A systematic review and meta-analysis of the use of succinylcholine to facilitate tracheal intubation in neonates

Use of succinylcholine in neonates is surrounded by many controversies. The need to review this topic stems from the fact that though there is an abundance of information, but there are divergent views regarding its use in neonates. We have analyzed the incidence of intubation attempts, bradycardia, and hemodynamic changes in clinical settings.The authors conducted a meta-analysis and systematic literature search to ascertain the risks and benefits of using succinylcholine in neonatal intubation by conducting a review in the online databases of PubMed, Cochrane, Scopus, Embase, Elsevier, and Google scholar. The combination of keywords used for the search included “Succinylcholine,” “succinylcholine” AND “neonates,” “neonates” AND “difficult airway,” “neuromuscular blockers” AND “neonates,” and “non-depolarizing neuromuscular blockers” AND “neonates”. The severe adverse reactions associated with use of succinylcholine include bradycardia, asystole, hyperkalemia, and apnea. The number of attempts required for intubation was significantly lower in the patients receiving succinylcholine as compared to those who did not receive succinylcholine. Evidence suggests that conscious awake intubation leads to adverse physiological responses in neonates. The main recommended indications for using succinylcholine include emergency intubation in laryngospasm, full stomach, difficult airway, absent intravenous access, and controlled endotracheal intubation in the neonatal intensive care unit. Hence, the use of succinylcholine can be rationally accepted after considerations of the pre-operative clinical status of the neonate and risk-benefit ratio with more research further to build up strong evidence for the most appropriate agents for use in neonatal patients.

A Comparative Study between Dexamethasone versus Paracetamol Added to Xylocaine in Local Intravenous Anesthesia in Upper Limb Minor Surgeries

Background Intravenous regional anesthesia (IVRA) is a technically simple, reliable and costeffective method of regional anesthesia for short operative procedures of the extremities. It is easy to be administered, of lower cost compared with general anesthesia, no need for deep sedation and can be used for emergency operations on extremities for patients with full stomach. Objective Comparison between the anesthetic and analgesic parameters in local intravenous anesthesia by adding Paracetamol and Dexamethasone to xylocaine. Patients and methods This study was carried out in Ain Shams University hospitals for six months (from August 2018 to February 2019) on 45 patients of both sexes aged 20-50 years belonging to ASA I & II undergoing forearm and hand surgeries using IVRA. Results There was no significant difference between group (P), Group (C) as regard sensory, motor recovery times, both had a shorter sensory and motor block time need to an opioid dose as an analgesic dose. Group (D) had the fastest sensory and motor block time and more prolonged recovery time than group (P) and group (C) need less opioid dose as analgesia for controlling pain. As regard postoperative analgesic requirements. Group (D) and group (P) needed less analgesic doses than group (C) but there was no significant difference between group (P) and group (C). Conclusion Addition of 8 mg Dexamethasone as adjuvant to xylocaine for intravenous regional anesthesia led to: Reduction the dose of xylocaine used for IVRA, Shortening the sensory and motor block onset times, Prolong the sensory and motor block recovery times, and Reduction the postoperative analgesic requirement with satisfaction for patient and surgeon.

Acute supplementation with whey protein or collagen does not alter appetite in healthy women: A randomized double-blind and crossover pilot study

Protein quality has an important role in increasing satiety. Evidence suggests that whey protein (WP) provides satiety via gastrointestinal hormone secretion. Hydrolysed collagen supplementation can also stimulate the production of incretins and influence satiety and food intake. Thus, we sought to compare the effect of acute supplementation of WP or hydrolysed collagen on post-intervention appetite and energy consumption. This was a randomized, double-blind, crossover pilot study with 10 healthy adult women (22.4 y/o) who were submitted to acute intake (single dose) of a beverage containing WP (40 g of concentrated WP) or hydrolysed collagen (40 g). Subjective appetite ratings (feelings of hunger, desire to eat and full stomach) were measured using the Visual Analog Scale (VAS), energy intake was quantified by ad libitum cheese bread consumption 2 hours after supplementation and blood was collected for leptin and glucose determination. There was no difference between treatment groups in the perception of hunger (P = 0.983), desire to eat (p = 0.326), full stomach feeling (p = 0.567) or food consumption (p = 0.168). Leptin concentrations at 60 min post supplementation were higher when subjects received hydrolysed collagen (p = 0.006). Acute supplementation with hydrolysed collagen increased leptin levels in comparison with WP but had no effect on appetite measured by feelings of hunger, desire to eat, full stomach feeling (VAS) or energy consumption.

Examining the effects of bodygrip 330 traps on domestic cat (Felis catus) cadavers

Bodygrip traps (also called Conibear traps) are nontoothed kill traps used for furbearers and nuisance wildlife. These traps pose a danger to nontarget animals, such as protected wildlife, domestic animals, and people, more so when used on dry land. Because of the potential for intentional or accidental misuse, diagnosis of bodygrip trap injuries may be of consideration in forensic casework. To determine whether trap-related injuries can be identified to narrow down or confirm the cause of death, standard 330 and Magnum 330 bodygrip traps were used on cadavers of 9 domestic cats (F. catus). Trap jaws were engaged in various locations on the bodies to simulate potential live entrapment situations. The cadavers were then imaged and necropsied. Trap-related damage was present only in one (1/9) cat and consisted of liver fractures, likely augmented by the presence of a full stomach. The remaining cats (8/9) had no grossly or radiographically visible injuries. Findings are consistent with past live animal studies in which trap-related injury was only rarely observed or documented. Because no specific injuries can be attributed to bodygrip traps, the diagnosis must rely on the circumstance and rule out other likely causes of death.

Adrenal Stereotactic Body Radiation Therapy: The Effects of a Full and Empty Stomach on Radiation Dose to Organs at Risk

IntroductionAdrenal recurrence after radical resection of the primary lesion is common. However, the adrenal glands are surrounded by radiosensitive organs such as the pancreas, kidneys, small intestine, and stomach. Treatment planning therefore requires many regulations due to the dose limit to the organ at risk. Radiotherapy can be adjusted for gastric capacity. We therefore performed an OAR analysis for SBRT to the left adrenal gland based on gastric state (empty or full stomach) at the time of irradiation. We examined whether it was possible to reduce the dose to OAR.Materials and MethodsA sample of 20 randomly selected stomachs was arranged in descending order from largest to the smallest size and divided into two groups of 10. The “empty group” is defined as the smaller stomach group (n = 10), while the “full group” is the larger stomach group (n = 10). Planning target volume (PTV) adds a 3 mm margin to the GTV. The prescribed PTV dose was 54 Gy / 6 fx and D 95 coverage of PTV(CTV) (the dose to 95% of the PTV volume). We compared the difference in OAR radiation dose between the two stomach volume groups.ResultsGastric OAR dose in the empty group was significantly lower than in the full group (D5 and D10). However, the OAR dose to the left kidney in the empty group was statistically significantly higher than in the full group (V12, V15, and V21).ConclusionWhen SBRT was performed on the left adrenal gland, it was found that the smaller the stomach size, the lower the radiation dose to the stomach. The stomach is an abdominal organ that can be artificially resized. It is therefore better to perform SBRT on patients who have an empty stomach.

Incidence and Associated Factors for Neuraxial Anaesthesia-Related Hypotension in COVID-19 Parturients Undergoing Caesarean Delivery: A Multicenter Case-Control Study

Background: COVID-19 continues to spread globally and results in additional challenges for perioperative management in parturients. The purpose of this study was to determine the incidence and identify associated factors for neuraxial anaesthesia-related hypotension in COVDI-19 parturients during caesarean delivery.Methods: We performed a multicenter case-control study at 3 medical institutions in Hubei province, China form 1th January to 30th May 2020. All ASA Physical Status II full termed pregnant women who received caesarean delivery under neuraxial anaesthesia were eligible for inclusion. The univariate analysis and binary logistic regression analysis were used to identified the independent predictors of neuraxial anaesthesia-related hypotension.Results: Present study included 102 COVID-19 parturients. The incidence of neuraxial anaesthesia-related hypotension was 58%. Maternal abnormal lymphocyte count (OR = 3.41, p = 0.03), full stomach (OR = 3.22, p = 0.04), baseline heart rate (OR = 1.04, p = 0.03), experience of anaesthetist (OR = 0.86, p = 0.02) and surgeon (OR = 0.76, p = 0.03), and combined spinal-epidural anaesthesia technique (OR = 3.27, p = 0.02) were associated with neuraxial anaesthesia-related hypotension. The area under the receiver operating characteristic curve achieved 0.83 which was significantly higher than 0.5 (p < 0.001). And the sensitivity, specificity and percentage correct were 75%, 79% and 75%, respectively. The Hosmer-Lemeshow test showed a good calibration of the model (H = 2.01, DF = 8, p = 0.98).Conclusions: Maternal abnormal lymphocyte count, full stomach, baseline heart rate, experience of anaesthetist and surgeon, and combined spinal-epidural anaesthesia technique were identified as the independent predictors of neuraxial anaesthesia-related hypotension.

The use of the Sanuki airway™ in three patients with suspected difficult airway

The Sanuki airway is a single-use intubation oral airway designed for fiberoptic bronchoscope intubation. Sanuki airway has a bite block function and a wide lumen for the tracheal tube to pass through. Here, three cases are reported in which Sanuki airway was used for oral fiberoptic bronchoscope intubation. Case 1 is a patient who presented with reduced mouth opening and intraoral edema due to facial bone fracture. Case 2 is a patient who suffered from severe neck stiffness and had reduced mouth opening due to systemic psoriatic arthritis. Case 3 is a patient who suffered from multiple facial traumas and was in a full-stomach state. In all patients, advancing the tip of the bronchofiber into the larynx using Sanuki airway was possible under dexmedetomidine sedation, which contributed to the successful tracheal intubation. Using Sanuki airway may be considered an option for oral fiberoptic bronchoscope intubation in patients anticipated with difficult airways.

Peptic Ulcer Disease : Can a Behavioral Factor be Implicated?

This article aims to highlight probable behavioral factors in the etiology of peptic ulcer (PUD). The working hypothesis is, due to an anatomic predisposition in the foregut blood supply and its gross anatomy, whenever a person with a replete or full stomach changes their position they may affect/disrupt blood supply to lower esophagus, stomach and proximal part of the duodenum. Our hypothesis states that if a person has habit of resting after meal, in reclined position, on either their right or left side, or is required to do so, due to prescribed bed rest, that the person will develop PUD, depending on their specific routine. Our hypothesis also proposes that different body positions are linked to different locations for the peptic ulcerative processes occurring. The proposed hypothesis has a number of implications. Firstly, PUD is somatic disorder and is a disease caused by lifestyle and systematically repeated habitual behaviors. As such, treatment should focus on the patient discussing their lifestyle habits, making them aware of their after-meal behavior and the link that the behavior has to PUD. Secondly, the primary therapeutic action should focus on postural behavioral therapy, adjusting habit-formed after-eating routines, that once remedied can reverse PUD.