The intubation scoop (i-scoop) - a new type of laryngoscope for difficult and normal airways.

The i-scoop is an intubation device with a curved guiding bar with laterally located lenses at its tip, rather than a blade. Twenty-five anaesthesiologists intubated a manikin that simulated first a normal and then a difficult airway. All participants were able to intubate the difficult airway with a good view of the glottis using the i-scoop. None was able to intubate using seven other laryngoscopes (Macintosh laryngoscope, GlideScope(®) GVL and AVL, McGrath(®) (Series 5/MAC), C-MAC(®) , A.P. Advance(™) ). Intubation was successful only with the Airtraq(®) (n = 10), the Airway Scope (n = 5), the C-MAC D-Blade (n = 2), the A.P. Advance DAB (n = 1) and the GlideScope DL Trainer (n = 1) (p < 0.001, success rate of i-scoop vs all 12 laryngoscopes combined). In contrast to all other videolaryngoscopes, intubation of the normal airway with the i-scoop was achieved even faster than with the Macintosh laryngoscope (p < 0.02). The i-scoop outperformed all other laryngoscopes in both difficult and normal airways, and therefore has potential as an easier and safer alternative to present devices.

Sustained high demand for intensive care unit resources for the treatment of burn patients during the COVID-19 pandemic in Northern Germany: A single-centre cross-sectional study.

Introduction: The ongoing COVID-19 pandemic caused by SARS-CoV-2 has changed everyday life worldwide. To reduce disease transmission, governments introduced various policies such as social distancing, stay-at-home orders, and travel restrictions. The goal of this study was to investigate the characteristics of burn patients admitted to the burn intensive care unit before and during the COVID-19 pandemic. Patients and methods: A retrospective descriptive analysis of the hospital's burn registry was performed from 1 March 2019 until 1 January 2022. Results: A total of 326 patients were included in this study. Eighty-eight patients presented before and 238 patients during the COVID-19 pandemic. The majority of burns occurred during private incidents (80% [2022], 92% [2020]), and burns were most frequently caused by flames (24% [2022], 32.99% [2021]). Work-related injuries occurred less frequently (7.76% [2020], 20% [2022]). Constant results were obtained regarding severity and total body surface area affected (1-80%). Conclusion: This study highlights high numbers of burn patients admitted to the burn intensive care unit before and during the COVID-19 pandemic. Consequently, burn intensive care units must retain their special position within the national health system and should not be included in resource relocation during the prioritisation of intensive care resources. Multicentre studies should focus on the national impact of COVID-19 on the treatment of burn patients.

Determination of polynuclear aromatic hydrocarbons present in asphaltenes from Mexican oil. A possible environmental risk.

A supercritical fluid extraction and HPLC analysis of the asphaltenes derived from Mexican oil was performed. The aim was to identify potentially mutagenic polynuclear aromatic hydrocarbons present in asphaltenes, since roof waterproofing applications in this country present a significant exposure to hot asphaltene vapors that might conceivably carry such toxic hydrocarbons and therefore pose a health hazard to the workers who apply molten asphaltenes.

In vitro lead cation-hyaluronic acid interaction.

It is the purpose of this investigation to study the in vitro spontaneous interaction lead-hyaluronic acid using the equilibrium dialysis technique. The following working conditions were used: membrane retention capacity starting from 12000 D; solvent was an aqueous buffer solution (pH 7.4); relation of internal-external volume of 0.5 : 25 mL: dialysis time 24 hours; lead concentration in dialyzing solution 4 micrograms/mL (always outside the bag); temperature 4 degrees C; concentrations of hyaluronic acid 0.3, 1.2, 2.1 and 3.0 mg/mL; concentration of plasma proteins 1.5 mg/mL; lead was determined in the internal solution of the bag, and was measured quantitatively by atomic absorption spectrometry. Testing separately hyaluronic acid and plasma proteins both types of marcromolecules turned out to bind lead. As the concentration of hyaluronic acid increases, the amount of lead retained increases as well, although this relation is only approximately linear. At the normal concentrations of plasma proteins and hyaluronic acid in synovial fluid, the proteins solution bound more lead than hyaluronic acid solution 16.2 +/- 2.1 and 5.7 +/- 0.4 micrograms/mL respectively (P < 0.0001). What these data show ist that both, hyaluronic acid and proteins are involved in the in vitro lead retention. The effect of both ligands must be synergistic, because when the two molecules are present, a higher amount of lead is retained compared to the amount bound separately, suggesting that lead can replace calcium by complexation with mucopolysaccharides; this explains the lead accumulation in synovial fluid since this fluid is rich in hyaluronic acid and proteins.

Lead concentration in different compartments of the bovine eye.

It is known that lead is a metabolic substitute of calcium and recently, in vitro results showed that glycosaminoglycans and proteins are capable of binding lead. Therefore, in this work, the level of lead in aqueous humor, vitreous humor, lens and sclera of bovine eyes was analyzed in order to establish a relationship between lead concentration and the contents of glycosaminoglycans, proteins, water and calcium in those structures. Lead was determined by means of atomic absorption spectrometry after acid digestion. Our results suggest a direct relationship between the contents of proteins and glycosaminoglycans, and the ability of the different eye structures to retain lead. Nevertheless, an inverse relationship between water content and lead concentration was found. No association between calcium and lead concentrations was observed.

Determination of lead in paired samples of blood and synovial fluid of bovines.

Exposure of synovial fluid to lead allows the entrance of this metal into the systemic circulation. In this study we report lead concentrations measured in bovine paired samples of synovial fluid and whole blood withdrawn from the coxo-femoral joints and jugular vein, respectively. Lead was determined by atomic absorption spectrophotometry. This study provides the "normal" values for lead in synovial fluid 12.15 +/- 5.41 and blood 3.54 +/- 1.31 micrograms% (mean +/- SD). The data distribution fits the GAUSSIAN curve (p < 0.02). The difference of concentration between synovial fluid and blood can not be explained only in terms of the solubility of lead in both fluids; other factors must be considered.

Effect of myotonia induced by anthracene-9-carboxylic acid on mitochondrial calcium, plasma creatinine-phosphokinase and aldolase activity in the rat.

The frequent association of myotonia with dystrophy and the knowledge that calcium is increased in injured skeletal muscle cells suggest a possible relationship between cell calcium and myotonic alterations. This investigation has been performed to study the role of calcium in experimental myotonia induced by anthracene-9-carboxylic acid (9-AC) in rats treated with several regimens of food and exercise. Thirty-two rats were divided into 4 groups of 8 rats each, one control and 3 experimental groups. The treatments included caffeine plus exercise (group 2), and a calcium-rich diet (group 3); these procedures were designed to increase intracellular calcium; another group was treated with 9-AC as a myotonia-inducer (group 4). The treatment for all groups lasted 60 days. No significant differences in plasma sodium, potassium, chloride and calcium between control and experimental groups were observed. Whole muscle calcium in wet tissue samples did no change with any treatment. On the contrary, mitochondrial calcium showed a significantly higher concentration in group 3 and 4. CPK and aldolase activities in groups 1, 2 and 3 were similar; but in group 4 these enzyme activities were significantly higher (p less than 0.05). The electrical and mechanical responses were not altered in any rat with any experimental treatment. Our data suggest that myotonia is a predisposing factor for an altered mitochondrial calcium homeostasis in this model; in addition, the enzyme activities of CPK and aldolase were increased in the rats of group 4 implicating that myotonia is a crucial factor in the development of enzymatic abnormalities.(ABSTRACT TRUNCATED AT 250 WORDS)

Propofol, remifentanil and mivacurium: fast track surgery with poor intubating conditions.

BACKGROUND: Mivacurium is widespread used because it is the non-depolarizing muscle relaxant with the shortest duration time. Therefore, it seems to be ideal for fast track or ambulatory surgery. However, especially in combination with propofol and remifentanil onset time remains unclear and incidence of poor intubating conditions seems to be higher than in other regimes of anesthesia. METHODS: We included 35 ear, nose and throat (ENT) patients in this study. Muscle relaxation was measured by acceleromyograhpy at the adductor pollicis muscle (a.p.m.) and intubating conditions were evaluated. Anesthesia was induced with 2.5 mg kg-1 propofol and 1 µg kg-1 remifentanil and intubation was performed three minutes after the administration of 0.2 mg kg-1 mivacurium. Open vocal cords conjoined with full relaxation of the a.p.m., easy mouth opening and prevention of coughing and bucking represented the primary endpoint in this study. RESULTS: Only 20% of patients (N.=7) had optimal intubating conditions and achieved the primary endpoint. In 21 patients (60%) a complete block of the a.p.m. could not be achieved and in six patients (17%) the vocal cords were closed. In seven patients (20%) we observed difficult mouth opening and in 11 patients (31%) coughing and bucking. In addition, we found a prolonged onset time of 228±95 seconds (mean±SD). CONCLUSION: In combination with propofol and remifentanil the muscle relaxant agent mivacurium led to uncertain muscle relaxation and to poor intubating conditions. Therefore the study was aborted after 35 patients. Probably mivacurium is not a useful muscle relaxant agent if fast and deep muscle relaxation is needed. The advantage of a short duration time is foiled by intubation complications due to insufficient muscle relaxation.