In this prospective study, continuous femoral nerve catheters were effective for postoperative analgesia but had a frequent rate of bacterial catheter colonization. We found no serious infections after short-term (2-day) infusion. Side effects were few, but one nerve injury occurred.
The modified Mallampati score is used to predict difficult tracheal intubation. We have conducted a meta-analysis of published studies to evaluate the Mallampati score as a prognostic test. A total of 55 studies involving 177 088 patients were included after comprehensive electronic and manual searches. The pooled estimates from the meta-analyses were calculated based on a random-effects model and a summary receiver operating curve. Meta-regression analyses were performed to explore sources of possible heterogeneity between the studies. The summary receiver operating curve demonstrated an area under the curve of 0.75. The pooled odds ratio for a difficult intubation with a modified Mallampati score of III or IV was 5.89 [95% confidence interval (CI), 4.74-7.32]. The pooled estimates of the specificity and sensitivity were 0.91 (CI, 0.91-0.91) and 0.35 (CI, 0.34-0.36), respectively. The pooled positive and negative likelihood ratios were 4.13 (CI, 3.60-4.66) and 0.70 (CI, 0.65-0.75), respectively. The meta-analyses had statistical and clinical heterogeneity ranging from 87.2% to 99.4%. Meta-regression analyses did not identify any significant explanation of the heterogeneity. We conclude that the prognostic value of the modified Mallampati score was worse than that estimated by previous meta-analyses. Our assessment shows that the modified Mallampati score is inadequate as a stand-alone test of a difficult laryngoscopy or tracheal intubation, but it may well be a part of a multivariate model for the prediction of a difficult tracheal intubation.
Mixtures of long-acting local anesthetics with lidocaine induced faster onset blocks of decreased duration. Whether there is a safety benefit is unclear, as the benefit of a decreased concentration of long-acting local anesthetic may be offset by the presence of a significant plasma concentration of lidocaine.
Ab initio calculations in the framework of the density functional theory ͑DFT͒ with 19-electron pseudopotential on silver atoms are performed to study the lowest-energy isomers of silver bromide clusters Ag n Br p (ϩ) (nр6, pϭn, nϪ1). The stability, the structural and electronic properties of neutral, and positively charged systems are examined. The B3LYP functional has been used. For the smallest species, the DFT/B3LYP results are very close to those obtained with multireference configuration interaction or coupled cluster methods. In Ag n Br nϪ1 clusters, the excess electron density shows a picture intermediate between that observed in alkali halide clusters ͑F-center or localization on a pending alkali atom͒ and that suggesting partial delocalization on a dimer or trimer silver subunit. Isomer stabilities, fragmentation energies, electric dipole moments, adiabatic and vertical ionization potentials are calculated. The use of 11-electron pseudopotential on silver is discussed.
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