Improving rigid fiberoptic intubation: a comparison of the Bonfils Intubating Fiberscope™ with a novel modification

<p>Abstract</p> <p>Background</p> <p>The Bonfils intubating fiberscope has a limited upward tip angle of 40° and requires retromolar entry into the hypopharynx. These factors may make its use less desirable when managing the difficult airway because most anesthesia providers are well versed in midline oral intubation rather than the lateral retromolar approach. The <it>Center for Advanced Technology and Telemedicine </it>at the University of Nebraska Medical Center has developed a novel fiberscope with a more anterior 60° curve to allow for easier midline insertion and intubation. The objective of this work was to evaluate the novel fiberscope, in comparison to the Bonfils intubating fiberscope, in terms of use and function in difficult airway intubation.</p> <p>Methods</p> <p>Twenty-two anesthesia providers participated in simulated intubations of a difficult airway mannequin to compare the Bonfils intubating fiberscope with the novel curved Boedeker intubating fiberscope. The intubations were assessed based upon the following variables: recorded Cormack Lehane airway scores, requests for cricoid pressure, time to intubation, number of intubation attempts and success or failure of the procedure.</p> <p>Results</p> <p>Participants using the Bonfils fiberscope recorded an average Cormack Lehane (CL) airway score of 1.67 ± 1.02 (median = 1); with the novel fiberscope, the recorded average airway grade improved to 1.18 ± 0.50 (median = 1). The difference in airway scores was not statistically significant (p = 0.34; Fishers Exact Test comparing CL grades 1&2 vs. 3&4). There was, however, a statistically significant difference in intubation success rates between the two devices. With the Bonfils fiberscope, 68% (15/22) of participants were successful in intubation compared to a 100% success rate in intubation with the novel fiberscope (22/22) (p = 0.008). After the intubation trial, the majority of participants (95%) indicated a preference for the novel fiberscope (n = 20).</p> <p>Conclusions</p> <p>With this data, we can infer that the novel fiberscope curvature appears to improve or maintain the quality of an intubation attempt (airway score, cricoid pressure requirement, intubation time, number of attempts, placement success). The data indicate that the novel fiberscope offers a superior intubation experience to currently available best practices. The instrument was well received and would be welcomed by most study participants should the device become clinically available in the future.</p

[Acute adrenal failure due to adrenal hemorrhagic necrosis secondary to heparin-induced thrombocytopenia]

The authors describe a clinical case with a peculiar sequence of unhealthy events. An operated by osteotomy woman presented a deep venous thrombosis of lever lower extremity with following pulmonary embolism. The patient was treated with heparin. After 5 days, the patient showed a thrombocytopenia, that was not determined by an immune mechanism. The heparin was stopped and the thrombocythemia returned to normal values. But the patient still presented somnolence, asthenia and hypotension. The tests of adrenocortical function showed below normal values. The abdominal CAT showed haemorrhagic necrosis of the suprarenal glands

Orbital head pain elicited by neuroendoscopy of the third ventricle performed under local anesthesia

Endoscopic third ventriculostomy (ETVS) is considered a minimally invasive procedure for blocked hydrocephalus. In 24 cases, this procedure was carried out in awake patients under local anesthesia. All patients reported abrupt orbital pain when the third ventricle floor was manipulated. Although recent advancements in knowledge of some forms of migraine and cluster headache could be regarded as a good basis for interpreting the pain triggered by ETVS, other hypotheses should also be taken into consideration

Massive venous air embolism in the semi-sitting position during surgery for acervical spinal cord tumor: anatomic and surgical pitfalls.

Although venous air embolism (VAE) in neurological surgery is mainly associated with posterior fossa procedures, this complication may also occur, with comparable severity, in the posterior cervical spine approach in patients who are semi-sitting. We report a patient with a massive VAE that occurred in the semi-sitting position during a posterior approach to an extended cervical-thoracic level (C3-T2) intramedullary tumor, which interrupted the surgical procedure. We discuss the possible causes of air embolism, the anatomic and pathogenetic mechanisms, treatment and preventive measures