Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Randomized Controlled Trial
A styletted tracheal tube with a posterior-facing bevel reduces epistaxis during nasal intubation: a randomized trial.
Epistaxis is a common complication of nasal intubation. Ease of insertion of the tracheal tube may be influenced by bevel orientation and tip bending. We examined ease of insertion and epistaxis with two tubes with different orientations and with or without a stylet to modify tip bending. ⋯ UMIN Clinical Trials Registry (UMIN-CTR), UMIN000011327.
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Observational Study
An observational cohort study to assess glycosylated hemoglobin screening for elective surgical patients.
Uncontrolled blood glucose is associated with a higher incidence of surgical site infections, greater utilization of resources, and increased mortality. Preoperative screening for diabetes in elective surgical patients is not routinely performed. The purpose of this study was to examine blood glucose control in a preoperative surgical population. ⋯ Many elective surgical patients are at risk for unrecognized postoperative hyperglycemia and associated adverse outcomes. Random blood sugar testing has limited value and HbA1c may be a more appropriate test for the preoperative assessment of diabetic patients.
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Intravenous leiomyomatosis is a rare disorder characterized by benign smooth-muscle tumours, termed leiomyomas, which originate from uterine leiomyomas or pelvic veins. Tumours may extend into the right-sided heart chambers, termed intracardiac leiomyomatosis (ICLM), and may be potentially life-threatening due to mechanical interference with cardiac structures or pulmonary arteries. While surgical excision is the optimal therapy, incomplete retrieval of a tumour or fatal retroperitoneal hemorrhage may occur. We present a case where intraoperative transesophageal ultrasound (TEU) guided complete removal of an intracardiac leiomyoma in a single-stage surgery solely through the right atrium without vein injury. ⋯ For cases with ICLM, intraoperative TEU plays a significant role in helping to plan the surgical approach, monitor the movement of the tumour and the IVC during the extraction, and assess the completeness of tumour resection.
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When exposed in the perioperative period to blood components containing immunoglobulin (Ig)A IgA-sensitized IgA-deficient patients are at an increased risk of transfusion-associated anaphylaxis. We present the case of an IgA-deficient patient whose candidacy for double-lung transplantation was under review in the preoperative period. ⋯ Through a multidisciplinary approach [corrected], a successful transplantation outcome was achieved in an IgA-deficient patient undergoing major surgery. Strategies to mitigate risk include the procurement and transfusion of IgA-deficient components, which may be challenging or untenable in emergent perioperative settings.
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Observational Study
Angular change in the line of vision to the larynx: implications for determining the laryngoscopic view.
We measured the angular change from the line of vision to the larynx around the upper incisors under defined laryngoscopic forces and investigated its association with the laryngoscopic view. ⋯ Compared with ELG, DLG is associated with a larger angle difference, i.e., a larger gap between the underside of the blade and the thyroid notch at all laryngoscopic forces (10-50 N). The concept of angle difference, based on the angular change in the line of vision around the upper incisors, may provide a new approach to understanding DLG. This study was registered with the Clinical Research Information Service, registration number KCT0000433.