Anterior cervical discectomy with fusion is a common surgical procedure for patients suffering pain and/ or neurological deficits and unresponsive to conservative management. For decades, autologous bone grafted from the iliac crest has been used as a substrate for cervical arthrodesis. However patient dissatisfaction with donor site morbidity has led to the search for alternative techniques. We present a literature review examining the progress of available grafting options as assessed in human clinical trials, considering allograft-based, synthetic, factor-and cell-based technologies.

Purpose Endotracheal intubation in critically ill patients is associated with a high risk of complications that tend to increase with multiple attempts at laryngoscopy. In this pilot study, we compared direct laryngoscopy (DL) with videolaryngoscopy (VL) with regard to the number of attempts and other clinical parameters during endotracheal intubation of critically ill patients performed by novice providers.Methods Patients were randomized to either VL or DL for endotracheal intubation. Exclusion criteria for the study included: requirement for immediate endotracheal intubation, cervical spine precautions, anticipated difficult intubation, oxygen saturation \ 90%, or systolic blood pressure \ 80 mmHg despite resuscitation. The providers, predominantly non-anesthesiology residents in their first three years of postgraduate training, received a one-hour teaching and mannequin session prior to performing the procedures. Results Forty patients, mean age 65 (standard deviation, 16) yr were randomized to VL (n = 20) or DL (n = 20). Sixty percent of the patients received endotracheal intubation for respiratory failure, and all patients received a neuromuscular blocker. Multiple attempts were required in 25/40 (63%) patients, and this did not differ with technique (P = 1.0) Video-laryngoscopy resulted in improved glottic visualization with 85% of patients having a Cormack-Lehane grade 1 view compared with 30% of patients in the DL group (P \ 0.001). Total time-to-intubation for VL was 221 sec Donald Griesdale was the principle investigator and responsible for the concept and design of the study. He had access to all of the data and takes full responsibility for the integrity of the data and the accuracy of the data analysis. Anton Chau, George Isac, Denise Foster, Corrie Irwin, and Peter Choi were involved in the design of the study. Denise Foster was involved in data acquisition, and Anton Chau, George Isac, Najib Ayas, Denise Foster, and Peter Choi were involved in interpretation of the data. Donald Griesdale, Anton Chau, George Isac, Najib Ayas, Denise Foster, Corrie Irwin, and Peter Choi helped draft the manuscript. Anton Chau, George Isac, Najib Ayas, Denise Foster, and Corrie Irwin critically revised the manuscript. Peter Choi was involved in interpretation of the data, and he also revised the manuscript prior to submission. RésuméObjectif L'intubation endotrache´ale chez des patients gravement malades est associe´e à un risque e´leve´de complications qui tendent a`eˆtre plus nombreuses apre`s de multiples tentatives de laryngoscopie. Dans cette e´tude pilote, nous avons compare´la laryngoscopie directe (DL) et la vide´o-laryngoscopie (VL) pour ce qui concerne le nombre de tentatives et d'autres parame`tres cliniques au cours de l'intubation endotrache´ale de patients gravement malades re´alise´e par des praticiens novices. Méthodes Les patients ont e´te´randomise´s dans un groupe d'intubation endotrache´ale par VL ou par DL. Les crite`res d'exclusion de l'e´tude e´taient les suivants : ne´cessite´d'une ...

High-flow nasal oxygen has been shown to provide effective pre-oxygenation and prolong apnoeic time during intubation attempts in non-pregnant patients. We aimed to compare pre-oxygenation using high-flow nasal oxygen (30-70 l.min À1 oxygen flow) via nasal prongs with standard 15 l.min À1 oxygen breathing via a tightfitting facemask. Forty healthy parturients were randomly allocated to these two groups, and furthermore each patient underwent the selected pre-oxygenation method with both 3-min tidal volume breathing and 30s tidal breathing followed by eight vital capacity breaths. With 3-min tidal volume breathing, the respective estimated marginal means for high-flow nasal oxygen and standard flow rate facemask pre-oxygenation were 87.4% (95% CI 85.5-89.2%) and 91.0% (95%CI 89.3-92.7%), p = 0.02; with eight vital capacity breaths the estimated marginal means were 85.9% (95%CI 84.1-87.7%) and 91.8% (95%CI 90.1-93.4%, p < 0.0001). Furthermore, high-flow nasal oxygen did not reliably achieve a mean end-tidal oxygen concentration ≥ 90% compared with the standard flow rate facemask. In this physiological study, high-flow nasal oxygen pre-oxygenation performed worse than standard flow rate facemask pre-oxygenation in healthy term parturients.

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Analgesia onset was most rapid with CSE with no difference between DPE and EPL techniques. The DPE technique has improved block quality over the EPL technique with fewer maternal and fetal side effects than the CSE technique for parturients requesting early labor analgesia.

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(Anesth Analg. 2017;124(2):560–569) Epidural (EPL) and combined spinal epidural (CSE) are commonly used and effective labor analgesia neuraxial techniques. EPL has minimal adverse effects, but has a slow onset time and may result in insufficient sacral spread/patchy sensory blockade. In contrast, CSE has rapid onset and excellent sacral coverage but has greater risk of adverse effects. The dural puncture epidural (DPE) technique (passing a spinal needle through the EPL needle, puncturing the dura but not injecting medication into the intrathecal space) has been shown to improve caudal spread of analgesia compared with the EPL technique, without the side effects seen with CSE. In the present study, the authors determined whether or not overall analgesia characteristics and side effects would favor the DPE technique, and hypothesized that onset of labor analgesia is most rapid with CSE, followed by DPE and EPL.

Anesthesiologists should recognize that patients receiving SGLT2i preoperatively are at risk of developing euDKA. Hence, based on the pharmacokinetics of SGLT2i, discontinuing the medication at least two days prior to surgery should minimize the risk. Diagnosing euDKA is challenging and often delayed because of its nonspecific signs and symptoms. When suspected, serum and urine ketones should be monitored to reduce the time to diagnosis and treatment.