British journal of anaesthesia
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Flexible bronchoscopy for tracheal intubation is indicated in patients with difficult airways, but the upper airway is frequently obstructed in sedated or anaesthetised apnoeic patients. This makes it more difficult to locate the glottis through bronchoscopy, and increases the risk of hypoxaemia. Nasal high-flow oxygenation is useful to prevent hypoxaemia during airway management, but no studies have assessed if this method of oxygenation improves the bronchoscopic view of the glottis by preventing upper airway obstruction. ⋯ Nasal high-flow oxygenation facilitates flexible bronchoscopy for tracheal intubation by widening the pharyngeal space and by improving the view of the glottis through the bronchoscope. Therefore, use of nasal high-flow oxygenation is useful in patients with difficult airways in whom flexible bronchoscopy for tracheal intubation is indicated.
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Postoperative neurocognitive decline is a frequent complication triggered by unclear signalling mechanisms. This observational case-control study investigated the effects of hip or knee replacement surgery on the composition of circulating extracellular vesicles (EVs), potential periphery-to-brain messengers, and their association with neurocognitive outcomes. ⋯ Our findings highlight the impact of surgery on plasma- and CSF-derived EVs, particularly in patients with poor neurocognitive outcomes, indicating a potential role for EVs. The small sample size necessitates verification with a larger patient cohort.
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The science of pilot trials is evolving, and understanding of their role in medical research is increasing. Perioperative randomised controlled trials often test interventions that are inherently multidisciplinary and complex; therefore, there might be compelling reasons to conduct pilot studies to assess feasibility and inform trial design. As pilot studies themselves require resources, investigators should not squander this opportunity; they should design them so that they properly address the sources of uncertainty regarding the success of the definitive trial.