Tracheal intubation in coronavirus disease 2019 (COVID-19) patients creates a risk to physiologically compromised patients and to attending healthcare providers. Clinical information on airway management and expert recommendations in these patients are urgently needed. By analysing a two-centre retrospective observational case series from Wuhan,

SummaryRecent studies have shown that the use of high dose rocuronium followed by sugammadex provides a faster time to recovery from neuromuscular blockade following rapid sequence induction than suxamethonium. In a manikin-based 'cannot intubate, cannot ventilate' simulation, we studied the total time taken for anaesthetic teams to prepare and administer sugammadex from the time of their initial decision to use the drug. The mean (SD) total time to administration of sugammadex was 6.7 (1.5) min, following which a further 2.2 min (giving a total 8.9 min) should be allowed to achieve a train-of-four ratio of 0.9. Four (22%) teams gave the correct dose, 10 (56%) teams gave a dose that was lower than recommended, four (22%) teams gave a dose that was higher than recommended, six (33%) teams administered sugammadex in a single dose, and 12 (67%) teams gave multiple doses. Our simulation highlights that sugammadex might not have saved this patient in a 'cannot intubate, cannot ventilate' situation, and that difficulties and delays were encountered when identifying, preparing and administering the correct drug dose. The first clinical use of sugammadex in humans to reverse neuromuscular blockade induced by rocuronium was reported in 2005 [1]. Since then, sugammadex has been shown to be clinically effective [2] and has become available for clinical use in hospitals throughout Europe [3]. Since its introduction into clinical practice, the role of sugammadex in rapid sequence induction has been investigated. In a recent review, no statistical difference in intubating conditions was found when suxamethonium was compared to high dose (1.2 mg.kg )1 ) rocuronium administration during rapid sequence induction [4]. The main advantage of suxamethonium over rocuronium is the faster spontaneous recovery from neuromuscular blockade that occurs following the former's use; this characteristic has been a main indication for using suxamethonium despite its possible severe side-effects [5]. The possibility of rapidly reversing the effects of rocuronium has raised the question of whether suxamethonium is still necessary in clinical practice [6,7]. High dose rocuronium administration can provide fast neuromuscular blockade that permits early tracheal intubation comparable to that found when using suxamethonium [8,9]. Lee et al. [10] found that the intravenous administration of 16 mg.kg )1 sugammadex, 3 min after giving 1.2 mg.kg )1 rocuronium, resulted in reversal of neuromuscular blockade that was faster than the spontaneous recovery following 1 mg.kg )1 suxamethonium.Sugammadex has the potential to provide early reversal of profound neuromuscular blockade should a 'cannot intubate, cannot ventilate' situation arise following induction of anaesthesia [11]. However, as it still takes 2.2 min for the train-of-four (TOF) ratio (the ratio of magnitudes of the fourth to the first twitches) to recover to 0.9 following administration of sugammadex, the margin of safety is narrow in the event of failed tracheal intubation with inability to vent...

In this randomized study, the i-gel supraglottic device resulted in a lower incidence of throat and neck complaints than the La Premiere LM airway.

In this study, the incidence rates for cardiovascular and respiratory complications were very similar. The first postoperative day was crucial with regard to cardiovascular complications. Age and chronic pulmonary diseases were the common risk factors for cardiovascular and respiratory complications.

SummaryThe aim of this study was to develop an audit tool to identify prospectively all peri-operative adverse events during airway management in a cost-effective and reproducible way. All patients at VU University Medical Center who required general anaesthesia for elective and emergency surgical procedures were included during a period of 8 weeks. Daily questionnaires and interviews were taken from anaesthesia trainees and anaesthetic department staff members. A total of 2803 patients underwent general anaesthesia, 1384 men and 1419 women, including 2232 elective patients and 571 emergency procedures, 697 paediatric and 2106 adult surgical procedures. A total of 168 airway-related events were reported. The incidence of severe airway management-related events was 24/2803 (0.86%). There were 12 (0.42%) unanticipated ICU admissions, two patients (0.07%) required a surgical airway. There was one (0.04%) death, one cannot intubate cannot oxygenate (0.04%), one aspiration (0.04%) and eight (0.29%) severe desaturations < S p O 2 50%. We suggest that our method to determine and investigate airway management-related adverse events could be adopted by other hospitals.

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This study shows that FDG SPECT can identify patients in whom LV function improves after revascularization. Because SPECT is widely available, this technique may contribute to more routine use of FDG for determination of viability.

SummaryThe VivaSight-DL TM is a new single-use double-lumen endobronchial tube with an integrated camera. We studied this device in 151 consecutive patients scheduled for elective thoracic surgery in four different hospitals. Endobronchial intubation was successful in 148 patients (98%) (95% CI 94-99%). Median (IQR [range]) endobronchial intubation time was 59 (47-82 [17-932]) s and lung isolation was successfully achieved in 147 (99%) patients (95% CI 96-99%). A fibreoptic bronchoscope was required to assist endobronchial tube placement in 19 (13%) patients (95% CI 8-19%). Sore throat was reported by 37 (25%) patients (95% CI 18-33%), but no major complications were observed.