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Vernon H Vivian,1 Tyson L Pardon,2 Samuel Vivian,3 André Van Zundert4,5 1Department of Anaesthesiology, Gympie General Hospital, Sunshine Coast, QLD, Australia; 2Emergency Department, Sunshine Cost Health Services, Sunshine Coast, QLD, Australia; 3Prehospital EMS, Queensland Ambulance Services, Brisbane, QLD, Australia; 4Department of Anesthesiology, Royal Brisbane & Women’s Hospital, Brisbane, Australia; 5The University of Queensland, Brisbane, QLD, AustraliaCorrespondence: Vernon H Vivian Email vjcsviv@hotmail.comAbstract: The laryngeal mask airway (LMA) is widely used for airway management in the emergency and elective treatment of patients in both the in-hospital and prehospital setting. The rate of prehospital use is increasing. The LMA is a vital link in the vortex approach to managing a difficult airway. Clinicians will be increasingly faced with the dilemma of managing the patient who has an LMA in place, but still requires the airway secured by an endotracheal tube (ETT). Flexible endoscopic intubation through an LMA is a simpler procedure than awake flexible endoscopic intubation. Furthermore, intubating flexible endoscopes are increasingly available and affordable (now single use) making its use out of the domains of the operating theater and intensive care unit feasible. The authors aim to inform clinicians about the indications, physical characteristics, and insertion/removal techniques related to a new device, the Rescue™ ETT (Genesis Airway Innovations®, Sunshine Coast, Australia), designed specifically for intubation through an LMA over a flexible endoscope and compare them to current devices used for this purpose.Keywords: laryngeal mask airway, intubation, fiberoptic, emergency, airway, scope, vortex

Nasotracheal intubation remains an underused but invaluable technique for securely managing the airway during oral and maxillofacial surgery. In this article, we present a modified clinical technique that allows for the potential introduction into clinical practice of 2 new airway devices: a nasal laryngeal mask airway and an interchangeable oral/nasal endotracheal tube. We hypothesize that with the use of proper techniques, these devices can add new and safer alternatives for securing an airway by the nasal route. The advantage of this novel technique is that the airway is secured by the oral route prior to performing a modified retrograde nasal intubation, eliminating the danger of profuse epistaxis precipitating a "cannot intubate, cannot ventilate" scenario. In addition, the design and materials used in the components of the devices may minimize trauma. The authors aim to inform clinicians about the indications, physical characteristics, and insertion/removal techniques related to these new devices., (© 2021 by the American Dental Society of Anesthesiology.)

Totipotency is the ability of a single cell to give rise to all of the differentiated cell types that build the conceptus, yet how to capture this property in vitro remains incompletely understood. Defining totipotency relies on a variety of assays of variable stringency. Here, we describe criteria to define totipotency. We explain how distinct criteria of increasing stringency can be used to judge totipotency by evaluating candidate totipotent cell types in mice, including early blastomeres and expanded or extended pluripotent stem cells. Our data challenge the notion that expanded or extended pluripotent states harbour increased totipotent potential relative to conventional embryonic stem cells under in vitro and in vivo conditions.