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Ioan Florin Marchis, Doinel Radeanu, Marcel Cosgarea ENT Department, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania Background: The rigid tube for laryngoscopy is an instrument used in ENT, for inspecting the larynx and its vicinity. We used it to facilitate intubation, in ENT patients. Methods: Twenty patients attending for surgery were included for study. Group 1 (n=10) had no airway pathology but at least two predictors of an anatomically difficult airway. Group 2 (n=10) had an obstructing airway pathology. After anesthesia induction, classical laryngoscopy was performed, and intubation grade registered. Using the retromolar approach the rigid tube advanced slowly, the epiglottis was lifted, and the vocal cords were visualized. The bougie was introduced through the rigid tube into the trachea, the rigid tube was extracted, and the intubating tube was placed in the trachea, over the bougie. Results: The mean (SD) maneuver duration was 59.4 (18.2) sec. The Cormack-Lehane view of the glottis at classical laryngoscopy was poor in four patients in Group 1 and six patients in Group 2. The lowest desaturation was 82%. No complications other than sore throat were noted. Conclusion: The rigid tube for laryngoscopy is a useful tool for intubation in ENT patients. We noticed an advantage against classical intubation in patients with base of tongue carcinoma, reduced mouth opening and protruding upper incisors with this instrument. Keywords: rigid tube, laryngoscopy, intubation, difficult cases intubation, difficult airway, retromolar approach, airway introducer

Constantin Stan,1,2 Doiniţa Vesa,2 Mihai Ionuț Tănase,1 Mara Bulmaci,1 Sever Pop,1 Doinel Gheorghe Rădeanu,1 Marcel Cosgarea,1 Alma Maniu1 1Department of ENT, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, România; 2Department of Surgical Clinical, “Dunărea de Jos” University, Faculty of Medicine and Pharmacy, Galați, RomâniaCorrespondence: Doinel Gheorghe Rădeanu, Department of ENT, “Iuliu Haţieganu” University of Medicine and Pharmacy, Migdalului Street No. 6, Cluj-Napoca, 400209, România, Tel +40723025325, Email dr.radeanu@gmail.com; doinel.radeanu@gmail.comAbstract: Simulation in endoscopic sinus surgery allows residents to learn anatomy, to achieve the correct handling of various rhinological instruments, and to practice different surgical procedures. Physically or non-virtual reality models are the main items in endoscopic sinus surgery simulation. The objective of this review is to identify and make a descriptive analysis of non-virtual endoscopic sinus surgery simulators which have been proposed for training. As a new state of the art, surgical simulators are developed continuously, so they can be used to learn basic endoscopic surgery skills by repetitive maneuvers, permitting detection of surgical error and incidents without risk for the patient. Of all training physical models, the ovine model stands out because of the similarities of the sinonasal pathways, the wide availability, and the low costs. Considering the similar nature of the tissues involved, the techniques and surgical instruments can be used almost interchangeably with minimal differences. Every surgical technique studied until now has a degree of risk and the only aspects that consistently reduced the number of complications are training, repetition, and hands-on experience.Keywords: simulator, training, physical, rhinology

Introducere. Polimorfisme genelor care codifică glutation S-transferazele (GSTM1/GSTT1/GSTP1) ar putea fi unul dintre factorii care pot influenţa variabilitatea susceptibilităţii pentru polipoză nazală şi hiposmie la indivizii sănătoşi sau pacienţii cu afecţiuni ORL. Rolul enzimelor din familia GST ar putea fi important în expunerea la leziunile induse de xenobiotice la nivelul mucoasei nazale. Obiective. Evaluarea distribuţiei variantelor polimorfice GST (alele nule GSTM1/GSTT1 şi polimorfismului Ile105Val GSTP1) în randul pacienţilor cu polipoză nazală şi hiposmie într-un studiu de tip caz-control. Subiecţi. Studiul include 75 de cazuri de pacienţi cu polipoză nazală şi hiposmie (evaluaţi cu Testul de olfacţie "Sniffin'Sticks"), recrutaţi din cadrul Departamentului de Otorinolaringologie a Spitalului Judeţean de Urgenţă, Cluj-Napoca şi 124 controale fără hiposmie şi patologii ORL asociate. Metode. Genotiparea GSTM1 şi GSTT1 a fost realizată folosind metoda Multiplex PCR, urmată de electroforeză în gel de agaroză. Varianta Ile105Val a genei GSTP1 a fost genotipată cu ajutorul tehnicii PCR-RLFP. Rezultate. Analiza comparativă pentru varianta Ile105Val a genei GSTP1 nu a relevat diferenţe statistic semnificative între pacienţi şi controale (χ2 = 3.012, p = 0.087, OR = 1.514, CI = 0.491 - 1.572). Analiza moleculară nu a evidenţiat o frecvenţă crescută pentru alele nule GSTT1 şi GSTM1 în grupul de pacienţi, comparativ cu controalele. GSTT1, (95% CI = 0.332 - 1.261, p = 0.192, OR = 0.641, χ2 = 2.120), GSTM1, (95% CI = 0.171 - 0.592, χ2 = 2.017, OR= 0.321, p = 0.062), însă au fost identificate diferenţe semnificative între purtătorii ambelor alele nule (heterozigoţi dublu-nuli) şi riscul de a dezvolta polipoză nazală comparativ cu lotul de control (p=0.0015, OR=4.0351; CI=1.706-9.543. De asemenea s-a evidenţiat un risc crescut pentru polipoză nazală şi hiposmie la pacienţii alergici comparativ cu cei fără alergii (p=0.027, OR=3.455, CI=1.147- 10.406) Concluzii. Prezenţa concomitentă a genotipurilor nule GSTM1/GSTT1 (dublu - nule) este considerată un factor de risc pentru dezvoltarea NP şi hiposmiei la persoanele alergice. Rezultatele studiului nostru nu identifică nici o corelaţie între polimorfismul Ile105Val al genei GSTP1, polipoza nazală şi hiposmie.

Background: Awake fiberoptic tracheal intubation is an established method of securing difficult airways, but there are some reservations about its use because many practitioners find it technically complicated, time-consuming, and unpleasant for patients. Our main goal was to test the safety and efficacy of a 300-mm working length fiberscope (video rhino-laryngoscope) when used for awake nasotracheal intubation in difficult airway cases., Methods: This was a prospective, single-center study involving adult patients, having an ASA physical status between I and IV, with laryngopharyngeal pathology causing distorted airway anatomy. Awake nasotracheal intubation, using topical anesthesia and light sedation, was performed using a 300 mm long and 2.9 mm diameter fiberscope equipped with a lubricated reinforced endotracheal tube. The primary outcomes were the success and duration of the procedure. Patients' periprocedural satisfaction and other incidents were recorded., Results: We successfully intubated all 25 patients included in this study. The mean ±SD duration of the procedure, starting from the passage of the intubating tube through one of the nostrils until the endotracheal intubation, was 76 ± 36 seconds. Most of the patients showed no discomfort during the procedure with statistical significance between the No reaction Group with the Slight grimacing Group (95%CI 0.13, 0.53, p = 0.047) and the Heavy grimacing Group (95%CI 0.05, 0.83, p = 0.003). The mean ±SD satisfaction score 24 hours post-intervention was 1.8 ± 0.86 - mild discomfort. No significant incidents occurred., Conclusions: Our study showed that a 300-mm working length flexible endoscope is fast, safe, and well-tolerated for nasotracheal awake intubation under challenging airways., Competing Interests: Conflicts of interest The authors declare no conflicts of interest., (Copyright © 2021 Sociedade Brasileira de Anestesiologia. Published by Elsevier España S.L.U. All rights reserved.)

The unexpected problematic airway represents a large proportion of anesthesia-related morbidity and mortality. The retromolar or paraglossal approach is an alternative to the majority of the rigid instruments used for tracheal intubation, which follow the midline to access the glottis. This single-center, prospective case-series study offers an option to conventional laryngoscopy in case of a poor glottic view, introducing an instrument (the rigid tube for laryngoscopy) that uses the retromolar approach to accomplish tracheal intubation. If after anesthesia induction, the modified Cormack-Lehane glottis view grade >2b, the intubation is carried further with the rigid tube. The tube follows the direction of the thyroid cartilage while advancing from the labial commissure, displacing the tongue to the contralateral side. Adjusting the position of the larynx with the nondominant hand by gently pushing the thyroid cartilage and following an imaginary line towards it while advancing it improves the time needed for proper glottis visualization. Once the epiglottis is in sight, the practitioner progresses slowly, lifting the epiglottis and aiming the tip of the tube more anteriorly. When the glottis appears in the visual field, the intubating tube introducer is placed in the trachea, and a lubricated cuffed intubating tube is advanced over the introducer after the rigid tube is extracted. This tool was tested on 30 patients with an unsatisfactory glottic view when using the Macintosh laryngoscope and obtained excellent results with respect to intubation time and complications. The reduced visual field is the main limitation of this method, which requires a training period for reasonable expertise. This simple, robust, and cheap instrument could be a rescue option in case of a difficult airway.