Assessing Full Stomach Prevalence with Ultrasound Following Preoperative Fasting in Diabetic Patients with Dysautonomia: A Comparative Observational Study.

BACKGROUND: Traditionally, diabetics have been considered patients with a high risk of aspiration due to having delayed gastric emptying; However, the evidence concerning residual gastric volume (GV) in fasting diabetic patients is inconsistent. This study aimed to compare the fasting GV of diabetic patients with or without dysautonomia with control patients scheduled for elective surgery using gastric ultrasound. METHODS: This bicentric prospective single-blinded case-control study was conducted at 2 university hospitals in Spain. Patients aged over 18 years, classified as American Society of Anesthesiologists (ASA) physical statuses I to III and having similar fasting statuses, were included in the study. The primary outcome was to compare the prevalence of risk stomach using the Perlas gastric content grading scale evaluated by ultrasound in the 3 groups. Secondary outcomes included the measurement of cross-sectional area (CSA) and GV in the right lateral decubitus (RLD) position, as well as the prevalence of solid gastric residue. RESULTS: A total of 289 patients were recruited for the study, comprising 145 diabetic patients (83 of whom had dysautonomia) and 144 patients in the control group. The percentage of patients classified as Perlas grade 2 was 13.2% in the control group, 16.1% in diabetic patients without dysautonomia, and 22.9% in diabetic patients with dysautonomia (P = .31). Antral CSA was significantly higher in diabetic patients with dysautonomia (6.5 [4.8-8.4]) compared to the control group (5.4 [4.0-7.2]; P = .04). However, no significant differences were observed between groups in residual GV. Among diabetic patients with dysautonomia, 12% exhibited solid gastric residue, which was twice the percentage observed in diabetic patients without dysautonomia (4.8%) and 3 times higher than that in the control group (3.5%; P = .03). The presence of dysautonomia was associated with an increased odds ratio of solid gastric residue (odds ratio [OR], 3.37; 95% confidence interval [CI], 1.28-8.87; P = .01) after adjusting for confounding factors. CONCLUSIONS: This study offers insights into the relationship between dysautonomia in patients with diabetes mellitus and the presence of full stomach, underscoring the significance of preoperative gastric ultrasound evaluation in managing perioperative risks in this population.

Dynamic versus standard bougies for tracheal intubation with direct or indirect laryngoscopy in simulated or real scenarios: a systematic review and meta-analysis.

INTRODUCTION: This systematic review and meta-analysis aimed to compare the efficacy of dynamic versus standard bougies to achieve tracheal intubation. METHODS: We searched MEDLINE, Embase, CENTRAL, Web of Science, Scopus and Google Scholar on 10 October 2023. We included clinical trials comparing both devices. The primary outcome was the first-attempt intubation success rate. The secondary outcome was the time required for tracheal intubation. RESULTS: Eighteen studies were included. Dynamic bougies do not increase first-attempt success rate (RR 1.11; p = 0.06) or shorten tracheal intubation time (MD -0.30 sec; p = 0.84) in clinical trials in humans. In difficult airways, first-attempt success intubation rate was greater for dynamic bougies (RR 1.17; p = 0.002); Additionally, they reduced the time required for intubation (MD -4.80 sec; p = 0.001). First-attempt intubation success rate was higher (RR 1.15; p = 0.01) and time to achieve intubation was shorter when using Macintosh blades combined with dynamic bougies (MD -5.38 sec; p < 0.00001). Heterogeneity was high. CONCLUSION: Dynamic bougies do not increase the overall first-pass success rate or shorten tracheal intubation time. However, dynamic bougies seem to improve first-attempt tracheal intubation rate in patients with difficult airways and in those intubated with a Macintosh blade. Further research is needed for definitive conclusions. REGISTRATION OF PROSPERO: CRD42023472122.

Intubación traqueal a ciegas a través de dos dispositivos extraglóticos: Ambu® AuraGainTM versus LMA FastrachTM / Blind tracheal intubation through 2 supraglottic devices: the Ambu AuraGain vs the LMA Fastrach

Objetivos: Los dispositivos extraglóticos se consideran actualmente como una alternativa de primera línea en un escenario de vía aérea difícil. El objetivo principal de nuestro estudio fue comparar el porcentaje de éxito global en la intubación a ciegas con los dispositivos Ambu® AuraGainTM frente a LMA Fastrach™. Método: Estudio de intervención de grupos paralelos, aleatorizado y simple ciego. Se evaluaron los siguientes parámetros: la ventilación adecuada, la visión de la glotis utilizando la escala Brimacombe, el éxito en la intubación a ciegas y los efectos adversos. Resultados: Los dispositivos se insertaron en 80 pacientes (40 pacientes por grupo). Se logró ventilación adecuada con ambos dispositivos (92,5% frente al 95% respectivamente). La visión fibroendoscópica de la glotis fue mejor con la Ambu® AuraGainTM en ambos intentos (p < 0,001). El éxito en la intubación fue mejor con LMA FastrachTM (70% frente al 17,5%, p < 0,001). La disfonía y la presencia de restos de sangre fueron más frecuentes con Ambu® AuraGainTM (12,5% frente al 0%, p = 0,027 y 17,5% frente al 0%, p = 0,006, respectivamente). Conclusiones: A pesar de la similar eficacia para la ventilación de ambos dispositivos, el éxito en la intubación a ciegas fue mayor con LMA FastrachTM (AU)

Background and objective: Supraglottic devices are now considered first-line tools for managing the difficult airway. Our main aim was to compare the percentage of successful blind intubations achieved with the Ambu AuraGain and LMA Fastrach devices. Methods: Randomized, single-blind, parallel group trial. The following variables were analyzed: adequate ventilation, visualization of the glottis on the Brimacombe scale, success of blind intubation, and adverse events. Results: The devices were inserted in 80 patients (40 per group). Adequate ventilation was achieved with both devices, in 92.5% in the AuraGain group and in 95% in the LMA group. The AuraGain provided a better view of the glottis on 2 attempts (P< aGain group and in 95% in the LMA group. The AuraGain provided a better view of the glottis on 2 attempts (P< 001). Hoarseness and signs of bleeding were observed more often with the AuraGain device than with the LMA: hoarseness, 12.5% vs 0%, respectively, P.027; blood, 17.5% vs 0%, P=.006 (AU)