Atelectasis occurs in the majority of children undergoing general anaesthesia. Lung ultrasound has shown reliable sensitivity and specificity for diagnosing anaesthesia-induced atelectasis. We assessed the effects of a recruitment manoeuvre on atelectasis using lung ultrasound in infants undergoing general anaesthesia. Forty infants, randomly allocated to either a recruitment manoeuvre group or a control group, received volume-controlled ventilation with 5 cmH O positive end-expiratory pressure. Lung ultrasound examination was performed twice in each patient, the first a minute after starting mechanical ventilation of the lungs and the second at the end of surgery. Patients in the recruitment manoeuvre group received ultrasound-guided recruitment manoeuvres after each lung ultrasound examination. The incidence of significant anaesthesia-induced atelectasis at the second lung ultrasound examination was less in the recruitment manoeuvre group compared with the control group (25% vs. 80%; p = 0.001; odds ratio (OR) 0.083; 95% confidence interval (CI): 0.019-0.370). The median (IQR [range]) lung ultrasound scores for consolidation and B-lines on the second examination were lower in the recruitment manoeuvre group compared with the control group; 6.0 (3.0-9.3 [0.0-14.0]) vs. 13.5 (11.0-16.5 [8.0-23.0]); p < 0.001 and 6.5 (3.0-12.0 [0.0-28.0]) vs. 15.0 (10.8-20.5 [7.0-28.0]); p < 0.001, respectively. The lung ultrasound scores for consolidation on the first and second examinations showed a negative correlation with age (r = -0.340, p = 0.008; r = -0.380, p = 0.003). We conclude that ultrasound-guided recruitment manoeuvres with positive end-expiratory pressure proved useful in reducing the incidence of anaesthesia-induced atelectasis in infants, although 5 cmH O positive end-expiratory pressure alone was not sufficient to eliminate it. In addition, the younger the patient, the more susceptible they were to atelectasis.

During spinal block, there seems to be a safety margin of 2-4 vertebral bodies and intervertebral spaces between the conus medullaris and Tuffier's line, which is consistent regardless of sex or presence of transitional vertebra. However, because the conus medullaris and Tuffier's line become closer with age and the clinical use of Tuffier's line requires palpation through subcutaneous fat, caution must be exercised regarding selection of the intervertebral space, especially in the aged and obese population.

Purpose The purpose of this study was to evaluate the effect of head rotation in adults and children on endotracheal tube (ETT) position and to confirm previous results regarding the influence of head flexion and extension on ETT position. Methods After inducing anesthesia in 24 young adults and 22 children (aged 1-9 yr), ETTs were secured on the right corner of each of their mouths. Using a fiberoptic bronchoscope, the distance from the carina to the tip of the ETT was measured with each patient's head and neck placed in a neutral position, flexed, extended, rotated to the right, and rotated to the left.

Clinicaltrials.gov (identifier: NCT02333786).

Nanocomposites of organophilic montmorillonite (C18-MMT), nitrile-butadiene rubber (NBR), and a coupling agent were produced during a melt compounding process at room temperature. During the process, it was clearly observed that organo-MMT particles were exfoliated into nanoscale layers of approximately 1-30 nm thickness, in addition to their original 40 m thickness. These MMT layers were uniformly dispersed in the NBR matrix. The effects of a coupling agent such as 3-(mercaptopropyl)trimethoxy silane in C18-MMT/NBR nanocomposites were studied. The C18-MMT/NBR nanocomposites in the presence of the coupling agent were identified and characterized by X-ray diffraction, transmission electron microscopy, a universal testing machine, thermogravimetric analysis, and IR spectroscopy. It was observed that an additional silane coupling agent, 3-(mercaptopropyl)trimethoxy silane, enhanced the chemical interaction and was accompanied by the formation of SiOOOSi coupling bonds between C18-MMT and the coupling agent and SiOC coupling bonds between NBR and the coupling agent. This work resulted in improved properties of organo-MMT/NBR nanocomposites because of the nanoscale effects and strong interaction of the coupling bonds between NBR and organo-MMT.

The Radical-7 Pulse CO-Oximeter can be useful as a trend monitor in children during surgery even immediately after intravascular volume expanders are administered. However, it is advisable to confirm the baseline hemoglobin level and to consider the influence of tHb level on the bias. In addition, one should be cautious with regard to using SpHb alone when making transfusion decisions.

No abstract

Background: Desaturation frequently occurs in infants after general anaesthesia in the prone position. We aimed to evaluate the effect of regular alveolar recruitment in preventing atelectasis in infants and children after general anaesthesia in the prone position. Methods: Children (<3 yr) undergoing general anaesthesia (>2 h) in the prone position were randomised to either receive regular alveolar recruitment or standardised care without recruitment. Ultrasound-guided alveolar recruitment was performed for both groups, and mechanical ventilation was started with a tidal volume of 6 ml kg À1 and PEEP of 7 cm H 2 O. During mechanical ventilation, the intervention (regular recruitment) group received alveolar recruitment once per hour. Lung ultrasound was performed after inducing anaesthesia and each position change. The primary outcome was the incidence of significant atelectasis (defined by consolidation score !2 in any region) before extubation, as evaluated by lung ultrasound undertaken by an investigator masked to trial allocation. Results: Seventy-three children (regular recruitment: 37; standardised care: 36) were included in the analysis. Before the hourly intervention, atelectasis was similar between children randomised to regular alveolar recruitment or standardised care in both supine (83.3%, both groups; P>0.99) and prone positions (88.9% vs 91.9%; P¼0.970). The incidence of atelectasis before extubation was lower in children receiving regular alveolar recruitment (8.1%), compared with 47.2% in children randomised to standardised care (absolute risk reduction: 39.1% [95% confidence interval: 20.6e57.6%); P<0.001). Conclusions: Regular alveolar recruitment reduced the incidence of atelectasis at the end of surgery in infants and children <3 yr undergoing general anaesthesia in the prone position. Clinical trial registration: NCT03486847.