Analysis of hypoxia-associated dendritic cells in colitic mice and effects of probiotics on IL-10 production in inflammatory dendritic-cells under hypoxia

The aim of this study was to analyse hypoxia-associated dendritic cells (DCs) in colitic mice and the effects of probiotics on interleukin (IL)-10 production in inflammatory DCs under hypoxic conditions. Extensive hypoxia was observed in the colonic mucosa of dextran sodium sulphate-induced colitic mice. Flow cytometric analysis demonstrated that hypoxia-inducible factor-1α⁺ DCs in colonic lamina propria (CLP) lymphocytes and mesenteric lymph nodes (MLN) were more abundant in colitic mice than those in controls. Among three subsets of DCs, i.e. plasmacytoid DCs, conventional DCs (cDCs), and monocyte-derived DCs (mDCs), cDCs and mDCs were more abundant in CLP of colitic mice. Bone marrow-derived Flt-3L-induced DCs (Flt-DCs) but not bone marrow-derived GM-CSF-induced DCs (GM-DCs), incubated with 1% O₂ exhibited an inflammatory phenotype, with higher CD86, IL-6, and tumour necrosis factor-α expression, and lower IL-10 levels than those in Flt-DCs incubated with 21% O₂. The hypoxia-induced decrease in IL-10 expression in Flt-DCs was restored by Bifidobacterium bifidum JCM 1255^T promoted IL-10 expression through the p38 pathway under normoxic conditions. The anti-inflammatory effects of B. bifidum JCM 1255^T in Flt-DCs were mediated through different cellular mechanisms under hypoxic and normoxic conditions. B. bifidum JCM 1255^T could be used therapeutically for its anti-inflammatory effects.

Functional expression of breast cancer resistance protein and cholesterol effect in human erythrocyte membranes

In human erythrocyte membranes, various influx and efflux transporters are functionally expressed. However, their transport characteristics and modulation under disease states are not fully understood. In this study, we first examined the expression and detailed transport characteristics of breast cancer resistance protein (BCRP), an efflux ABC transporter, using inside-out membrane vesicles (IOVs) prepared from human erythrocytes, and then studied the effect of membrane cholesterol on BCRP function. The expression of BCRP was confirmed by western blotting; most of them being homodimers. The uptake of lucifer yellow (LY), a fluorescent BCRP substrate, into IOVs was time-, temperature-, and ATP-dependent, and the concentration of ATP which induced half-maximal stimulation of LY uptake was calculated to be 0.39 mM. The uptake of LY by IOVs was saturable with a Km value of 166 μM, and was inhibited by various BCRP inhibitors and substrates, such as fumitremorgin C and mitoxantrone. When membrane cholesterol content was increased by treating IOVs with cholesteryl hemisuccinate, LY uptake decreased with increasing cholesterol content. These results suggest that transport activity of BCRP in human erythrocyte membranes may be suppressed under disease states, such as hypercholesterolemia, that increase membrane cholesterol content.

[Acute Postoperative Negative Pressure Pulmonary Edema Caused by the Compression of Brachiocephalic Artery]

We report a case of negative-pressure pulmonary edema occurring by tracheal obstruction caused by the brachiocephalic artery. The patient had deformed thorax with cerebral palsy, which deformed thorax placing the brachiocephalic artery high over the trachea, resulting in close and tight contact between the artery and trachea. Additional deformity of the thorax associated with myotonic attacks after general anesthesia might shorten the distance between the sternal notch and the vertebral body, resulting in the tracheal obstruction by the artery.

[Anesthetic Management of Patients Undergoing Single-lumen Tracheal Tube Ventilation with Artificial Pneumothorax in Thoracolaparoscopic Esophagectomy]

We report anesthetic management of patients undergoing single-lumen tracheal tube ventilation with artificial pneumothorax in thoracolaparoscopic esophagectomy in prone position. No adverse effect against respiratory and circulatory management was found during esophagectomy. Single-lumen tracheal tube ventilation with artificial pneumothorax potentially is a feasible method for thoracolaparoscopic esophagectomy in prone position.

[Tracheal Intubation Using the Pentax-AWS during Chest Compression: A Meta-analysis]

BACKGROUND

The aim of this meta-analysis is to evaluate the efficacy of the Pentax-AWS for tracheal intubation during chest compression, compared with that of the Macintosh laryngoscope.

METHODS

The systematic search, data extraction, critical appraisal, and pooled analysis were performed according the PRISMA statement. The relative risk (RR), mean difference (MD), and their corresponding 95% confidence intervals (CIs) were calculated by the Review Manager 5.2 software for dichotomous and continuous outcomes, respectively.

RESULTS

Twelve trials included 424 tracheal intubations by Pentax-AWS and 421 tracheal intubations by Macintosh laryngoscope. In studies examining novice laryngoscopists, successful intubation (RR1.4, 95% CI 1.1-1.6, P < 0.0007) and time for instrumentation (MD -7.7 sec, 95% CI -10.1 sec--5.4 sec, P < 0.00001) were improved using the Pentax-AWS. With respect to experts' hands there was no difference between the two devices in both of these outcomes.

CONCLUSIONS

Compared to the Macintosh laryngoscopy, Pentax-AWS offers advantages for novice laryngoscopists during chest compression, while these benefits are not seen with experts' hands.

[Video Laryngoscopy Reduces the Incidence of Erroneous Esophageal Intubation: A Meta-analysis]

BACKGROUND

The aim of this meta-analysis is to compare the incidence of erroneous esophageal intubations by video laryngoscopy to that by direct laryngoscopy.

METHODS

The systematic search, data extraction, critical appraisal, and pooled analysis were performed according the PRISMA statement. The odds ratio(OR) and 95% confidence interval (CI) were calculated by the Review Manager 5.2 software for dichotomous outcome.

RESULTS

Eleven trials included 1425 tracheal intubations by video laryngoscopy and 1632 tracheal intubations by Macintosh laryngoscopy. Video laryngoscopy reduced the risk of erroneous esophageal intubations (OR 0.10, 95% CI 0.04-0.24, P < 0.00001, I2 : 0%) compared with Macintosh laryngoscopy.

CONCLUSIONS

Our meta-analysis showed that video laryngoscopy would reduce the incidence of erroneous esophageal intubations.

[Successful tracheal intubation using the GlideScope AVL in a pediatric patient with Pierre Robin syndrome]

We report a successful use of GlideScope AVL in a pediatric patient with Pierre Robin syndrome. A 36-day-old boy weighing 2.8 kg with Pierre Robin syndrome presented for tracheostomy after several weeks of trial airway management in prone position, who had failed to relieve his obstructive apnea. The Pentax-AWS videolaryngoscope equipped with the neonate Introck could not visualize his glottic opening. The GlideScope AVL single-use video laryngoscope equipping the #1 stat captured the view of the vocal cords. A tracheal tube (2.5 mm ID) with 90 degrees angled stylet, however, did not advance into the glottic opening, colliding with the anterior wall of the larynx and/or the laryngeal ventricle. Bending the tip of the stylet in a direction opposite to the inherent memory of the tube facilitated the placement of the tube into the trachea

Pentax Airway Scope® vs Macintosh laryngoscope for tracheal intubation in adult patients: a systematic review and meta-analysis

The Pentax Airway Scope(®) is a single-use optical videolaryngoscope designed to assist with difficult tracheal intubation. We systematically reviewed the efficacy of the Pentax Airway Scope with that of a conventional laryngoscope for tracheal intubation in adults with 'normal' and 'difficult' airways. We included 17 randomised controlled trials with a total of 1801 participants. We used the DerSimonian and Laird random-effects model to calculate pooled relative risk or weighted mean differences. The relative risk (95% CI) of a Cormack-Lehane grade-1 laryngeal view was 2.40 (1.76-2.49) with the Pentax Airway Scope compared with the Macintosh laryngoscope, p < 0.00001. We found no other differences between the two laryngoscopes. Despite a superior laryngeal view, the Pentax Airway Scope provides little clinical benefit over the conventional laryngoscope.

[Efficacy of videolaryngoscopes for nasotracheal intubation: a meta-analysis of randomized controlled trials]

BACKGROUND

Increased evidence indicates that the videolaryngoscope is useful for nasotracheal intubation. The aim of this meta-analysis is to assess the efficacy of videolaryngoscopes (Glidescope, Airtraq and Pentax-AWS) in nasotracheal intubations, comparing with that of Macintosh laryngoscopy.

METHODS

The systematic search, data extraction, critical appraisal, and pooled analysis were performed according to the PRISMA statement. The relative risk (RR), mean difference (MD), and their corresponding 95% confidence intervals (CIs) were calculated by the Comprehensive Meta-analysis version 2.2.040 software for dichotomous and continuous outcomes, respectively.

RESULTS

Seven randomized controlled trials included 294 tracheal intubations by videolaryngoscopes and 253 tracheal intubations by Macintosh laryngoscopy. Videolaryngoscopes showed higher success rate (RR 1.116, 95% CI 1.021-1.220, P < 0.0155, I2 : 51%) and shorter intubation time (MD -11.9 sec, 95% CI-18.9(-) -5.0 sec, P < 0.0008, I2 84%) compared with the Macintosh laryngoscope.

CONCLUSIONS

Our meta-analysis showed that the videolaryngoscope has an advantage over Macintosh laryngoscope in nasotracheal intubations.

[GlideScope AVL single-use video laryngoscope]

BACKGROUND

The aim of this case series was to evaluate the performance of GlideScope AVL single-use video laryngoscope for the visualization of the glottis and endotracheal intubations.

METHODS

Visualization of the glottis with GlideScope AVL single-use video laryngoscope was performed in 200 consecutive patients who required tracheal intubation for surgery. The time to complete instrumentation and the visualization of the glottis according to the Cormack-Lehane grade was recorded.

RESULTS

GlideScope AVL single-use video laryngoscope provided the grade I view of the glottis in 156 patients and the gradeII view in 44 patients. Intubation with GlideScope AVL single-use video laryngoscope was successful in 199 of the 200 patients. The mean (+/- SD) time for instrumentation was 38 +/- 23 s for orotracheal intubation (n = 170) and 36 +/- 16 s for nasotracheal intubation (n = 28).

CONCLUSIONS

GlideScope AVL single-use video laryngoscope could be an effective aid for airway management in surgical patients.

[Efficacy of Glidescope video laryngoscope in difficult airways: a meta-analysis of randomized controlled trials]

BACKGROUND

Increased evidence indicates that the Glidescope video laryngoscope (GVL) is useful for difficult tracheal intubations. The aim of this meta-analysis was to assess the efficacy of the GVL in difficult tracheal intubations, comparing with that of Macintosh laryngoscopy.

METHODS

The systematic search, data extraction, critical appraisal, and pooled analysis were performed according to the PRISMA statement. The relative risk (RR), mean difference (MD), and their corresponding 95% confidence intervals (CIs) were calculated by the Comprehensive Meta-analysis version 2.2.040 software for dichotomous and continuous outcomes, respectively.

RESULTS

Fifteen randomized controlled trials including 860 tracheal intubations by GVL and 860 tracheal intubations by Macintosh laryngoscopy. GVL showed higher success rate (RR 1.065, 95% CI 1.017-1.117, P < 0.008) than does the Macintosh laryngoscope, whereas no difference was found in the duration for instrumentation.

CONCLUSIONS

Our meta-analysis showed that GVL has an advantage over Macintosh laryngoscope in respect to the success rate for difficult tracheal intubations.

[Comparison of Pentax-AWS, GlideScope Cobalt, and Macintosh laryngoscope in patients for nasotracheal intubation]

BACKGROUND

We compared the time for instrumentation in nasotracheal intubation using Pentax-AWS and Glidescope to that using the Macintosh laryngoscope in patients with normal airway.

METHODS

After local ethics board approval, 60 patients requiring dental or oral surgery were allocated randomly to Pentax-AWS, Glidescope and Macintosh groups. One experienced anesthesiologist performed nasotracheal intubation in all patients.

RESULTS

The times for instrumentation using Pentax-AWS and Glidescope, and Macintosh laryngoscope were 37 +/- 12s, 33 +/- 9s, and 30 +/- 12s, respectively. There were no differences among the three devices.

CCONCLUSIONS

When operated by experienced anesthesiologists, both Pentax-AWS and Glidescope showed similar performance for nasotracheal intubation compared with Macintosh laryngoscope in normal airway patients.

[Channeled videolaryngoscope: A meta-analysis of randomized controlled trials]

BACKGROUND

The aim of this meta-analysis was to assess the efficacy of the channeled videolaryngoscopes in routine tracheal intubation.

METHODS

The systematic search, data extraction, critical appraisal, and pooled analysis were performed according to the PRISMA statement. We included randomized controlled trials in humans comparing Airtraq and Pentax-AWS to Macintosh laryngoscopy regarding the successful first-attempt and time for instrumentation. The relative risk (RR), mean difference (MD), and their corresponding 95% confidence intervals (CIs) were calculated for dichotomous and continuous outcomes, respectively.

RESULTS

We included 20 trials with total of 2,370 patients. The channeled videolaryngoscopes showed higher success rate (RR 1.103, 95%CI 1.042 to 1.167, P <0.00069) and shorter duration for instrumentation (MD-10.873 s, 95%CI-18.588 s to-3.158 s, P< 0.0057). In studies examining novice laryngoscopists, successful first-attempt intubation (RR 1.28, 95%CI 1.14 to 1.45, P<0.000067) and time for instrumentation (MD-22.9 s, 95%CI-29.4 to-16.4, P<0.00001) were improved using the channeled videolaryngoscopes. With respect to experts' hands, there was no difference between the two devices in both of these outcomes for non-difficult intubations, while successful first-attempt intubation was improved for difficult intubations (RR 1.09, 95%CI 1.05 to 1.15, P<0.00011).

CONCLUSIONS

Compared to the Macintosh laryngoscopy, channeled videolaryngoscopy offers advantages for novice laryngoscopists, while these benefits are not seen with experts' hands in normal airways. Even with skillful hands, channeled videolaryngoscopy improves the successful first-attempt intubation in difficult intubations.

[Airtraq for difficult airways: A meta-analysis of randomized controlled trials]

BACKGROUND

Increased evidence indicates that the Airtraq is useful for difficult tracheal intubations. The aim of this meta-analysis was to assess the efficacy of the Airtraq in difficult airways, comparing with that of Macintosh laryngoscopy.

METHODS

The systematic search, data extraction, critical appraisal, and pooled analysis were performed according to the PRISMA statement. The relative risk (RR), mean difference (MD), and their corresponding 95% confidence intervals (CIs) were calculated by the Comprehensive Meta-analysis version 2.2.040 software for dichotomous and continuous outcomes, respectively.

RESULTS

Sixteen randomized controlled trials included 863 tracheal intubations by Airtraq and 865 tracheal intubations by Macintosh laryngoscopy. Airtraq showed higher success rate (RR 1.242, 95%CI 1.137 to 1.357, P<0.00001) and shorter duration for instrumentation (MD-8.259 s, 95%CI-13.122 s to-3.396 s, P <0.00087).

CONCLUSIONS

There is considerable evidence that Airtraq has an advantage over Macintosh laryngoscope in difficult airways.

[Efficacy of Pentax-AWS in difficult airways: a meta-analysis of randomized controlled trials]

BACKGROUND

Increased evidence indicates that the Pentax-AWS (AWS) is useful for difficult airways. The aim of this meta-analysis was to assess the efficacy of the AWS in difficult airways, comparing that of Macintosh laryngoscopy.

METHODS

The systematic search, data extraction, critical appraisal, and pooled analysis were performed according to the PRISMA statement. The relative risk (RR), mean difference (MD), and their corresponding 95% confidence intervals (CIs) were calculated by the Comprehensive Meta-analysis version 2.2.040 software for dichotomous and continuous outcomes, respectively.

RESULTS

Eighteen randomized controlled trials, performed in simulated difficult airways (published between 2006, October and 2012, May), included 981 tracheal intubations by AWS and 986 tracheal intubations by Macintosh laryngoscopy. AWS showed higher success rate (RR: 1.220, 95% CI: 1.126 to 1.322, P < 0.00001) and shorter duration for instrumentation (MD: -10.319 s, 95% CI: -14.309 s to -6.328 s, P < 0.00001).

CONCLUSIONS

There is considerable evidence that AWS has an advantage over Macintosh laryngoscope in difficult airways.

[Cervical spine motion during laryngoscopy with the Pentax-AWS with a new thinner blade (Introck-T)]

BACKGROUND

The Pentax-AWS equipped with a new thinner blade (Introck-T) is an intubation device that provides a non-line-of sight view of the glottis. A non-line-of sight view is expected to cause less movement of the cervical spine during laryngeal visualization. We measured the degree of cervical spine movement during laryngoscopy with the device.

METHODS

Twenty patients requiring general anesthesia were studied. Each patient underwent laryngoscopy using the Pentax-AWS with the Introck-T. Movements of cervical spine were measured by radiography in the same patient both at neutral head position and during laryngoscopy.

RESULTS

The anterior movement of the vertebral bodies from baseline was 16.7 +/- 5.2 mm, 16.5 +/- 4.4 mm, 16.5 +/- 4.7mm and 15.5 +/- 4.7mm at the atlas (C1), C2, C3, and C4 vertebrae, respectively, during laryngoscopy. The change in angle during laryngeal visualization was 8.3 +/- 4.0 degrees, 7.6 +/- 3.7 degrees, 1.7 +/- 2.4 degrees, and 1.6 +/- 3.3 degrees, at Occiput/C1, C1/C2, C2/C3, and C3/C4 motion segments, respectively. The total change in angle between the occiput and C4 was 19.1 +/- 5.1 degrees (95% CI 16.6 degrees - 21.5 degrees).

CONCLUSIONS

Laryngeal visualization using the Pentax-AWS with the new thinner Introck-T produces the anterior movement and extension of the cervical spine.

[Cervical spine movement during bag-mask ventilation]

BACKGROUND

Every airway maneuver will cause some degree of neck movement. Ventilation via face-mask technique requires lifting the mandible (jaw thrust) to the facemask. A significant degree of cervical spine motion induced by bag-mask ventilation has been reported on human cadavers with destabilized cervical vertebrae. However, to our knowledge, no quantitative data have reported evaluating the effects of bag-mask ventilation on cervical spine motion in living humans. We measured the cervical spine movement during bag-mask ventilation.

METHODS

Twenty patients requiring general anesthesia were studied. Each patient underwent bag-mask ventilation. Movements of cervical spine were measured by radiography in the same patient both at neutral head position and during bag-mask ventilation.

RESULTS

The anterior movements of the vertebral bodies from baseline were 11.3 +/- 5.8 mm, 11.1 +/- 4.9 mm, 11.0 +/- 4.7 mm and 10.6 +/- 4.4 mm at the atlas, C2, C3, and C4 vertebrae, respectively, during bag-mask ventilation. The changes in angle during bag-mask ventilation were 7.4 +/- 4.5 degrees, 4.9 +/- 4.2 degrees, 1.7 +/- 3.2 degrees, and -0.1 +/- 2.3 degrees, at occiput/C1, C1/C2, C2/C3, and C3/C4 motion segments, respectively. The total change in angle between the occiput and C4 was 13.8 +/- 6.4 degrees (95% CI 10.9 degrees-16.8 degrees).

CONCLUSIONS

The lifting the mandible causes both extension and anterior disposition in the cervical vertebrae.

[Glidescope cobalt videolaryngoscope]

GlideScope Cobalt video laryngoscope is a novel indirect laryngoscope for tracheal intubation. It consists of a reusable high-resolution miniature video camera and light source, and a disposable transparent sheath that enshrouds the video camera, thereby preventing contact with the patient. To evaluate the per- formance of GlideScope Cobalt, endotracheal intubation was performed in 100 consecutive patients requiring tracheal intubation for surgery. The time to complete instrumentation, the visualization of the glottis by the Cormack-Lehane grade and optimizing procedures were recorded. GlideScope Cobalt allowed successful intubation in all patients examined, including two patients with difficult airway with the Macintosh laryngoscope. Endotracheal intubation was performed within one minute in 83 cases. GlideScope Cobalt provided Cormack-Lehane grade 1 or 2 visualization of the glottis in 100 patients. It was easily handled not only by experienced anesthetists but also by novice personnel. GlideScope Cobalt could be an effective aid to airway management in surgical patients.

[Successful resuscitation in a life-threatening obstetric hemorrhagic patient with hematocrit 3%: a case report]

We report a postpartum woman who suffered from obstetric bleeding after caesarean section. Her lowest hematocrit was 3% when a large amount of blood was lost. "Guidelines for management of critical bleeding in obstetrics" published by the Japanese Society of Anesthesiologists and four related academic societies was helpful for the resuscitation of the parturient. A systematic approach was effective for the care of women with major obstetric hemorrhage.

Safe esophageal reconstruction by ileocolic interposition

Many techniques have been proposed for esophageal reconstruction after esophagectomy when a gastric tube cannot be employed. There are two essential criteria for such a substitute: substitute length and sufficient blood supply. We propose ileocolic interposition as an easy and safe option. Two technical aspects contributing to the high success rate of this method are the preservation of an intact arterial network allowing normal blood flow to the ileocolic area, and the ability to quantify blood flow using a Doppler pulse flow meter in six cases. These are enabled by a long (up to 20cm) ileocolic segment. The preservation of the right colic artery is important, because its interruption would reduce blood supply to the long ileum segment. Between July 2003 and October 2008, we used this method in six patients in whom a gastric tube was not an option. We assessed perioperative morbidity and swallowing difficulties in each patient, quantifying dysphagia on scale of 0 to 4. There was no mortality and no anastomotic leak. There was one wound infection, and in one patient, recurrent nerve paralysis was observed. The postoperative hospital stay was 29.5 ± 10.8 days. The average dysphagia score for the six patients was 0.17 ± 0.41 after the operation. All patients can eat normally, without any dietary limitations. Ileocolonic interposition after esophagectomy requires careful assessment of the vascular supply. In this small series, morbidity was low and there was no perioperative mortality. We believe that this is an easy and safe method of reconstruction after esophagectomy in cases in whom a gastric tube cannot be used as a substitute.

Laparoscopy-assisted spleen-preserving pancreatic resection for epidermoid cyst in an intrapancreatic accessory spleen

A rare case of an epidermoid cyst originating in an intrapancreatic accessory spleen in a 50-year-old Japanese female is reported. A hypoechoic cystic tumor was detected incidentally by abdominal ultrasonography. It appeared to be a single cyst in the pancreatic tail with a contrasted mass lesion beside it. Laparoscopy-assisted spleen-preserving pancreatic tail resection was performed. Microscopic examination revealed that the cyst was surrounded by fibrous tissue and a thin layer of splenic tissue, adjacent to normal pancreatic parenchyma. The inner surface of the cyst was lined with non-keratinizing squamous epithelium. The diagnosis of an epidermoid cyst occurring in an intrapancreatic accessory spleen was confirmed. Laparoscopy-assisted spleen-preserving pancreatic resection is a safe and effective procedure for benign or low-grade malignant cystic diseases in the pancreas.

[GlideScope Ranger: clinical assessment of the performance in 100 patients]

To evaluate the suitability of GlideScope Ranger, endotracheal intubation was performed in 100 surgical patients undergoing general anesthesia. The time to complete intubation, percentage of glottic opening score and optimizing procedures were recorded. GlideScope Ranger allowed visualization of the glottis and successful intubation in all 100 patients, including two patients with difficult airway. Endotracheal intubation was performed within one minute in 81 cases, and percentage of glottic opening score of 75% or more was obtained in 75 cases. It was easily handled not only by experienced anesthetists but also by novice personnel. GlideScope Ranger could be an effective aid to airway management in surgical patients.

[Case of unexpected difficult intubation caused by asymptomatic congenital laryngeal web]

We report a case of unexpected difficult intubation in a patient with an asymptomatic congenital laryngeal web. A 44-year-old female with left ovarian tumor and endometrial polyp was scheduled for abdominal hysterectomy and left salpingo-oophorectomy under general anesthesia. With aid of laryngoscopy using Macintosh laryngoscope, we attempted to place a tracheal tube (ID 7.5 mm and 7.0 mm), but could not perform instrumentation because of the resistance against the tube just under the vocal cord. We visualized the glottic opening through the Airway Scope and found a membranous lesion at the ventral side of the glottis, diagnosing a congenital laryngeal web. We finally could insert a tracheal tube of ID 6.5 mm into the dorsal side of the glottis. Airway Scope may be a useful device for unexpected difficult tracheal intubation.

[Submental tracheal intubation for a panfacial fracture patient]

Panfacial fractures represent a unique challenge to the surgical and anesthetic team. Often nasal and oral intubations interfere with surgical procedure, while tracheotomies include a number of potential complications as well as the formation of poor scarring in a highly visible area. Tracheal intubation through the floor of the mouth, mentioned as submental tracheal intubation, is a simple quick and effective alternative to oral and nasal tracheal intubation or tracheostomy in the surgical management of selected patients with panfacial fractures. In this case report, with successful submental tracheal intubation, the potential complications associated with a tracheotomy were avoided.

[Use of sugammadex in a patient with limb girdle muscular dystrophy]

Limb girdle muscular dystrophy, a chronic progressive muscular atrophic disease, leads to high sensitivity to depolarizing and non-depolarizing neuromuscular blocking agents. We report the successful use of the sugammadex in a patient with limb girdle muscular dystrophy (dysferlinopathy, Miyoshi distal myopathy) to reverse rocuronium-induced neuromuscular block. After neuromuscular recovery to a train-of-four ratio = 43%, we administered 3.2 mg x kg(-1) of sugammadex (200 mg) intravenously, reversing neuromuscular blockade to a train-of-four ratio = 95% within 3 min. Sugammadex can be used to reverse rocuronium-induced neuromuscular blockade in patients with limb girdle muscular dystrophy.

[Use of Parker Flex-Tip tracheal tube in a patient with Kniest dysplasia]

A 37-year-old man with Kniest dysplasia and thoracic myelopathy was scheduled for T3-12 laminectomy. Kniest dysplasia is a severe chondrodysplasia characterized by short trunk and limbs. Awake fiberoptic intubation was attempted to prevent airway obstruction because we had predicted his difficult airway. During fiberoptic tracheal intubation, we easily succeeded in the insertion of the fiberscope itself into the trachea, but were not able to insert the tip of a reinforced tube into the trachea, because the tip of the reinforced tube impinged on laryngeal structures. We succeeded in placing the Parker Flex-Tip tracheal tube into the trachea. We considered that the Parker Flex-Tip tube, having a tip that reduces the gap between the fiberscope and the inside of the tube, resulted in success of the passage of the tube into the trachea during fiberoptic intubation.

Morphological evaluation of cranial and maxillary shape differences of the brachymorphic mouse with spontaneous malocclusion using three-dimensional micro-computed tomography

OBJECTIVES

The aim of this study was to determine whether significant cranial and maxillary deformity exists in BALB/c-bm/bm (brachymorphism) mouse with spontaneous malocclusion using three-dimensional (3D) images.

MATERIALS AND METHODS

Thirty female mice were divided into the following three groups: control group (BALB/c mice, n = 10), Norm group (BALB/c-bm/bm mice with normal occlusion, n = 10), and Mal group (BALB/c-bm/bm mice with malocclusion, n = 10). Nine points in the skull were selected, and transverse and antero-posterior distances were measured using three-dimensional images of micro-computed tomography (CT). Moreover, 3D images were superimposed at the median plane to visualize the skull shape asymmetry.

RESULTS

The transverse distances at the posterior cranial and maxillary region and the antero-posterior distances in the Norm and Mal groups were significantly shorter than those in the control group. The nasal septum of the Mal group was significantly shorter than that of the Norm group. Morphological measurements and superimposed 3D images showed that lateral deviation occurred at the anterior cranial and maxillary region in the Mal group.

CONCLUSION

The 3D micro-CT images revealed that the antero-posterior length and posterior transverse width at the cranium and maxilla in BALB/c-bm/bm mice were significantly smaller than those in BALB/c mice. It was quantitatively and morphologically clear that BALB/c-bm/bm mice show a spontaneous transverse crossbite owing to lateral deviation of the maxilla and nasal bone.

[Distortion of the anterior airway anatomy and cervical spine motion during laryngoscopy with GlideScope videolaryngoscope: a comparison of mid-size blade vs large blade]

BACKGROUND

GlideScope videolaryngoscope (GVL) is a novel indirect laryngogoscope for tracheal intubation. Both mid-size and large blades of the GVL are available for adult patients. The distortion of the anterior airway anatomy and cervical spine motion using the mid-size GVL is unknown. We compare the degree of anterior airway distortion and cervical spine movement during the use of the mid-size GVL compared with the large GVL.

METHODS

Twenty patients requiring general anesthesia and tracheal intubation were studied. Each patient underwent laryngoscopy with both mid-size and large GVLs. During each laryngoscopy, a radiograph for the lateral view of the head and neck was taken when the best view of the larynx was obtained. Based on the radiographs, independent radiologists evaluated anterior airway movement and cervical spine movement.

RESULTS

The tip of the mid-size GVL was anteriorly positioned during laryngoscopy, compared with large GVL. The distance between epiglottis and posterior laryngeal wall was longer with the mid-size GVL than with the large GVL. Both the mid-size and large GVL caused a significant anterior movement in the cervical spine during laryngoscope. The difference in the movement in the atlas and C2 was small, but statistically significant. No difference was found in the anterior movement with C3 and C4. During laryngoscopy, cervical spinal extension occurred with both GVLs, while there was no difference in the cervical spinal extension between the mid-size and large GVL.

CONCLUSIONS

The tip of the mid-size GVL during laryngoscopy is anteriorly positioned and the distortion of the anterior airway was greater with the mid-size GVL than with the large GVL.

Chitosan-Coated Fibers for Use in Papermaking

Chitosan was precipitated onto wood pulp, glass and polypropylene fibers suitable for papermaking. The coating which formed on the fibers was characterized by photomicrography after the formation of colored derivatives, and by scanning electron microscopy. The most uniform and adherent coatings were formed on the wood pulp fibers and the least were formed on the polypropylene fibers. Paper handsheets were readily formed from the chitosan-coated wood pulp and glass fibers, but not from the chitosan-coated polypropylene fibers.

[Airtraq optical laryngoscope: clinical assessment of its performance in 100 children]

BACKGROUND

The aim of the present study was to evaluate the suitability of Airtraq optical laryngoscope for the tracheal intubation in children.

METHODS

Endotracheal intubation was performed using the Airtraq optical laryngoscope in 100 pediatric patients undergoing general anesthesia. The time to complete tracheal intubation and optimizing procedures were recorded.

RESULTS

The Airtraq optical laryngoscope allowed visualization of the glottis and successful intubation in the 100 patients, including three patients with difficult airway. Utilization of a gum elastic bougie was helpful to introduce a tube tip to the trachea.

CONCLUSIONS

The Airtraq optical laryngoscope might be an alternative apparatus for endotracheal intubation in pediatric patients.

[Successful tracheal intubation using the pediatric Airtraq optical laryngoscope in a pediatric patient with Robin sequence]

We report a successful use of pediatric Airtraq optical laryngoscope in a pediatric patient with Robin sequence. Robin sequence accompanies a characteristic facies and its clinical presentation is marked by micrognathia, retrognathia, glossoptosis, and respiratory obstruction. A 1-year-5 month-old boy with Robin sequence was scheduled for palate repair under general anesthesia. After anesthetic induction with thiopental and neuromuscular paralysis with rocuronium, initial laryngeal view with the conventional Macintosh laryngoscope was Cormack-Lehane grade II due to restricted mouth opening and micrognathia. The Airtraq Pedi provided the glottic view with Cormack-Lehane grade I and a preformed tracheal tube (ID 4 mm) was placed correctly into the trachea through the built-in tube channel. We conclude that the pediatric Airtraq has potential advantages over conventional direct laryngoscopy in children with difficult airway.

[Case report of endotracheal intubation using AirWay Scope (Pentax-AWS) in a Forestier's disease patient]

A Forestier's disease patient was scheduled for endoscopic mucosal resection under general anesthesia, because of his hypoxic episode during gastric endoscopy. Endotracheal intubation was planned while awake, because he was suspected as a case of difficult airway. By using AWS, we could easily confirm his larynx and aditus of trachea in spite of his narrow pharynx caused by Forestier's disease. The procedure was successful with no complications. AWS seems to be a useful device for endotracheal intubation in Forestier's disease.

[Nasotracheal intubation using GlideScope videolaryngoscope or Macintosh laryngoscope by novice laryngoscopists]

BACKGROUND

We compared the performance of GlideScope videolaryngoscope with that of the conventional Macintosh laryngoscope for nasotracheal intubation by non-anesthesia residents.

METHODS

Forty patients requiring nasal endotracheal intubation for surgical convenience were allocated to intubation with the GlideScope videolaryngoscope or Macintosh laryngoscope. Each intubation was performed by non-anesthesia residents.

RESULTS

The time to secure the airway was shorter with GlideScope laryngoscopy than with the Macintosh laryngoscopy. Magill forceps were not needed for any patient during GlideScope videolaryngoscopy, while Macintosh laryngoscopy required Magill forceps utilization for 75% of the patients.

CONCLUSIONS

The unobstructed view of the glottic opening on the video monitor helped the laryngoscopist performing the nasal endotracheal intubation while an assistant provided laryngeal manipulation to improve the coordinated effort. GlideScope seems to facilitate nasotracheal intubation for individuals training in airway management.

[Anesthesia for cesarean section: a retrospective analysis at the Center for Perinatal and Neonatal Medicine in Jichi Medical University Hospital]

BACKGROUND

To evaluate obstetric and anesthetic problems relating to cesarean delivery, we investigated parturients who had undergone cesarean section at the Center for Perinatal and Neonatal Medicine in Jichi Medical University Hospital.

METHODS

Obstetric and anesthetic data were gathered from January 2007 to December 2007 for all cesarean sections.

RESULTS

In all, 607 parturients received cesarean section during the period. Of the 607 cesarean deliveries, 308 were performed in elective condition, and 299 were done in emergency situation. Of the 299 emergencies, 125 underwent cesarean section at nights and/or holidays. Population risk included maternal age (age >35 year, 33.1%), preterm birth (31.5%), and obesity (BMI >35 kg x m(-2), 3.3%). Complicated pregnancy included multifetal pregnancies (15.2%) and placenta previa (12.5%).

CONCLUSIONS

At the center for perinatal and neonatal medicine, population risk is increasing because of increases in maternal age, obesity, placenta previa, and rates of multifetal pregnancies.

[Effect of training period on learning process in endotracheal intubation using Macintosh laryngoscope]

PURPOSE

To determine the learning process in endotracheal intubation using the Macintosh laryngoscope, we investigated time needed for instrumentation and rate of erroneous esophageal intubation.

METHODS

We compared the results of 456 endotracheal intubations by non-anesthesia residents with those of 81 endotracheal intubations by anesthesia residents.

RESULTS

The mean (+/-SD) times for instrumentation were 77 +/- 46 seconds, 61 +/- 41 seconds, 41 +/- 21 seconds, and 41 +/- 22 seconds in non-anesthesia residents with training period for 1-2 month, 3-4 month, 5-6 month, and 7-8 month, respectively; while that by anesthesia residents was 41 +/- 21 seconds. No significant difference was found in the rate of erroneous esophageal intubation between non-anesthesia residents (34 times, 7.5%) and anesthesia residents (2 times, 2.5%). Of the 34 esophageal intubations by non-anesthesia residents, 26 (76.5%) occurred in the first- and second-month period.

CONCLUSIONS

Two month training course for anesthesia management in our institution seems to be insufficient for learning skills in endotracheal intubation. It is most likely to require 6 months to acquire the sufficient skill in endotracheal intubation.

[Use of the GlideScope video laryngoscope in 50 pediatric patients]

BACKGROUND

The GlideScope video laryngoscope (Verathon Inc. Bothell, Washington, USA) is a relatively new device for tracheal intubation, which provides a excellent glottic visualization. We here report the clinical experience of the GlideScope (small) in 50 pediatric patients.

METHODS

Tracheal intubation with GlideScope (small) was performed in 50 consecutive pediatric patients requiring orotracheal intubation for surgery. The view of glottic opening was scored according to the classification of Cormack-Lehane. The time required to intubate and the number of intubation attempts were recorded.

RESULTS

In all, 50 children included 4 neonates, 8 infants under 1 year and 38 children between 1 year and 9 years. Cormack-Lehane classification 1 or 2 was obtained in 74% and 22%, respectively, and successful intubation was achieved in 48 of 50 children (96%). In remaining two babies, GlideScope failed to intubate the trachea. The mean +/- SD time for instrumentation in successful intubation at first attempt was 56.6 +/- 34.2 seconds.

CONCLUSIONS

GlideScope seemed to be a novel device in pediatric patients. Further studies are required to evaluate the usefulness in neonates, small infants and children with a difficult airway.