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Airway management in patients presenting with severe airway obstruction can present a challenge to the anaesthetist, as conventional difficult airway pathways are often inappropriate. The use of a transtracheal jet cannula is an alternative means of airway securement, but lack of familiarity has limited its use in general tertiary hospitals. We report a retrospective audit of the use of transtracheal jet ventilation in a general tertiary healthcare centre over the past seven years, with a total of 50 patients with severe airway compromise undergoing pharyngolaryngeal surgery. Transtracheal jet ventilation was successful in 98% of patients, and was the definitive means of airway management in 43 cases. In six cases, the technique was a useful temporising measure while the airway was secured by other means. Minor complications occurred in 12% of patients. No major morbidities or mortalities were recorded. We conclude that transtracheal jet ventilation for high-risk pharyngolaryngeal surgery can be performed using a high frequency jet ventilator, with a high rate of success and only minor complications. Cannulation of the trachea below the cricothyroid membrane is feasible but more challenging. Low-flow apnoeic oxygenation through the transtracheal jet ventilation cannula maintains oxygenation during initial surgical airway manipulation.Copyright © The Author(s) 2021.

Background: Management of the difficult airway in ENT surgery can be challenging, particularly because conventional difficult airway algorithms often are not applicable. Awake tracheostomies are now less frequently performed by surgeons, and in some cases may not be feasible due to the location and spread of pathology. Transtracheal jet ventilation (TTJV) offers a safe, feasible alternative that can be performed with minimal discomfort on the awake patient, yet is rarely practiced in Australian healthcare centers due to lack of familiarity.1 To our knowledge, no audit has been performed on TTJV in Australia on this scale for ENT surgery. Method(s): We report a retrospective audit of the use of TTJV in a tertiary healthcare centre in Melbourne, Victoria, over the past 7 years, with a total of 50 patients with severe airway compromise undergoing pharynolar-yngeal surgery. Result(s): TTJV was successful in 98% of patients. Only one patient required further postoperative attention for possible airway compromise, but recovered uneventfully. Minor complications occurred in 12% of patients, which is a substantial improvement compared to other cases in the literature. Rates of complications and ease of insertion (measured by number of needle passes) demonstrated improvement. Conclusion(s): TTJV should always be performed using a high-frequency jet ventilator (HFJV). Imaging prior to TTJV is highly recommended. Cannulation of the trachea below the cricothyroid membrane is feasible but more challenging to the inexperienced anaesthetist. Apnoeic oxygenation through the TTJV cannula is delays desaturation in the well-preoxygenated patient.

Working memory (WM), the ability to store and manipulate information for short periods of time, is an important predictor of scholastic aptitude and a critical bottleneck underlying higher-order cognitive processes, including controlled attention and reasoning. Recent interventions targeting WM have suggested plasticity of the WM system by demonstrating improvements in both trained and untrained WM tasks. However, evidence on transfer of improved WM into more general cognitive domains such as fluid intelligence (Gf) has been more equivocal. Therefore, we conducted a meta-analysis focusing on one specific training program, n-back. We searched PubMed and Google Scholar for all n-back training studies with Gf outcome measures, a control group, and healthy participants between 18 and 50 years of age. In total, we included 20 studies in our analyses that met our criteria and found a small but significant positive effect of n-back training on improving Gf. Several factors that moderate this transfer are identified and discussed. We conclude that short-term cognitive training on the order of weeks can result in beneficial effects in important cognitive functions as measured by laboratory tests.

Gynecologic leiomyosarcoma are uncommon malignancies. Although pulmonary metastases are frequent complications, endobronchial metastases are rare. We report 1 case of gynecologic leiomyosarcoma with endobronchial metastases, along with a review of the topic and bronchoscopic image of this uncommon phenomenon. © 2007 Lippincott Williams & Wilkins, Inc.