Aids for facilitation of difficult tracheal intubation review and recent advances.

Management of difficult tracheal intubation has been facilitated by different techniques which include the use of stylets, introducers, intubating laryngeal mask airway, as well as by the development of special laryngoscope blades and fiberoptic laryngoscopes. The most recent advances for facilitation of difficult tracheal intubation is the introduction of the video-assisted laryngoscopes. The management of difficult tracheal intubation by video-assisted laryngoscopy can be further facilitated by using suspension laryngoscopy which frees the hands of the anesthesiologist to handle the insertion of the endotracheal tube with the aid of an endotracheal tube introducer, and a curved pipe stylet, under an umbrella of pharyngeal oxygen insufflation.

Can zinc be an adjuvant therapy for juvenile onset recurrent respiratory papillomatosis?

OBJECTIVES: To report a severe case of juvenile onset recurrent respiratory papillomatosis (JORRP) controlled by zinc replacement therapy. To review the contemporary adjuvant therapies used in JORRP. METHODS: The trial of zinc was described in terms of its effect on the inter-surgical interval, site score and clinical symptoms. Long-term follow-up with dose adjustment was detailed. Articles reporting trials of adjuvant therapies over the past 20 years were reviewed in terms of regimen used, mode of assessment, side effects and final outcome. RESULTS: Zinc was effective in decreasing the severity of the disease, the rate of relapse and the need for surgery. There was an obvious relation between the dose used and the degree of improvement. Prolonged treatment seems to be needed to sustain the positive effect. No side effects were noticed over a 45-month follow-up period. The literature does support the role of zinc in modulating the immune system. Eight adjuvant therapies were reviewed as published in 40 reports. Interferon was the most used substance. It is definitely effective but often associated with relapse upon discontinuation. The effect of cidofovir was favorable yet not dramatic as initially expected. Other less commonly used therapies showed humble effects. The HspE7 vaccine seems to be promising awaiting further trials. CONCLUSIONS: Zinc replacement therapy may benefit JORRP patients with zinc deficiency and should be investigated in more cases. Several adjuvant therapies are available for use in JORRP. They are generally beneficial though mostly not curative.

Muallem endo-tracheal tube introducer: (METTI)--an aid for the difficult airway.

This is a brief report evaluating a new single use endotracheal tube introducer (METTI) which has a soft curved atraumatic tip. The introducer was tried in 44 patients, whose direct laryngoscopic view was simulated to Cormack IIIb score, and in six patients with real Cormack III score. The overall success rate of railroading of the tracheal tube over the introducer was 94% from the first attempt.