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ResumenJustificación y objetivosLa evaluación ecográfica preoperatoria de la glándula tiroides hecha por los cirujanos puede prevenir los retos en el manejo de las vías aéreas. El objetivo de este estudio observacional fue evaluar los efectos de parámetros relacionados con la tiroides investigados por cirujanos antes de la operación, mediante ecografía y radiografía de tórax en condiciones de intubación.MétodosFueron inscritos 50 pacientes sometidos a cirugía de tiroides. La distancia tiromentoniana, puntuación de Mallampati, circunferencia del cuello y amplitud de movimiento del cuello fueron evaluados antes de la operación. También fueron registrados el volumen de la tiroides, signos de invasión o compresión, y desviación de la tráquea en la radiografía de tórax. Las condiciones de intubación se calcularon con la puntuación de Cormack y Lehane y la escala de intubación difícil (EID). Los análisis estadísticos fueron realizados con el software SPSS 15.0.ResultadosLa media del volumen de la tiroides de los pacientes fue de 26,38±14mL. La mediana de la EID fue 1 (0-2). Fueron correlacionados con la EID la distancia tiromentoniana (p=0,011; r=0,36; IC 95%: 0,582-0,088), puntuación de Mallampati (p=0,041; r=0,29; IC 95%: 013-0,526), signos de compresión o invasión (p=0,041; r=0,28; IC 95%: 0,006-0,521) y desviación de la tráquea en la radiografía de tórax (p=0,041; r=0,52; IC 95%: 0,268-0,702). Los pacientes fueron clasificados en 2 grupos también relacionados con la EID (grupo i, n=19: EID=0; grupo ii, n=31: 1

To investigate the diagnostic value of plasma-free DNA concentration (PF-DNA) in septic patients compared to nonseptic patients and to correlate it with clinical outcome. Materials and methods: Forty-two mechanically ventilated consecutive patients (11 septic, 31 nonseptic) admitted to the intensive care unit (ICU) were recruited. On admission, besides PF-DNA concentration, APACHE II and SOFA scores and serum C-reactive protein (CRP), procalcitonin (PCT), and serum lipid concentrations, together with clinical outcome, were assessed. Plasma samples from 11 volunteers were also collected. Appropriate statistics were used for analysis. Results: Median PF-DNA concentrations on admission were significantly higher in septic patients compared to nonseptic patients [14,285 (48-180,311) GE/mL versus 546.5 (0-7674) GE/mL, P < 0.0001]. For distinguishing septic and nonseptic patients on admission, the area under the curve obtained for PF-DNA concentration was 0.9 (sensitivity 84%, specificity 95%; cutoff 4083 GE/mL). There were no significant differences between PF-DNA concentrations of nonsurvivors and survivors. Additionally, DNA concentration demonstrated a significant correlation with CRP, PCT, and high-density lipoprotein concentrations. Conclusion: Plasma DNA seems to be a potentially valuable tool to confirm sepsis diagnosis upon ICU admission.

UNLABELLED Anesthesiologists have often been confronted with the difficult question of determining which patient will present an increased difficulty for endotracheal intubation. The limits of the previously reported morphometric airway measurements for predicting difficult intubation have inadequately addressed the normal patient population variables. We designed this prospective study to investigate the age and sex-related changes in the morphometric measurements of the airway in a large group of patients without anatomic abnormality and a group of cadavers. Hyomental, thyromental, sternomental distances, neck extension, and Mallampati scores were evaluated in 12 cadavers and in 334 patients. Patients were allocated to three groups based on age: Group 1 (20-30 yr), Group 2 (31-49 yr), and Group 3 (50-70 yr). Male and female sex differences were also evaluated. Hyomental distance was the only variable not affected by age. In addition, the mean population values were less than the threshold values suggested as criteria for difficult endotracheal intubation. All the other criteria were age-dependent and inversely affected by the increase in age. Male sex was also a distinction for increased measurements of all the morphometric distances. The mean degree of neck extension was similar in both sex groups. This study provides a more comprehensible approach to the morphometric measurements of the human airway. Adequate data of normal values may help the clinician to identify patients that are outside the range and therefore may be challenging. IMPLICATIONS This study was performed to establish data on the average values of airway morphology in the adult population of different age groups and sex. Hyomental, thyromental, sternomental distances and neck extension values were measured on 12 cadavers and 334 patients.

Recent evidence suggests that the plasma-free DNA concentration has potential use as a prognostic marker in many clinical situations including sepsis, trauma, and acute stroke [1]. However, its predictive value is arguable. We hypothesized that plasma DNA is increased in septic patients admitted to the ICU compared with nonseptic ICU patients, and it is correlated with disease severity and clinical outcome. Forty-two consecutive patients (11 septic, 31 nonseptic) admitted to a mixed ICU and mechanically ventilated were recruited. Plasma-free DNA concentration was measured by real-time PCR assay for the β-globin gene, and the APACHE II score, SOFA score, serum C-reactive protein (CRP) concentrations, procalcitonin (PCT) concentrations, serum lipid concentrations, and clinical outcome (ICU/hospital days and mortality) were assessed on admission to the ICU. Assessments and samplings were repeated as the diagnosis of the patients changed (sepsis, severe sepsis and septic shock). Finally, 86 plasma samples were collected. Descriptive statistics, Mann–Whitney U, Kruskall–Wallis and Spearman's tests, and receiver operating characteristic analysis were used when appropriate. Demographic data were similar. ICU and hospital mortalities were 26.2% and 33.3%, respectively. The mean DNA concentrations on admission were significantly higher in ICU patients compared with healthy subjects (n = 11) (13,405 GE/ml versus 390 GE/ml, P < 0.05) and septic patients compared with nonseptic patients (33,170 GE/ml versus 1,171 GE/ml, P < 0.001). Furthermore, during the overall ICU stay, increased DNA concentration associated with the increase of severity of illness was noted; however, this increase was statistically significant only between septic and septic shock samples (26,624 GE/ml versus 42,861 GE/ml, P < 0.05). The area under the curve obtained for the plasma-free DNA concentration in distinguishing between septic and nonseptic patients on admission was 0.9 (sensitivity 84%, specificity, 95%; cutoff 4,083 GE/ml). Also, the plasma-free DNA concentration was found to be higher in patients who died in the ICU compared with patients who survived, although not statistically significant. The DNA concentration demonstrated a significant correlation with CRP (P = 0.037, r = 0.365), PCT (P = 0.007, r = 0.457) and high-density lipoprotein (P = 0.015, r = -0.415) concentrations. In conclusion, plasma DNA may be a potentially valuable tool to confirm the diagnosis of sepsis on admission to the ICU and to monitor disease severity.

ResumoJustificativa e objetivosA avaliação ultrassonográfica pré‐operatória da glândula tireóide feita por cirurgiões pode prever desafios no manejo das vias aéreas. O objetivo deste estudo observacional foi avaliar os efeitos de parâmetros relacionados à tireóide investigados pré‐operatoriamente por cirurgiões mediante ultrassonografia e radiografia de tórax em condições de intubação.MétodosForam inscritos 50 pacientes submetidos à cirurgia de tireóide. Distância tireomentoniana (DTM), escore de Mallampati, circunferência do pescoço e amplitude de movimento do pescoço foram avaliados antes da operação. Volume da tireóide, sinais de invasão ou compressão e desvio da traqueia na radiografia de tórax também foram registrados. As condições de intubação foram avaliadas com o escore de Cormack e Lehane (CL) e a escala de intubação difícil (EID). Análises estatísticas foram feitas com o software SPSS 15.0.ResultadosA média do volume da tireóide dos pacientes foi de 26,38±14mL. A mediana da EID foi de 1 (0‐2). DTM (p=0,011; r=0,36, IC 95% 0,582‐0,088); escore de Mallampati (p=0,041; r=0,29, IC 95% 013‐0,526); sinais de compressão ou invasão (p=0,041; r=0,28; IC 95% 0,006‐0,521) e desvio da traqueia na radiografia de tórax (p=0,041; r=0,52, IC 95% 0,268‐0,702) foram correlacionados com a EID. Os pacientes foram classificados em dois grupos também relacionados à EID (Grupo I, n=19: EID=0; Grupo II, n=31: 1 < EID ≤ 5) e os preditivos de intubação difícil e os parâmetros da tireóide relacionados foram comparados. Apenas o escore de Mallampati foi significativamente diferente entre os grupos (p=0,025).ConclusãoO volume da tireóide não está associado à intubação difícil. Contudo, os parâmetros de avaliação clínica podem prever intubação difícil.AbstractBackground and objectivesPreoperative ultrasonographic evaluation of the thyroid gland done by surgeons could let us foresee airway management challenges. The aim of this observational study was to evaluate the effects of thyroid‐related parameters assessed preoperatively by surgeons via ultrasonography and chest X‐ray on intubation conditions.MethodsFifty patients undergoing thyroid surgery were enrolled. Thyromental distance, Mallampati score, neck circumference and range of neck movement were evaluated before the operation. Thyroid volume, signs of invasion or compression and tracheal deviation on chest X‐ray were also noted. The intubation conditions were assessed with Cormack and Lehane score and the intubation difficulty scale. Statistical analyses were done with SPSS 15.0 software.ResultsThe mean thyroid volume of the patients was 26.38±14mL. The median intubation difficulty scale was 1 (0‐2). Thyromental distance (p=0.011; r=0.36; 95% CI 0.582‐0.088), Mallampati score (p=0.041; r=0.29; 95% CI 0.013‐0.526), compression or invasion signs (p=0.041; r=0.28; 95% CI 0.006‐0.521) and tracheal deviation on chest X‐ray (p=0.041; r=0.52; 95% CI 0.268‐0.702) were correlated with intubation difficulty scale. Also patients were classified into two groups related to their intubation difficulty scale (Group I, n=19: intubation difficulty scale=0; Group II, n=31: 1

Postoperative pain management in pediatric strabismus patients is infrequently studied. Pediatric patients can be mobilized earlier if postoperative pain is minimized. In this study, two different regional anesthetic techniques, retrobulbar block and local infiltration, were compared with a "no block" control group for the postoperative management of pain in pediatric patients undergoing elective strabismus surgery.Thirty patients were randomly allocated to one of the study groups: group 1 (n=10) control, group 2 (n=10) retrobulbar block, and group 3 (n=10) subconjunctival bupivacaine infiltration. The parameters that were evaluated during the early postoperative period (6 hours) were circulatory, pain scores by Visual Analog Scale (VAS) and Modified Pediatric Objective Pain Scale (MPOPS), additional analgesic requirement, nausea, and vomiting. The parameters that were evaluated after discharge from the hospital (on postoperative days 1 and 2) through questionnaires were additional analgesic requirement, nausea, vomiting, sleep disturbances, activity, and appetite.Group 3 had significantly higher VAS and MPOPS scores at postoperative 120, 180, 240, 300, and 360 minutes than groups 1 and 2 (P.05). Patients in group 2 seemed to have a higher incidence of nausea and vomiting both in the early (6 hours) and late postoperative (postoperative days 1 and 2) periods; however, the difference was not statistically significant. Group 2 required less analgesic compared with groups 1 and 3 during the late postoperative period. Late postoperative activity and appetite were better in groups 2 and 3.Because there was no significant difference in terms of postoperative analgesia in the retrobulbar block or subconjunctival local anesthetic infiltration groups compared with the control group, we suggest that conventional methods of pain treatment are adequate for postoperative analgesia in strabismus surgery.