Usefulness of Airway Scope for intubation of infants with cleft lip and palate-comparison with Macintosh laryngoscope: a randomized controlled trial.

BACKGROUND: Airway Scope (AWS) with its plastic blade does not require a head-tilt or separate laryngoscopy to guide intubations. Therefore, we hypothesized that its use would reduce the intubation time (IT) and the frequency of airway complication events when compared with the use of Macintosh Laryngoscope (ML) for infants with cleft lip and palate (CLP). METHODS: The parents of all patients provided written consents; we enrolled 40 infants with CLP (ASA-PS 1). After inducing general anesthesia using sevoflurane and rocuronium, we performed orotracheal intubations using either AWS (n = 20) or ML (n = 20), randomly. We define the duration between manual manipulation using cross finger for maximum mouth opening and the first raising motion of the chest following intubation by artificial ventilation as "IT;" further, the measured IT as primary outcomes. Airway complications were considered secondary outcomes. Moreover, we looked for associations between IT and the patient's characteristics: extensive clefts, age, height, and weight. We used the Mann-Whitney test and Fisher's exact probability test for statistical analysis; p < 0.05 was considered as statistically significant. RESULTS: The mean IT was 31.5 ± 8.3 s in AWS group and 26.4 ± 8.9 s in ML group. Statistical significant difference was not found in IT between the two groups. The IT of AWS group was statistically related to extensive clefts. Airway complications were detected in ML group. CONCLUSION: AWS could be useful for intubation of infants with CLP; it required IT similar to that required using ML, with a lower rate of airway complications. TRIAL REGISTRATION: UMIN-CTR Registration number UMIN000024763 . Registered 8 November 2016.

The potential of the nasal mucosa route for emergency drug administration via a high-pressure needleless injection system.

It is often difficult to expeditiously establish an intravenous (IV) route in a medical emergency, and alternatives to an IV route may also be difficult for many dentists to accomplish. The purpose of this article is to demonstrate that without the necessity of advanced training, the nasal mucosa route of administration is a promising alternative to the IV route in an emergency without complications, and will also show that epinephrine can be quickly absorbed into systemic circulation from the nasal mucosa. Ten beagle dogs were administered 400 microg of epinephrine in the nasal septal mucosa. The mean peak value of the plasma epinephrine (20.1 +/- 12.4 ng/mL) was obtained after 15 seconds, and the peak systolic pressure was 200% of the control value after 60 seconds. Although the dose of epinephrine must be considered because blood flow decreases during cardiopulmonary resuscitation, this method presents a promising alternative to the IV route.