Effects of using the simplified airway risk index vs usual airway assessment on unanticipated difficult tracheal intubation - a cluster randomized trial with 64,273 participants.

BACKGROUND: Unanticipated difficult intubation remains a challenge in anaesthesia. The Simplified Airway Risk Index (SARI) is a multivariable risk model consisting of seven independent risk factors for difficult intubation. Our aim was to compare preoperative airway assessment based on the SARI with usual airway assessment. METHODS: From 01.10.2012 to 31.12.2013, 28 departments were cluster-randomized to apply the SARI model or usual airway assessment. The SARI group implemented the SARI model. The Non-SARI group continued usual airway assessment, thus reflecting a group of anaesthetists' heterogeneous individual airway assessments. Preoperative prediction of difficult intubation and actual intubation difficulties were registered in the Danish Anaesthesia Database for both groups. Patients who were preoperatively scheduled for intubation by advanced techniques (e.g. video laryngoscopy; flexible optic scope) were excluded from the primary analysis. Primary outcomes were the proportions of unanticipated difficult and unanticipated easy intubation. RESULTS: A total of 26 departments (15 SARI and 11 Non-SARI) and 64 273 participants were included. In the primary analyses 29 209 SARI and 30 305 Non-SARI participants were included.In SARI departments 2.4% (696) of the participants had an unanticipated difficult intubation vs 2.4% (723) in Non-SARI departments. Odds ratio (OR) adjusted for design variables was 1.03 (95% CI: 0.77-1.38). The proportion of unanticipated easy intubation was 1.42% (415) in SARI departments vs 1.00% (302) in Non-SARI departments. Adjusted OR was 1.26 (0.68-2.34). CONCLUSIONS: Using the SARI compared with usual airway assessment we detected no statistical significant changes in unanticipated difficult- or easy intubations. CLINICAL TRIAL REGISTRATION: NCT01718561.

[Survival in ovarian cancer treated in a gynecological department of a central hospital]. / Overlevelsen ved ovariecancer behandlet og efterbehandlet i en gynaekologisk afdeling på et centralsygehus.

The characteristics of 73 patients with all stages of epithelial ovarian cancer were retrospectively analysed with emphasis on prognostic factors and survival. The patients underwent total hysterectomy, bilateral oophorectomy and infracolic omentectomy. Efforts were made to reduce the tumor burden as much as possible without endangering the general health status of the patient. Postoperative treatment was cisplatin 60 mg/m2 body surface and cyclophosphamide 50 mg/m2 every four weeks (CP). Patients with low general health status were offered either treosulphane 1 g daily for four weeks alternating with four weeks without treatment, or no treatment. Patients in FIGO stage IA and B generally received no postoperative chemotherapy treatment. Fifteen percent were in FIGO stage I, 7% in stage II, 5% in stage III and 23% in stage IV. Fifteen patients could be radically operated, however, only three patients who were in stage III. Fifty-four patients were treated with CP, 11 with treosulphane and eight patients did not receive postoperative treatment. In 28 patients second look laparotomy was performed. Only six patients had a complete pathological response, two of these in stage III. Stage and tumour grade could be identified as prognostic factors. Three-year survival was 70% in stage I, 67% in stage II, 28% in stage III and 0% in stage IV. Survival in 43 patients in stage III and IV was statistically compared to 265 patients from a prospective, randomized study by the Danish Ovarian Cancer Group (DACOVA), comparing cyclophosamide and cisplatin with and without doxorubicin. We found no statistical difference in survival between patients in our material and the DACOVA-material except in patients with low grade tumours whose survival in the CAP-arm of the DACOVA-study was superior. The rate of complete pathological response was significantly better in the DACOVA-study.