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Pawel Ratajczyk,1 Bartosz Dominikowski,2 Agnieszka Czylkowska,3 Bartlomiej Rogalewicz,3 Cezary Kulak,4 Tomasz Gaszynski1 1Department of Anaesthesiology and Intensive Therapy, Medical University of Lodz, Lodz, Poland; 2Institute of Electrical Engineering Systems, Lodz University of Technology, Lodz, Poland; 3Institute of General and Ecological Chemistry, Lodz University of Technology, Lodz, Poland; 4Medical Simulation Center, Medical University of Lodz, Lodz, PolandCorrespondence: Tomasz Gaszynski, Department of Anaesthesiology and Intensive Therapy, Medical University of Lodz, Kopcinskiego Str 22, Lodz, 90-153, Poland, Email tomasz.gaszynski@umed.lodz.plIntroduction: The aim of the article is to determine the appropriate concentration of desflurane to effectively counteract the increase in blood pressure resulting from surgical stress. In medical practice, this increase is often limited by using additional doses of opioid drugs. Additional medications or higher doses of those already used may adversely affect your health. During anesthesia, physician must note the use of drugs and remember them, especially those that he has recently administered, which affect his concentration. For this purpose, the authors decided to propose support for the selection of desflurane concentration so that frequent use of opioid drugs is not necessary. The authors used a system based on AI issues to accomplish this task. The learned system supports the anesthesiologist’s work by imitating him.Patients and Methods: The proposed method for selecting the desflurane concentration is based on a fuzzy controller. This system includes a learning mechanism that allows for minimizing the operating error. The main advantage of this system is the ability to build a function allowing the selection of anesthesia parameters without knowledge of the mathematical description of the process. To accomplish this task, you need an expert who will provide information in the construction of logical if-then sentences (points in space). The fuzzy controller connects the points in the consideration space appropriately, generating a hypersurface. The algorithm test was performed only by computer without the participation of patients.Results: The operation of the proposed algorithm was verified by computer simulation. The authors of the article analyzed the compliance of the obtained results with the table provided by the expert. The desflurane concentration values obtained by computer simulation are similar to those given in the table Minimal driver error does not affect the patient’s clinical response. This error results from the functions used in the fuzzy system and its settings. The results of the performance test of the proposed algorithm are presented in a time course, and it has the shape of a step function. The work proposes a function that allows you to enter the time needed for the body’s reaction to reach the desired Etdes level.Conclusion: In this study, a controller was created to support the selection of the concentration of desflurane allowing for a reduction in blood pressure (resulting from surgical stress). The results obtained by computer simulation provide valuable insights for optimizing anesthesia. This system can also be used as an important simulation program for teaching purposes.Keywords: fuzzy logic, anesthetic support, desflurane, mathematical models of desflurane

Tomasz Gaszynski,1 Pavel Michalek,2 Pawel Ratajczyk1 1Department of Anaesthesiology and Intensive Therapy, Medical University of Lodz, Lodz, Poland; 2Department of Anaesthesia and Intensive Medicine, Charles University and General University Hospital, Prague, Czech RepublicCorrespondence: Tomasz Gaszynski, Department of Anaesthesiology and Intensive Therapy, Medical University of Lodz, Lodz, Poland, Email tomasz.gaszynski@umed.lodz.plBackground: The visualization of the glottis may be inadequate in morbidly obese patients when a standard Macintosh blade laryngoscope (MCL) is used. The Vie Scope® (VS) is a novel type laryngoscope consisting of a straight, enclosed, illuminated tube that offers intubation via a bougie using the paraglossal technique. In this prospective, nonrandomized comparative study, we tested the research hypothesis that the VS may improve visualization of the glottic larynx in comparison to the MCL.Materials and Methods: After obtaining institutional ethics committee approval, 60 morbidly obese patients (BMI > 40 kg/m2) undergoing elective non-head and neck surgery were included in the study. After induction of general anesthesia (GA), the glottic visualization was performed using the two laryngoscopes in succession, first MCL size 3 or 4 followed by the VS and was assessed using the modified Cormack–Lehane scale. Tracheal intubation was performed using the VS The first pass intubation success and the total success rate was recorded only for the VS Intubation time was not measured because of the paired study design.Results and Discussion: Mean demographic data included: age 41.9± 8.2 years, height 171.2± 10.2 cm, weight 129.9± 21.6 kg, BMI 44.95± 3.85 kg/m2. Using MCL, Cormack–Lehane grade 1 was observed in 36 (60%) cases; grade 2 in 7/60 (11.6%); grade 3 in 13/60 (21.7%); and grade 4 in 4/60 (6.7%). Poor laryngeal views represented by grades 3 and 4 were observed in 28.4% of patients with the MCL. Grades obtained with the VS were all grade 1 (100%). The first attempt intubation success was in 58/60 (96.7%) with the VS. No complications were observed.Conclusion: The Vie Scope® laryngoscope, using the paraglossal technique of tracheal intubation, significantly improves visualization of the vocal cords in morbidly obese patients compared to the standard Macintosh laryngoscope.Keywords: morbid obesity, intubation, Vie Scope® laryngoscope, direct laryngoscopy, Macintosh, difficult airway

Tomasz Gaszynski Department of Emergency and Disaster Medicine, Medical University of Lodz, Lodz, Poland Background: Super-obese patients are at increased risk of difficult mask ventilation and difficult intubation. Therefore, devices that allow for simultaneous ventilation/oxygenation during attempts to visualize the entrance to the larynx, increase patient safety. TotalTrack video intubating laryngeal mask is a new device that allows for ventilation during intubation efforts. Patients and methods: Twenty-four super-obese patients (body mass index >50 kg/m2) were divided into two subgroups: intubation efforts using 1) TotalTrack and 2) Macintosh blade standard laryngoscope in induction of general anesthesia. Visualization and successful intubation was evaluated for both groups with ventilation and post-mask complications additionally evaluated for TotalTrack. Results: In all cases in the TotalTrack group, the Cormack-Lehane score was 1, ventilation and intubation was successful in 11/12 patients. No hypoxia during intubation efforts was recorded. No serious complications of use of TotalTrack were observed. In the Macintosh blade laryngoscope group, all patients were intubated, but the Cormack-Lehane score was 2 in four cases, and 3 in three cases. Conclusion: TotalTrack video intubating laryngeal mask is a device that allows for better visualization of the larynx compared to the standard Macintosh blade laryngoscope, it provides effective ventilation/oxygenation and intubation in super-obese patients. Keywords: super-obese, intubation, ventilation, laryngeal mask, standard laryngoscope, video laryngoscope

Marcin Cierniak,1 Dariusz Timler,1 Renata Sobczak,1 Andrzej Wieczorek,2 Przemyslaw Sekalski,3 Natalia Borkowska,2 Tomasz Gaszynski1 1Department of Emergency Medicine and Disaster Medicine, Barlicki University Hospital, 2Department of Anesthesiology and Intensive Therapy, Medical University of Lodz, 3Department of Microelectronics and Computer Science, IT Centre, Lodz University of Technology, Lodz, Poland Background: Intubation is still one of the best methods to secure the airway. In the case of prehospital or early hospital conditions when factors such as urgency, stress, or inaccuracy of the undertaken activities are involved, the risk of causing complications, for instance, edema or postintubation injuries, increases, especially while dealing with a difficult intubation. The risk of improper inflation of the endotracheal tube cuff also increases, which is considered in this study.Objective: The aim of this study was to evaluate the prevalence of postintubation complications, such as postintubation injuries or edema, in a research sample, and to examine whether such complications occur more often, for example, while using a guidewire. In this study, we also evaluated the injuries associated with the inflation of the endotracheal tube cuff.Materials and methods: This study was performed on a group of 153 patients intubated in prehospital conditions. The tests were carried out in three clinical sites that received patients from prehospital care. Postintubation injuries were revealed and photographed using videolaryngoscope, such as the C-MAC and the McGrath series 5. The endotracheal tube cuff pressure was measured using a pressure gage manual (VBM Medizintechnik GmbH). The quantitative analyses of differences between incidence of variables were assessed using χ2 test for P

Andrzej Wieczorek,1 Tomasz Gaszynski2 1Department of Anesthesia and Intensive Care, Medical University of Lodz, Lodz, Poland; 2Department of Emergency Medicine and Disaster Medicine, Medical University of Lodz, Lodz, Poland Introduction: There are some patients with severe respiratory disturbances like adult respiratory distress syndrome (ARDS) and suspicion of brain death, for whom typical performance of the apneic test is difficult to complete because of quick desaturation and rapid deterioration without effective ventilation. To avoid failure of brain death confirmation and possible loss of organ donation another approach to apneic test is needed. We present two cases of patients with clinical symptoms of brain death, with lung pathology (acute lung injury, ARDS, lung embolism and lung infection), in whom apneic tests for recognizing brain death were difficult to perform. During typical performance of apneic test involving the use of oxygen catheter for apneic oxygenation we observed severe desaturation with growing hypotension and hemodynamic destabilization. But with the use of Boussignac CPAP system all necessary tests were successfully completed, confirming the patient’s brain death, which gave us the opportunity to perform procedures for organ donation. The main reason of apneic test difficulties was severe gas exchange disturbances secondary to ARDS. Thus lack of positive end expiratory pressure during classical performance of apneic test leads to quick desaturation and rapid hemodynamic deterioration, limiting the observation period below dedicated at least 10-minute interval. Conclusion: The Boussignac CPAP system may be an effective tool for performing transparent apneic test in case of serious respiratory disturbances, especially in the form of acute lung injury or ARDS. Keywords: brain death, organ donor, ARDS, ALI, Boussignac CPAP

Andrzej Wieczorek, Andrzej Tokarz, Wojciech Gaszynski, Tomasz Gaszynski Department of Anesthesiology and Intensive Therapy, Medical University of Lodz, Lodz, Poland Abstract: Doripenem is a novel wide-spectrum antibiotic, and a derivate of carbapenems. It is an ideal antibiotic for treatment of serious nosocomial infections and severe sepsis for its exceptionally high efficiency and broad antibacterial spectrum of action. Doripenem is eliminated mainly by the kidneys. In cases of acute kidney injury, dosing of doripenem depends on creatinine clearance and requires adjustments. Doripenem is eliminated during hemodialysis because its molecular weight is 300–400 Da. The aim of this study was to establish the impact of continuous renal replacement therapy (CRRT) slow low-efficiency dialysis (SLED) on doripenem serum concentrations in a population of intensive-therapy patients with life-threatening infections and severe sepsis. Ten patients were enrolled in this observational study. Twelve blood samples were collected during the first administration of doripenem in a 1-hour continuous infusion while CRRT SLED was provided. Fluid chromatography was used for measurement of the concentration of doripenem in serum. In all collected samples, concentration of doripenem was above the minimum inhibition concentration of this antibiotic. Based on these results, we can draw the conclusion that doripenem concentration is above the minimum inhibition ­concentration throughout all of CRRT. The dosing pattern proposed by the manufacturer can be used in patients receiving CRRT SLED without necessary modifications. Keywords: AKI, antibiotic, antimicrobial therapy, carbapenem, CRRT, infection, MODS, SLED

Ewelina Gaszynska,1 Franciszek Szatko,1 Malgorzata Godala,2 Tomasz Gaszynski3 1Department of Hygiene and Health Promotion, Medical University of Lodz, Lodz, Poland; 2Department of Nutrition and Epidemiology, Medical University of Lodz, Lodz, Poland; 3Department of Emergency Medicine and Disaster Medicine, Medical University of Lodz, Lodz, Poland Objectives: To determine oral health status, dental treatment needs, and to identify barriers that prevent easy access to dental care by elderly care home residents in Lodz.Background: Studies in many countries show that oral health status of elderly care home residents is poor and there is an urgent need to improve it.Methods: The study included 259 care home residents, aged 65 years and older. The oral examination was performed. In face-to-face interviews, subjects were asked about frequency of cleaning teeth and/or dentures, whether they needed assistance, and whether the assistance was available; they were also asked about the perceived dental needs, and about the time since their last visit to a dentist and the purpose of the visit. If they had not visited the dentist in the past 12 months, they were asked about reasons for failing to visit the dentist.Results: Forty-six percent of the subjects were edentulous. Only 5.8% of all participants had a sufficient number of functional natural teeth. Dental treatment was found to be necessary in 59.8% of the respondents. One in four subjects reported reduced ability of correctly cleaning teeth and dentures themselves, of whom only one-third were helped by others. An insufficient level of hygiene was found in every other subject. About 42% of residents had not visited a dentist for over 5 years, mainly due to organizational reasons.Conclusion: Expanding the current scope of medical care for the elderly care home residents to include dental care would improve their currently poor oral health status. Keywords: dental care, institutionalized elderly, treatment needs, oral behaviors

Ewelina Gaszynska,1 Malgorzata Godala,2 Franciszek Szatko,1 Tomasz Gaszynski3 1Department of Hygiene and Health Promotion, Medical University of Lodz, Poland; 2Department of Nutrition and Epidemiology, Medical University of Lodz, Poland; 3Department of Emergency Medicine and Disaster Medicine, Medical University of Lodz, Poland Background: Maintaining good physical fitness and oral function in old age is an important element of good quality of life. Disability-related impairment of oral function contributes to a deterioration of the diet of older people and to the reduction of their social activity.Objectives: Investigate the association between masseter muscle tension, dental status, and physical fitness parameters.Materials and methods: Two hundred fifty-nine elderly care home residents (97 men, 162 women; mean age, 75.3±8.9 years) were involved in this cross-sectional study. Their chewing ability was evaluated by masseter muscle tension palpation, differences of masseter muscle thickness, self-reported chewing ability, number of present and functional teeth, and number of posterior tooth pairs. Masseter muscle thickness was measured by ultrasonography. To assess physical fitness, hand grip strength and the timed up-and-go test were performed. Nutritional status was assessed using body mass index and body cell mass index (BCMI), calculated on the basis of electrical bioimpedance measurements. Medical records were used to collect information on systemic diseases and the number of prescribed medications. Subjects were also evaluated for their ability to perform ten activities of daily living.Results: Ninety-seven percent of the subjects suffered from systemic diseases. The three most prevalent illnesses were cardiac/circulatory 64.5%, musculoskeletal 37.3%, and endocrine/metabolic/nutritional 29.3%. Of the participants, 1.5% were underweight and more than one third (34.4%) were overweight. Malnutrition (BCMI below normal) was found in almost half (45.2%) of the subjects. Only 5.8% had a sufficient number of functional natural teeth. Statistically significant correlations were found between palpation of masseter muscle tension and perceived chewing ability, number of present teeth, number of functional teeth, number of posterior tooth pairs, timed up-and-go, hand grip strength, body mass index, BCMI, and activities of daily living. In a multivariate model, after adjusting for age, sex, and education, subjects with higher BCMI, higher hand grip strength, and more present teeth had a significantly higher chance of strong masseter muscle tension.Conclusion: There is a relationship between chewing ability and physical fitness in elderly people. Efficiency of masseter muscles is related to physical fitness in the elderly. Masseter muscle tension examined by palpation can be used in public dentistry as one of the indicators of quality of life. Keywords: physical fitness, chewing ability, masseter muscle tension

Tomasz Gaszynski,1 Ewelina Gaszynska,2 Tomasz Szewczyk31Department of Anesthesiology and Intensive Therapy, 2Department of Hygiene and Health Promotion, 3Department of Gastroenterology, Oncology, and General Surgery, Barlicki University Hospital, Medical University of Lodz, PolandAbstract: Super-obese patients (body mass index [BMI] >50 kg/m2) are at a particularly high risk of anesthesia-related complications during postoperative period, eg, critical respiratory events including respiratory arrest, and over-sedation leading to problems with maintaining airway open, hypoxia and hypercapnia. In this paper authors present a case of a 39-year-old super-obese (BMI 62.3 kg/m2) female patient who was admitted for surgical treatment of obesity. Preanesthesia evaluation revealed hypertension and type 2 diabetes mellitus (DM) as comorbidities as well as potential for a difficult intubation– neck circumference of 46 cm, reduced neck mobility and DM type 2. Patient was intubated using "awake intubation" method using topical anesthesia and dexmedetomidine infusion. General anesthesia was maintained with sevoflurane and dexmedetomidine infusion instead of opioid administration in "opioid-free anesthesia method".Keywords: morbid obesity, non-opioid anesthesia, dexmedetomidine

Ewelina Gaszynska, Tomasz GaszynskiDepartment of Emergency Medicine and Disaster Medicine, Medical University of Lodz, Lodz, PolandAbstract: Intubation of patients with a supraglottic mass causing obstruction of the glottis remains a difficult problem for the experienced anesthesiologist. Awake fiberscopic endotracheal intubation is the recommended approach in such cases; however, use of a video laryngoscope for awake intubation can be an alternative to a fiberscope. Here we present two cases of awake intubation using a King Vision™ video laryngoscope in patients with a supraglottic mass, and a literature review on use of video laryngoscopes for awake intubation. After topical anesthesia and sedation with opioids, the patients were successfully intubated.Keywords: airway management, difficult airway, awake intubation, video laryngoscope

Tomasz Gaszyński Department of Anaesthesiology and Intensive Therapy, Medical University of Łódź, Łódź, Poland Abstract: The C-MAC videolaryngoscope was evaluated for intubation in patients with predicted extremely difficult airway. The presented cases are patients with neoplasm tumors in larynx. In all cases, awake intubation using C-MAC videolaryngoscope was performed in patients breathing spontaneously, under local anaesthesia, with oxygen administered via nasal catheter. All intubations were successful and uneventful. The pre-surgery examination (CT scans and fiberscope laryngeal examination) was compared with view of larynx obtained during laryngoscopy. Based on my experience, I assume that C-MAC videolaryngoscope is a very useful tool for anaesthesiologists and can be applied not only for unexpected difficult intubation but also for predicted difficult airway. Moreover, it could be used as an additional diagnosis tool before larynx surgery. The view obtained with the C-MAC videlaryngoscope corresponds with larynx examination performed before surgery, and could potentially reveal more details. Keywords: videolaryngoscope, airway management, predicted difficult airways, C-MAC

Tomasz Gaszyński Department of Anaesthesiology and Intensive Therapy, Medical University of Łódź, Łódź, Poland Abstract: Videolaryngoscopes improve the view of the entry to the larynx in morbidly obese patients. Super obesity is one of the risk factors for difficult mask ventilation as well as difficult intubation. Super obese patients should be intubated awake either with a fiber-optic scope or with a videolaryngoscope. The glottic view during video-intubation in super obese patients using different devices was compared. The McGrath MAC (MGM) was used in all patients and then compared to the King Vision (KV) in three patients, the APA videolaryngoscope in two patients and the Airtraq Avant with a video camera in four patients. The pictures were of the same patient for two used devices. All obtained images were analyzed using the Percentage of Glottic Opening (POGO) scale. The POGO score for the MGM was better than for the KV and the APA but comparable to the Airtraq device. The images were processed electronically, and the best view of the laryngeal inlet that was obtained by the evaluated devices in the same patient was superimposed onto the other one and then compared. Keywords: super obese, videolaryngoscopes, intubation, glottic visualization

Background: Pulse oximetry is a standart of anesthesia for perioperative monitoring. Due to the principles of Hb oxygen dissociation curve, peripheral oxygen saturation has an approximate sensitivity and specificity of 90% for the detection of hypoxemia., Objectives: The primary outcome of the study was to evaluate ORi Ⓡ as an early parameter to determine hypoxia in morbidly obese patients. The secondary outcome was to compare the effectiveness of ORi Ⓡ with SpO 2 in non-obese patients., Design: Prospective, observational study., Setting: Department of elective operating room at tertiary hospital., Patients and Methods: Observational study included written informed consent from 51 patients with 19 < BMI < 25 kg/m 2 and 51 patients with BMI > 40 kg/m 2 undergoing an elective surgery requiring tracheal intubation. In addition to standard monitors, an ORi sensor was placed and baseline values were recorded. The patients were preoxygenated until end tidal expiratory oxygen concentration is reached to 90%. After anesthesia induction and tracheal intubation, the breathing circuit was not connected tracheal tube until the SpO 2 decreased to 95%. Shapiro-Wilk, Pearson Chi-square, t-test, and Mann Whitney U test were used for the study., Main Outcome Measures: Times of tolerable apnea, ORi Ⓡ and SpO 2 values at the end of preoxygenation, beginning of intubation, beginning of the ORi alarm, when SpO 2 reached 95%, and when ORi reaches a plateau., Sample Size: 102 patients., Results: The alert period: time to reach ORi Ⓡ from 0.24 to a value of 95% SpO 2 was observed as 32 s in morbidly obese patients and 94 s in patients with a normal body mass index. The SpO 2 alert period was determined as time difference between 97% and 95% SpO 2 . The data were recorded as 15 s and 36 s, respectively. It was observed that tolerable apnea, ORi Ⓡ , SpO 2 and added alert times were longer in patients with normal BMI compared to morbidly obese patients., Conclusions: As a result, ORi Ⓡ can provide an early warning to prevent unexpected hypoxia before saturation begins to decrease in morbidly obese patients., Limitations: Inability to perform arterial blood gas sampling in the time periods when we looked at the parameters to determine the relationship between ORi Ⓡ and PaO 2 ., Gov Identifier: NCT05480748 registered 2022-07-29., (© 2024. The Author(s).)

Background: The i-gel® Plus is a modified version of the i-gel® supraglottic airway device. It contains a wider drainage port; a longer tip; ramps inside the breathing channel; and an additional port for oxygen delivery. There has been no prospective evaluation of this device in clinical practice., Methods: This international, multicentre, prospective cohort study aimed to evaluate the performance of the i-gel Plus in adult patients undergoing elective procedures under general anaesthesia. The primary outcome was overall insertion success rate, defined as the ability to provide effective airway management through the device from insertion until the end of the surgical procedure. Secondary outcomes included device performance and incidence of postoperative adverse events. Data from the first 1000 patients are reported., Results: In total, 1012 patients were enrolled; 12 forms were excluded from the final analysis due to incomplete data leaving 1000 included patients (545 female). Overall insertion success rate was 98.6%, with a first-attempt success rate of insertion of 88.2%. A significant difference between females and males was seen for the overall success rate (97.4% vs. 99.6% respectively) but not for first-attempt successful insertion. Mean (SD) oropharyngeal seal pressure was 32 (7) cmH 2 O. The only independent factor that increased the risk of first-attempt failure was low operator experience. Complications included desaturation < 85% in 0.6%; traces of blood on the device in 7.4%; laryngospasm in 0.5%; and gastric contents inside the bowl in 0.2% of patients., Conclusions: The i-gel Plus appears to be an effective supraglottic airway device that is associated with a high insertion success rate and a reasonably low incidence of complications., (© 2024 The Author(s). Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.)

The primary objective of this in vitro study was to prevent the risk of toxicity associated with bupivacaine, widely used in clinical practice, by using magnesium (Mg), a readily available and cost-effective element, as an adjuvant. We hypothesized that Mg might exhibit a protective effect against cytotoxicity in a colon cell culture model under conditions of bupivacaine-induced LAST. Our secondary aim was to investigate its effect on genotoxicity, apoptosis, and iROS. CCD-18Co cells were used in our study. Control group (group C), Bupivacaine group (group B), Magnesium group (group M), and Bupivacaine+Mg group (group BM) were created. The viability of CCD-18Co cells incubated for 24 h in group C was determined to be 100%. These cells were evenly divided, and bupivacaine was administered to group B at concentrations of 5 to 300 μM. In group M, doses of Mg at 0.625 to 320 mEq were added. It was determined that the maximum viability was observed at a Mg dose of 40 mEq ( p < 0.05). In group BM, bupivacaine was administered at the same concentrations in combination with Mg (40 mEq), and cell viability was measured. DNA damage, apoptosis, and iROS were assessed at concentrations of bupivacaine by administering 40 mEq Mg. In group B, viability decreased dose-dependently in CCD-18Co ( p < 0.05, p < 0.01, p < 0.001). In group BM, the viability decreased in cells at increasing concentrations compared to group C ( p < 0.05, p < 0.01, p < 0.001), but the viability was affected positively compared to group B ( p < 0.05). In group B, DNA damage increased ( p < 0.05, p < 0.001). In group BM, DNA damage increased ( p < 0.05, p < 0.001). However, in group BM, DNA damage levels were reduced compared to group B ( p < 0.05, p < 0.01). In group B, apoptosis increased ( p < 0.05, p < 0.001); in group BM, apoptosis increased ( p < 0.001) compared to group C. However, in group BM, apoptosis decreased compared to group B ( p < 0.05). iROS increased in group B ( p < 0.05, p < 0.01, p < 0.01) and group BM ( p < 0.05, p < 0.01, p < 0.001) compared to the group C. However, in group BM, iROS decreased in comparison to group B ( p < 0.05). In conclusion, Mg exhibits a protective effect against bupivacaine-induced toxicity.

The primary objective of this study was to demonstrate whether the Miller blade laryngoscope could provide better visualization of the vocal cords in morbidly obese patients than the Macintosh blade laryngoscope. The secondary objective was to identify the patient-measured factors associated with better visualization of the vocal cords when using the Miller vs. Macintosh blade, as well as whether the application of external pressure might improve the visibility of the glottis during intubation. A prospective, observational study encompassing 110 patients with a BMI > 40 undergoing elective bariatric surgery and intubation procedure was performed. The evaluation of the vocal cords was performed according to the Cormack-Lehane scale and POGO scale in the same patient during intubation, performed with a Miller and a Macintosh blade laryngoscope, in a random matter. The following parameters were assessed: body weight, height, BMI, neck circumference, thyromental distance, sternomental distance, mouth opening, and Mallampati scale and their impact on visualization of the vocal cords using the Miller blade without the application of external pressure. The Miller blade provides an improved view of the glottis compared to the Macintosh blade measured with both the Cormac-Lehane scale (45 (40.91%) without external pressure application on the larynx, and 18 (16.36%) with external pressure application on the larynx) and the POGO scale (45 (40.91%) without external pressure application on the larynx, and 19 (17.27%) with external pressure application on the larynx). The application of laryngeal pressure improved the view of the glottis. Among the measured features, a significant improvement in the visibility of the glottis could be found in patients with a BMI over 44.244 kg/m 2 and a neck circumference over 46 cm. To conclude, the usage of the Miller blade improves the visibility of the glottis compared to the Macintosh blade in morbidly obese patients. The recommendation to use the Miller blade in this group of patients requires further investigation, taking into account the effectiveness of the intubation. Trial Registration: NCT05494463.

Background: New devices are more available in the pre-hospital environment operational theaters and emergency departments. One is an intubrite laryngoscope (INT) with Dual LED lighting that combines ultraviolet and white LED. The study aimed to compare the efficacy of endotracheal intubation using INT and conventional laryngoscope performed by inexperienced paramedics (paramedics students) and paramedics with experience in advanced airways management in full and limited accessibility settings., Methods: It was an open, prospective, crossover manikin study. Sixty paramedics and paramedic students were recruited. Participants were divided into 2 equal groups depending on their experience (n = 30). Experienced participants were further randomly divided into 2 groups (n = 15). Inexperienced participants were also randomly divided into 2 groups (n = 15). The criterion of inexperience was 5 or fewer intubation by any laryngoscope. Inexperience participants were asked to perform tracheal intubation in standard pre-hospital settings (without limited access to manikin) (scenario A) and difficult pre-hospital settings (limited access to manikin - narrow space between benches) (scenario B). Experience participants were asked to intubate manikin in difficult pre-hospital settings., Results: In the normal pre-hospital environment, the success rate after the first attempt was 56,7% for conventional laryngoscope and 66,7% for intubrite. However, the overall effectiveness of tracheal intubation using both laryngoscopes in 3 attempts was 90% for both devices. The successful rate of first attempt intubation in a difficult environment by inexperienced was 73,3% for INT and 50% for conventional laryngoscope. Overall effectiveness was 83,3% and 86,7% respectively. The successful rate of first attempt intubation in the experienced group was 86,7% with INT compared to 60% with a conventional laryngoscope in difficult settings. Overall effectiveness was 96,7% for both devices., Conclusion: Intubrite provided better working conditions and make up for deficiencies in successful tracheal intubation by inexperienced participants in a normal and difficult environment. Tracheal intubation with intubrite was more effective in the experienced group. Tracheal intubation effectiveness with intubrite was also higher in the experienced group., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: The visualization of the glottis may be inadequate in morbidly obese patients when a standard Macintosh blade laryngoscope (MCL) is used. The Vie Scope ® (VS) is a novel type laryngoscope consisting of a straight, enclosed, illuminated tube that offers intubation via a bougie using the paraglossal technique. In this prospective, nonrandomized comparative study, we tested the research hypothesis that the VS may improve visualization of the glottic larynx in comparison to the MCL., Materials and Methods: After obtaining institutional ethics committee approval, 60 morbidly obese patients (BMI >40 kg/m 2 ) undergoing elective non-head and neck surgery were included in the study. After induction of general anesthesia (GA), the glottic visualization was performed using the two laryngoscopes in succession, first MCL size 3 or 4 followed by the VS and was assessed using the modified Cormack-Lehane scale. Tracheal intubation was performed using the VS The first pass intubation success and the total success rate was recorded only for the VS Intubation time was not measured because of the paired study design., Results and Discussion: Mean demographic data included: age 41.9±8.2 years, height 171.2±10.2 cm, weight 129.9±21.6 kg, BMI 44.95±3.85 kg/m 2 . Using MCL, Cormack-Lehane grade 1 was observed in 36 (60%) cases; grade 2 in 7/60 (11.6%); grade 3 in 13/60 (21.7%); and grade 4 in 4/60 (6.7%). Poor laryngeal views represented by grades 3 and 4 were observed in 28.4% of patients with the MCL. Grades obtained with the VS were all grade 1 (100%). The first attempt intubation success was in 58/60 (96.7%) with the VS. No complications were observed., Conclusion: The Vie Scope ® laryngoscope, using the paraglossal technique of tracheal intubation, significantly improves visualization of the vocal cords in morbidly obese patients compared to the standard Macintosh laryngoscope., Competing Interests: Professor Tomasz Gaszynski reports personal fees from Adroit Surgical LLC, outside the submitted work. The authors report no other conflicts of interest in this work., (© 2023 Gaszynski et al.)

Background : The correct analysis of COVID-19 predictors could substantially improve the clinical decision-making process and enable emergency department patients at higher mortality risk to be identified. Methods : We retrospectively explored the relationship between some demographic and clinical factors, such as age and sex, as well as the levels of ten selected factors, namely, CRP, D-dimer, ferritin, LDH, RDW-CV, RDW-SD, procalcitonin, blood oxygen saturation, lymphocytes, and leukocytes, and COVID-19 mortality risk in 150 adult patients diagnosed with COVID-19 at Provincial Specialist Hospital in Zgierz, Poland (this hospital was transformed, in March 2020, into a hospital admitting COVID-19 cases only). All blood samples for testing were collected in the emergency room before admission. The length of stay in the intensive care unit and length of hospitalisation were also analysed. Results : The only factor that was not significantly related to mortality was the length of stay in the intensive care unit. The odds of dying were significantly lower in males, patients with a longer hospital stay, patients with higher lymphocyte levels, and patients with higher blood oxygen saturation, while the chances of dying were significantly higher in older patients; patients with higher RDW-CV and RDW-SD levels; and patients with higher levels of leukocytes, CRP, ferritin, procalcitonin, LDH, and D-dimers. Conclusions : Six potential predictors of mortality were included in the final model: age, RDW-CV, procalcitonin, and D-dimers level; blood oxygen saturation; and length of hospitalisation. The results obtained from this study suggest that a final predictive model with high accuracy in mortality prediction (over 90%) was successfully built. The suggested model could be used for therapy prioritization.

Background: Routine endotracheal intubation requires a patient in supine position with an operator standing behind the patient's head. In case of a morbidly obese patient positioned in the recommended semi-recumbent position, an alternative method can be considered. Face-to-face intubation can be used both in patients in sitting as well as in prone position and when there is difficult access to the head. Evaluation of effectiveness and safety of face-to-face intubation in morbidly obese adult patients with body mass index over 40 kg m-2., Methods: The study was approved by the Local Ethics Committee and written informed consent from patients was obtained. We conducted a parallel randomized controlled trial with patients scheduled for elective sleeve gastrectomy. The trial was registered in ClinicalTrials with a number NCT04959149. Randomization and allocation to trial groups were carried out using the envelope method. The primary outcomes were the time of intubation and the first pass success of endotracheal intubation., Results: 76 patients (routine intubation n = 36, face-to-face intubation n = 40) were included in the study with no dropouts. The intubation success rates were 82.5% versus 100%, mean intubation time was 17.1 ± 18 seconds versus 29 ± 11 seconds and the need for additional maneuvers (backward, upward, rightward pressure or flexing the neck) was 15% versus 19.5%, in face-to-face and routine intubation, respectively. No injuries to teeth or mucosa have been reported. There were no incidents of desaturation below 92% or other complications associated with intubation., Conclusion: Face-to-face intubation is shorter than the routine intubation in obese patients. This method may be an alternative to standard intubation in case of airway management in morbidly obese patients in semi-erect position; however, it requires both training and practice., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

Morbidly obese patients are in the group of patients, who can desaturate fast because of changes in lung volumes and reduction in Functional Residual Capasity due to obesity. There are novel methods to improve preoxygenation and to maintain oxygneation during intubation efforts. In this paper we present methods of apneic oxygenation for morbidly obese patients., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Saudi Journal of Anesthesia.)

Background: Videolaryngoscopes improve visualization of glottic in morbidly obese patients. Super-obesity is one of the risk factors influencing probability of difficult mask ventilation and difficult intubation. Super-obese (BMI > 50 kg/m 2 ) patients should be intubated either with fiberscope awake intubation or with video laryngoscopes., Methods: In prospective observational study we decided to compare glottis view during intubation using I-view and McGrath Mac videolaryngoscopes in super obese patients. Patients were randomly allocated into group M (McGrath Mac) or group I (I-View). Obtained view was analyzed regarding POGO (Percentage Of Glottis Opening) scale and the necessity to use of additional aid like intubation stylet was recorded. Hemodynamic response to videolaryngoscopy was assessed., Results: As results POGO score was better in group M when compared to group I: 81.66 ± 22.8% vs 96.66 ± 7.24% (p = 0.0132) in I and V groups respectively. The use of intubation stylet was similar in both groups. The hemodynamic response to videolaryngoscopy was similar between groups., Conclusion: The POGO score was better for McGrath Mac than for I-view videolaryngoscope, however, both devices allowed for safe and effective intubation in super-obese patients. The hemodynamic response to videolaryngoscopy was similar between devices.