR-10 chez le Tabac, nous a permis de mettre en évidence une augmentation statistiquement significative des teneurs endogènes de certaines cytokinines