Using Ultrasonography to Determine Optimal Head-down Tilt Position Angle in Patients before Catheterization of the Internal Jugular Vein.

CONTEXT: It is believed that 15°-25° head-down tilt position increases the internal jugular vein cross-sectional area (IJV CSA). The increase in IJV CSA before puncture reduces the risk of its perforation. This pattern was not observed in all patients. We assumed that the absence of respiratory-based IJV excursion is one of the criteria of head-down tilt position effectiveness. AIMS: The aim of this study is to determine the head-down tilt angle, which ensures the absence of the respiratory-based IJV excursion. SUBJECTS AND METHODS: Prospective study included twenty adult patients. The IJVs scanning was carried out in 1 min after placing the patients in a horizontal position on their back and in 1 min after placing them in the head-down tilt position at 5°, 10°, 15°, and 20° tilt angles. RESULTS: We found that collapsibility index of <9% indicating the absence of respiratory-based IJV excursion was recorded in 25% of patients in the horizontal supine position. In this case, placing the patients in the Trendelenburg position for IJV catheterization may not be indicated. In 65% of the patients, the respiratory-based excursion was not observed at 10° head-down tilt position. Only 35% of the patients required 15° head-down tilt position. CONCLUSIONS: In clinical settings, the disappearance of respiratory-based vein excursion on the ultrasound scanner screen can be considered as criteria of the head-down tilt position effectiveness.

The dynamics of changing internal jugular veins diameter based on increasing head elevation angle.

CONTEXT: Venous outflow from the cranial cavity occurs mainly through the internal jugular vein (IJV). The increase in venous outflow through IJV is possible by head elevation. IJV collapse may indicate the reduction of blood volume in the vein and show the head elevation effectiveness. AIMS: The aim of this study is to examine the impact of head elevation on IJV size. SUBJECTS AND METHODS: IJV ultrasound scanning in 31 healthy volunteers was carried after gradual head elevation at 15°, 30°, and 45°. Maximum and minimum IJV diameters were recorded. Mean ± standard deviation, median, range, and collapsibility index were calculated. RESULTS: Thirty-one volunteers were involved (19 males), their average age was 37.0 ± 11.5 years. Increasing the head elevation angle by 15°, 30° and 45° resulted in a decrease in IJV diameter in the right and left sides in all patients. The occurrence of the vein walls collapse corresponds to the collapsibility index equal to 100%. The results showed that 100% collapsibility index was recorded in 6 patients (19%) at 15° head elevation, in 12 patients (39%) at 30°, in 11 patients (35%) at 45°. In two volunteers (6%), 100% collapsibility index was not recorded even at maximum 45° head elevation. CONCLUSIONS: Ultrasound IJV scanning during gradual head elevation together with the collapsibility index calculation could be useful guidance for the venous outflow assessment. In order to prove and extend the study findings, more research is needed.

Modified Stange test gives new gynecological criteria and recommendations for choosing caesarean section childbirth.

Pregnancy and childbirth often threaten the life and health of the fetus. The greatest threat to the fetus during these periods is intrauterine hypoxia. The threat of intrauterine fetal hypoxia increases during natural childbirth and decreases during caesarean section. Therefore, it is no coincidence that the rate of C-section births is increasing worldwide. However, the generally accepted recommendations on the choice of caesarean delivery need to be clarified. A new test is needed to simulate intrauterine hypoxia and predict fetal survival during natural childbirth. Such a test would improve current C-section recommendations and newborn health outcomes. The most appropriate basis for such a functional test is the generally accepted Stange test. The fact is that the Stange test is a very easy to use and accurate functional test based on the duration of the longest breath hold. For more than 100 years, the Stange test has been successfully used to assess the adaptation reserves of adults to hypoxia in real time. The purpose of this letter is to present a new easy-to-use functional test designed to assess the resistance to hypoxia not only of the pregnant woman, but also of her fetus in real time. This new test could be a new vector in obstetric practice aimed at improving neonatal health and reducing infant mortality during delivery.

COVID-19: Artificial sputum, respiratory obstruction method and screening of pyolitic and antihypoxic drugs.

COVID-19 causes non-specific pneumonia, which has become a new cause of hypoxia, leading to the death of many patients. Today, there are no effective drugs that provide an urgent increase in blood oxygenation. Therefore, it is urgently necessary to develop drugs to increase blood oxygenation in order to save the lives of patients with the new coronavirus infection. Since hypoxia develops in this disease due to the blockage of respiratory tract with viscous mucus and sputum, an appropriate experimental model is needed for screening and finding new drugs. However this model is yet missing. Therefore, the development of an experimental model of respiratory obstruction by sputum with traces of blood can accelerate the discovery of drugs that eliminate hypoxia and prevent the death of patients with nonspecific pneumonia complicated by respiratory obstruction. The purpose of this letter was to present a model for evaluating the biological activity of drugs, which can become a new vector for the development of effective ways to increase blood oxygenation across pulmonary and save the lives of patients with severe atypical pneumonia complicated by respiratory obstruction in COVID-19.

Ultrasound-guided internal jugular vein cannulation in the obese patient in a forced semi-sitting position.

INTRODUCTION: Central venous cannulation may be difficult in morbidly obese patients. We present a case of successful right internal jugular vein catheterization under real-time ultrasound guidance in an obese patient in a forced semi-sitting position. CASE REPORT: A 43-year-old male patient with body mass of 182 kg (body mass index, 52.2 kg/m2) was admitted to the clinic 48 h after the trauma. The patient was in a forced semi-sitting position (37° head elevation). The patient was not able to perform the Valsalva maneuver. In the reported case, the lateral access for right internal jugular vein catheterization was chosen. We selected a lateral-oblique probe position for the ultrasound-guided internal jugular vein cannulation. Internal jugular vein catheterization was successful at the first attempt. CONCLUSION: Ultrasound imaging enables us to choose a desirable access for successful internal jugular vein cannulation in the obese patient without head-down tilt position. The lateral-oblique probe position for internal jugular vein cannulation may have advantages in certain clinical situations.

Changes in the Internal Size of the Jugular Vein in Adult Patients with Hypovolemia.

The present study is aimed at establishing the values of internal jugular vein (IJV) anterior-posterior and medial-lateral sizes in patients with hypovolemia. A total of 25 adult Intensive Care Unit patients with hypovolemia were studied. It was found that the anterior-posterior vein size in patients with hypovolemia was significantly less than medial-lateral size during inhalation and during exhalation as well (P < 0.05). Besides, the value of the anterior-posterior size (Dmin) <7 mm was recorded in 20 from 25 patients (80%). At the same time, the medial-lateral size (Dmin) <7 mm was recorded only in six patients (24%). In patients with hypovolemia, the medial-lateral diameter of IJV is more than its anterior-posterior diameter. These data might be useful for justifying the benefits of using lateral access for IJV catheterization under ultrasound imaging in patients with hypovolemia.

The off-label use of drugs for parenteral nutrition as a solvent of substances slightly soluble in water in pharmacological research.

Because of the problem to evaluate biological activity in water-soluble substances in all phases of preclinical and clinical studies, the research work enabled to develop the original solvent for poorly soluble compounds based on substances for parenteral nutrition. The main aim is to examine the impact of the original solvent based on substances for parenteral nutrition on biological systems exemplified by the hemostatic system, characterized by sensitivity and variability of the effects in response to any impact, and its comparison with the solvents that are conventional in pharmacological research. Experimental work is performed according to the "guidance on preclinical research of new pharmacological substances" in vitro. The findings show that traditional solvents at low dosages affect all the researched indicators of the hemostasis system. The smallest effect in respect of the hemostatic system was characterized by ethanol, and the most apparent antiaggregational effect was registered with dioxane. 10% concentration of original blend of lipids made no effect on hemostasis system. Thus, according to their own findings and experience in application of lipid emulsions as substances of parenteral nutrition, they can be considered to be an adequate solvent in all phases of preclinical and clinical studies of new drugs.

Continuous Positive Airway Pressure Prevents Hypoxia in Dental Patient with Obstructive Sleep Apnea Syndrome under Intravenous Sedation.

Use of sedation in patients with obstructive sleep apnea (OSA) in dentistry is limited. Hypoxia may develop during medication sleep in dental patients with OSA because of repetitive partial or complete obstruction of the upper airway. In this regard, anesthesiologists prefer not to give any sedative to surgical patients with OSA or support the use of general anesthesia due to good airway control. We report a case where we could successfully sedate a dental patient with OSA using intraoperative continuous positive airway pressure (CPAP) without hypoxia. Use of sedation and intraoperative CPAP in patients with OSA may be considered only if the effectiveness at home CPAP therapy is proven.

Management of exaggerated gag reflex in dental patients using intravenous sedation with dexmedetomidine.

Pharmacological sedation is one of the effective ways of prevention of gag reflex development in patients experiencing anxiety and fright before dental treatment. We are reporting a case where we could successfully eliminate exaggerated gag reflex (intravenous [IV] Gagging Severity Index) in a dental patient using IV sedation with dexmedetomidine. IV administration of dexmedetomidine provided elimination of gag reflex at a depth of sedation for the patient with the Richmond Agitation-Sedation Scale score of -2 and -1. The patient received dexmedetomidine 1.0 µg/kg for 10 min and then a continuous infusion of dexmedetomidine 0.4 µg/kg/h. The use of dexmedetomidine for sedation may be an alternative to other pharmacological agents in patients with dental anxiety accompanied by exaggerated gag reflex.