BackgroundThe intubation difficulty scale (IDS) has been used as a validated difficulty score to define difficult intubation (DI). The purpose of this study is to identify airway assessment factors and total airway score (TAS) for predicting DI defined by the IDS.MethodsThere were 305 ASA physical status 1-2 patients, aged 19-70 years, who underwent elective surgery with endotracheal intubation. During the pre-anesthetic visit, we evaluated patients by 7 preoperative airway assessment factors, including the following: Mallampati classification, thyromental distance, head & neck movement, body mass index (BMI), buck teeth, inter-incisor gap, and upper lip bite test (ULBT). After endotracheal intubation, patients were divided into 2 groups based on their IDS score estimated with 7 variables: normal (IDS < 5) and DI (IDS ≥ 5) groups. The incidence of TAS (> 6) and high score of each airway assessment factor was compared in two groups: odds ratio, confidence interval (CI) of 95%, with a significant P value ≤ 0.05.ResultsThe odds ratio of TAS (> 6), ULBT (class III), head & neck movement (< 90°), inter-incisor gap (< 4 cm), BMI (≥ 25 kg/m2) and Mallampati classification (≥ class III) were respectively 13.57 (95% CI = 2.99-61.54, P < 0.05), 12.48 (95% CI = 2.50-62.21, P < 0.05), 3.11 (95% CI = 0.87-11.13), 2.32 (95% CI = 0.75-7.19), 2.22 (95% CI = 0.81-6.06), and 1.22 (95% CI = 0.38-3.89).ConclusionsWe suggest that TAS (> 6) and ULBT (class III) are the most useful factors predicting DI.
BackgroundInhalation anesthetics are an important factor for postoperative hepatic and renal dysfunction. In this regard, TIVA can reduce the risk of hepatic and renal dysfunction inherited to inhalation anesthetics. The present study was conducted to determine whether hepatic and renal functions differ after anesthesia with sevoflurane and propofol.MethodsTwo hundred patients, ASA physical status class I, II, scheduled for an elective thyroidectomy were randomly divided into two groups. Anesthesia was maintained with sevoflurane 1-2% and remifentanil in the sevoflurane group (Group S) and propofol 2-5 ug/ml and remifentanil 2-5 ng/ml at the effect site, using a target controlled infusion (TCI) pump in the TIVA group (Group T) to maintain BIS of 40-60. To evaluate the hepatic and renal function, aspartate aminotransferase (AST), alanine aminotransferase (ALT), blood urea nitrogen (BUN) and creatinine were tested at preoperation (baseline), postoperative 1 day and 3 days.ResultsAST was increased at postoperative 1 day and 3 days, compared with that of the preoperation in Group S, and postoperative 1 day in Group T, but the values were within its normal limit. ALT was not changed after anesthesia in both groups. BUN was increased at postoperative 1 day, compared with that of the preoperation in Group S, but the value was within its normal limit. Creatinine was not changed after anesthesia in both groups.ConclusionsThe changes of hepatic and renal function after inhalation anesthesia with sevoflurane and TIVA with propofol and remifentanil for thyroidectomy were clinically insignificant, and there was no difference between the two methods.
Background Unlike the right internal jugular vein (RIJV), there is a paucity of data regarding the effect of the Trendelenburg position on the left internal jugular vein (LIJV). The purpose of this study is to investigate the cross-sectional area (CSA) of the LIJV and RIJV and their response to the Trendelenburg position using two-dimensional ultrasound in adult subjects.MethodsThis study enrolled fifty-eight patients with American Society of Anesthesiologists physical status class I-II who were undergoing general anesthesia. CSAs of both the RIJV and LIJV were measured with a two-dimensional ultrasound in the supine position and then in a 10° Trendelenburg position.ResultsIn the supine position, the transverse diameter, anteroposterior diameter, and CSA of the RIJV were significantly larger than those of the LIJV (P < 0.001). Of 58 patients, the RIJV CSA was larger than the LIJV CSA in 43 patients (74.1%), and the LIJV CSA was larger than the RIJV CSA in 15 patients (25.9%). In the Trendelenburg position, CSAs of the RIJV and LIJV increased 39.4 and 25.5%, respectively, compared with the supine position. However, RIJV changed at a rate that was significantly greater than that of the LIJV (P < 0.05). Of 58 patients, the RIJV CSA was larger than the LIJV CSA in 48 patients (82.8%), and the LIJV CSA was larger than the RIJV CSA in 10 patients (17.2%).ConclusionsIn supine position, the RIJV CSA was larger than the LIJV CSA. The increased CSA in the Trendelenburg position was greater in the RIJV than the LIJV.
BackgroundThe microRNA (miRNA) pathway has emerged as one of the biologic pathways implicated in stem cell regulation. miRNA is a noncoding, single-stranded RNA consisting of 20-25 nucleotides that inhibits the protein production at the step of translation. The molecular effects of lidocaine and procaine on adipose stem cells were investigated by examining RNA expression array.MethodsAdipose stem cells were isolated from a prior abdominal liposuction procedure. The human adipose stem cells were cultured and then added to a mixture of 1 ml of culture medium plus 1 ml of 2% lidocaine or 2% procaine for the duration of 30 minutes. The expression levels of miRNAs were estimated by using peptide nucleic acid (PNA)-miRNA array analysis throughout the denaturation and hybridization processes after the isolation of miRNA. The miRNAs detected by microarray that either decreased by half fold or increased by 1.5 fold from the control level were interpreted as significant.ResultsAccording to microarray analysis there were 61 miRNAs in total, and no miRNA had decreased expression levels. The stem cells treatment with lidocaine showed 4 alteration of expression with miR-9a* (1.53 fold), miR-29a (1.64 fold), miR-296-5p (1.64 fold) and miR-373 (1.94 fold). The stem cells treated with procaine showed 32 miRNAs that were significantly up-regulated with a range of 1.5 to 2.06 fold. They were stem cell differentiation-related miRNAs, apoptosis and cell cycle-associated miRNAs, immunity-associated miRNAs and hormonal response-related miRNAs.ConclusionsLidocaine and procaine affect the miRNA expression on adipose stem cells and the effect of procaine is more marked than that of lidocaine.
BackgroundThe aim of this study was to investigate whether a small dose of midazolam and lessening the propofol dosage could prevent cardiovascular change at tracheal intubation for induction in aged patients.MethodsEighty patients over 65 years (ASA physical status 1, 2) scheduled for elective surgery received general anesthesia with remifentanil and propofol or midazolam. Patients in group P (n = 40) were induced with 0.9% NaCl 0.03 ml/kg, propofol 1. 2 mg/kg and remifentanil. Patients in group MP (n = 40) were induced with midazolam 0.03 mg/kg, propofol 0.8 mg/kg and remifentanil. The time taken to reach loss of consciousness (LOC) and the value of bispectral index score (BIS) at LOC were recorded. After LOC, 0.8 mg/kg of rocuronium was given and tracheal intubation was performed. The mean blood pressure (MBP) and heart rate (HR) were recorded before induction as the base value, before intubation, immediately post-intubation and 3 minutes after intubation.ResultsCompared with the base values, MBP at before intubation and 3 minutes after intubation was significantly decreased in group P and group MP (P < 0.05). Compared with group P, the decrease of MBP was significantly less at before intubation, immediately after intubation and 3 minutes after intubation in group MP (P < 0.05). The time taken to reach LOC was significantly decreased in group MP compared with that in group P (P < 0.05). There were no significant differences of HR at any time between the two groups.ConclusionsCo-induction with midazolam and propofol could prevent a marked BP decrease at tracheal intubation for induction in aged patients.
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