Laryngeal mask in prone position: pure exhibitionism or a valid technique.

AIM: The laryngeal mask airway (LMA) is used worldwide during general anesthesia with controlled or spontaneous breathing. Normally its use is limited to patients undergoing surgery in the supine but not the prone position. METHODS: A prospective study of 50 consecutive ASA 1 and 2 patients who underwent ambulatory surgery in the prone position. In the first 25 patients anesthesia was induced in the supine position on a transport trolley after which the patients were turned face down following tracheal intubation. The next 25 patients were asked to lie comfortably in the prone position before receiving anesthesia. Induction and insertion of LMA were performed when they were already prone. RESULTS: There were neither complications nor airway loss when LMA was used in the prone position. The induction-incision time was 23.6+/-3.6 min (range 21-37) in Group 1 and 7+/-2.44 min (range 5-15) in Group 2 (P<0.0001) and the manpower required for positioning (the number of medical and paramedical personnel required to place the patient prone) was considerable reduced in Group 2 (LMA) compared to Group 1 (1.0 versus 3.12+/-0.6 (range 2-4; P<0.0001). Group 2 showed also, significantly more favorable hemodynamic parameters. CONCLUSION: To start anesthesia with patients already prone shortens the induction-incision time, reduces the manpower involved in the positioning process and causes fewer hemodynamic changes than the standard technique of induction and intubation in the supine position followed by turning the patient facedown.

Laryngeal mask airway and the Robinow syndrome.

The Robinow syndrome is an extremely rare congenital syndrome that causes facial malformations, as well as genital, cardiac and skeletal abnormalities. Patients with this syndrome undergo several operations during their life. Because of the facial abnormalities they carry a potential risk for difficult intubation. We describe the case of a boy who underwent several operations with documented difficult intubation. The laryngeal mask airway provided a good solution for airway control and afforded adequate ventilation under both controlled mechanical ventilation and spontaneous breathing.

Retrograde tracheal intubation: beyond fibreoptic endotracheal intubation.

BACKGROUND: Flexible fibreoptic laryngoscopy is the method of choice for coping with difficult tracheal intubations, a leading cause of catastrophic outcomes in anaesthesia. However, this technique is not always available or feasible. Retrograde intubation is a minimally invasive airway management technique with a flat learning curve and a high level of skill retention. METHODS: A retrospective review of the anaesthesia records of 24 patients who underwent retrograde intubation. The success rate and the incidence of complications were recorded. RESULTS: Retrograde tracheal intubation was successful in all 24 patients. In 21 patients it succeeded on the first attempt. In two patients it succeeded when the technique was changed from sliding over a guide wire to a pulling technique. The most common complication was a sore throat in almost 60% of the patients. Two patients had mild subcutaneous emphysema and one had minimal bleeding at the puncture site. CONCLUSIONS: In these patients retrograde tracheal intubation was easy to perform, had a high success rate and a low incidence of complications. It is a reliable alternative when fibreoptic intubation is precluded, fails or is unavailable.

Increase in leukocyte adhesiveness and aggregation with stress: a model of human congestive heart failure.

Stress has a significant influence on the function of the human organism. A simple, rapid, inexpensive, and reliable marker for stress would therefore be of great value. We have recently noted that stress increases the state of leukocyte adhesiveness and aggregation in the peripheral blood. We evaluated 64 patients who had various degrees of congestive heart failure, a condition known to induce a state of physiologic stress, to verify whether a relation exists between the intensity of the stress response and the magnitude of leukocyte adhesiveness. Included in the 64 were 53 patients without congestive heart failure, 23 with compensated failure, 22 with significant congestive heart failure, and 19 with florid pulmonary edema. The percentage of aggregated leukocytes in these four group was 6% +/- 4%, 6% +/- 4%, 10.5% +/- 5%, and 15% +/- 14%. Values for the third and fourth group differed in a statistically significant way. Thus, with further investigation into additional stress-inducing conditions, the state of leukocyte adhesion and aggregation may prove to be a reliable marker for the detection of stress and an inexpensive tool for quantifying its severity.

Prothymosin alpha gene in humans: organization of its promoter region and localization to chromosome 2.

A genomic clone encoding prothymosin alpha (gene symbol: PTMA), a nuclear-targeted protein associated with cell proliferation, was isolated and the 5'-regulatory region subcloned and sequenced. Because of previously reported discrepancies between several cDNA clones and a genomic clone for prothymosin alpha, we determined the sequence of the first exon and of a 1.7-kb region 5' to the first exon. The sequence of the genomic clone reported here corresponds to the published cDNA sequences, suggesting that the previously noted discrepancies may be due to genetic polymorphism in this region. In addition, our sequence data extend the known 5'-upstream sequence by an additional 1.5 kb allowing the identification of numerous, potential cis-acting regulatory sites. This 5'-flanking cloned probe permitted us to localize the prothymosin gene to chromosome 2 in humans.

The age-dependent proliferation of rat aortic smooth muscle cells is independent of differential splicing of PDGF A-chain mRNA.

Arterial smooth muscle cells (SMC) from old rats proliferate in vivo (after injury) and in vitro more rapidly than smooth muscle cells from young rats. We previously observed that SMC from old rats contained more PDGF-like growth factor activity than did young SMC. We therefore tested the hypothesis that age-related differences in type of PDGF A-chain gene expression might be responsible for the difference in growth factor activity, since PDGF B-chain gene is minimally expressed both in young and old SMC. Specifically we tested if the old SMC predominantly expressed the long form of the A-chain mRNA, leading to autocrine stimulation by cell-associated PDGF AA-homodimers. A partial cDNA for the rat PDGF A-chain was cloned and sequenced; it is highly conserved compared to the human PDGF-A chain and similarly has two forms, a long form containing all exons, which tends to remain cell-associated and a short form lacking exon 6, which tends to be secreted. Different tissues of both young and old animals express different ratios of these two forms of PDGF-A. However, the relative expression of the different mRNA forms does not change with age, suggesting that differential splicing of PDGF-A and accumulation of cell-associated PDGF A-chain does not determine the enhanced growth potential of old rat SMC.