[Tracheal Intubation Using the Pentax-AWS during Chest Compression: A Meta-analysis].

BACKGROUND: The aim of this meta-analysis is to evaluate the efficacy of the Pentax-AWS for tracheal intubation during chest compression, compared with that of the Macintosh laryngoscope. METHODS: The systematic search, data extraction, critical appraisal, and pooled analysis were performed according the PRISMA statement. The relative risk (RR), mean difference (MD), and their corresponding 95% confidence intervals (CIs) were calculated by the Review Manager 5.2 software for dichotomous and continuous outcomes, respectively. RESULTS: Twelve trials included 424 tracheal intubations by Pentax-AWS and 421 tracheal intubations by Macintosh laryngoscope. In studies examining novice laryngoscopists, successful intubation (RR1.4, 95% CI 1.1-1.6, P < 0.0007) and time for instrumentation (MD -7.7 sec, 95% CI -10.1 sec--5.4 sec, P < 0.00001) were improved using the Pentax-AWS. With respect to experts' hands there was no difference between the two devices in both of these outcomes. CONCLUSIONS: Compared to the Macintosh laryngoscopy, Pentax-AWS offers advantages for novice laryngoscopists during chest compression, while these benefits are not seen with experts' hands.

[Anesthetic Management of Patients Undergoing Single-lumen Tracheal Tube Ventilation with Artificial Pneumothorax in Thoracolaparoscopic Esophagectomy].

We report anesthetic management of patients undergoing single-lumen tracheal tube ventilation with artificial pneumothorax in thoracolaparoscopic esophagectomy in prone position. No adverse effect against respiratory and circulatory management was found during esophagectomy. Single-lumen tracheal tube ventilation with artificial pneumothorax potentially is a feasible method for thoracolaparoscopic esophagectomy in prone position.

The effect of dexmedetomidine on arterial-cardiac baroreflex function assessed by spectral and transfer function analysis.

PURPOSE: The α(2)-adrenergic receptor agonist dexmedetomidine reportedly weakens heart rate (HR) responses to 'rapid' (during a few seconds) reduction in arterial pressure, but does not affect HR responses to 'gradual' (during 60 s) reduction in arterial pressure. As the speed of neurotransmission along the parasympathetic nerve is relatively rapid, alteration of parasympathetic-mediated arterial-cardiac baroreflex function plays a more important role in HR responses to 'rapid' changes in arterial pressure. We therefore hypothesized that dexmedetomidine attenuates parasympathetic-mediated arterial-cardiac baroreflex function. METHODS: Twelve healthy men received placebo, low-dose (loading, 3 µg/kg/h for 10 min; maintenance, 0.2 µg/kg/h for 60 min) (low-DEX), or moderate-dose (loading, 6 µg/kg/h for 10 min; maintenance, 0.4 µg/kg/h for 60 min) (moderate-DEX) dexmedetomidine infusions in a randomized, double-blind, crossover study. Before and after 70 min of infusion, arterial-cardiac baroreflex function was assessed by spectral and transfer function analysis between arterial pressure variability and HR variability. RESULTS: The high-frequency power of systolic arterial pressure (SAP) variability increased significantly with low-DEX and moderate-DEX infusions (significant interaction effects, P = 0.005), whereas the high-frequency power of R-wave-R-wave interval (RRI) variability (as an index of cardiac parasympathetic activity) did not change significantly at any dose infusions. Then, transfer function gain in the high-frequency range (as an index of parasympathetic arterial-cardiac baroreflex) decreased significantly with low-DEX and moderate-DEX infusions (significant interaction effects, P = 0.007). CONCLUSIONS: The present results suggest that dexmedetomidine attenuates parasympathetic-mediated arterial-cardiac baroreflex function, implying weakened HR response to 'rapid' reduction in arterial pressure.

Clinical course of pain in a patient with neuropathic pain induced by ligation of an intercostal nerve.

A patient with severe right chest pain and mechanical allodynia induced by an intercostal drainage tube to his chest is presented. It was not relieved by treatment with diclofenac sodium and was worsened by movement and touch to the right chest wall. Mechanical allodynia was also present. The patient's wrenching pain disappeared immediately after stitch removal, but the dull pain and mechanical allodynia persisted, gradually decreasing to zero in 7 days.