The Use of Cerebral Oximetry in Cardiac Surgery: A Systematic Review and Meta?Analysis of Randomized Controlled Trials

High prevalence of cerebral desaturation is associated with postoperative neurological complications in cardiac surgery. However, the evidence use of cerebral oximetry by correcting cerebral desaturation in the reduction of postoperative complications remains uncertain in the literature. This systematic review and meta?analysis aimed to examine the effect of cerebral oximetry on the incidence of postoperative cognitive dysfunction in cardiac surgery. Databases of MEDLINE, EMBASE, and CENTRAL were searched from their inception until April 2021. All randomized controlled trials comparing cerebral oximetry and blinded/no cerebral oximetry in adult patients undergoing cardiac surgery were included. Observational studies, case series, and case reports were excluded. A total of 14 trials (n = 2,033) were included in this review. Our pooled data demonstrated that patients with cerebral oximetry were associated with a lower incidence of postoperative cognitive dysfunction than the control group (studies = 4, n = 609, odds ratio [OR]: 0.15, 95% confidence interval [CI]: 0.04 to 0.54, P = 0.003, I 2 = 88%; certainty of evidence = very low). In terms of postoperative delirium (OR: 0.75, 95%CI: 0.50–1.14, P = 0.18, I 2 = 0%; certainty of evidence = low) and postoperative stroke (OR: 0.81 95%CI: 0.37–1.80, P = 0.61, I 2 = 0%; certainty of evidence = high), no significant differences (P > 0.05) were reported between the cerebral oximetry and control groups. In this meta?analysis, the use of cerebral oximetry monitoring in cardiac surgery demonstrated a lower incidence of postoperative cognitive dysfunction. However, this finding must be interpreted with caution due to the low level of evidence, high degree of heterogeneity, lack of standardized cognitive assessments, and cerebral desaturation interventions.

A Comparison and Validation of Predicted Continuous Positive Airway Pressure Formulas vs Autotitration

Background: Continuous positive airway pressure (CPAP) is the treatment of obstructive sleep apnea (OSA). The CPAP pressure is generally estimated by manual titration or an auto-CPAP device. An alternative method involves the use of the predictive equation. There is limited study available for the Indian population. Objectives: To compare CPAP pressure obtained by mathematical formulas with auto-CPAP titration and formulation, a preliminary predictive equation from derived data to be validated with titrated CPAP. Methods and materials: A retrospective observational study was performed in 130 patients in Department of Pulmonary Medicine of our institute from April 2019 to July 2021. Detailed history, anthropometric parameters, whole-night level-II polysomnography (PSG), and CPAP titration were performed. Stepwise linear regression was applied to establish predictive equation. This equation results were compared with available other equations and autotitrated readings. Results: The mean (SD) of age, BMI, neck girth, Epworth score, lowest SPO2 (%), and AHI was 56.72 (11.31), 33.87 (6.43), 39.7 (4.46), 17.75 (3.18), 84.65 (8.44), and 48.75 (21.09), respectively, with male杅emale ratio of 3:2. Mild, moderate, and severe OSA were 7 (5.4%), 18 (13.8%), and 105 (80.8%), respectively. Continuous positive airway pressure obtained from equations was in the range of 7.40�.95 cm H2O. Obtained readings by equations showed a comparable correlation with CPAP-titrated results (p <0.001). Conclusion: The optimum titration pressure correlates with pressure derived from the predictive equation that is predicted average therapeutic CPAP pressure = 3.98 + 0.065 (ODI) + (AHI) + 0.018 (nadir SPO2) - 0.013 (NC).

Exercise causes oxygen desaturation and hypercapnia in stable chronic obstructive pulmonary disease patients

Background: Assessment of severity of chronic obstructive pulmonary disease (COPD) is the cornerstone of therapy. Spirometric measurements have traditionally remained as the popular diagnostic tool of choice. Oxygenation and carbon dioxide removal cannot be assessed by Spirometry alone, especially during exercise. Therefore, we studied whether desaturation and hypercapnea occur in response to exercise in COPD patients. Aims and Objectives: To know whether bicycle pedaling as an exercise can unravel the gas exchange abnormalities and airflow limitation that might be precipitated by physical activity. This is done by estimating the changes in Oxygen saturation by pulse oximetry, and by estimating the changes in Blood CO2 levels by capnography. Materials and Methods: Thirty stable COPD patients and controls were included for the study. Here we measured the change in oxygen saturation from rest to submaximal exercise (done using bicycle ergometry). Concomitantly, we measured the change in carbon dioxide levels of expired air from rest to submaximal exercise. Results: We found that COPD patients experience oxygen desaturation. ?SaO2 (difference between resting and exercise SaO2) was only 1% in controls whereas 8.86% in COPD. Hypercapnia occurred in response to a submaximal exercise in COPD patients (End tidal carbon dioxide of 48.87 mmHg). We also found that they become tachypneic and show greater degree of exhaustion. Conclusion: Our study points out that exercise-induced desaturation and hypercapnia are a definite occurrence in COPD patients. It is a marker of progressive disease. It can be used as a form of stress test for the pulmonary system.

Predictors of Nocturnal Oxygen Desaturation in Normoxemic Patients with Moderate to Very Severe Chronic Obstructive Pulmonary Disease.

Introduction: COPD is associated with complications suchas reduced oxygen saturation and hypoventilation duringsleep and is underdiagnosed among normoxemic patients. Toidentify the daytime parameters to predict nocturnal oxygendesaturation in normoxemic patients with moderate to verysevere chronic obstructive pulmonary disease. To correlate thepresence of nocturnal oxygen desaturation with pulmonaryhypertension.Material and methods: A cross-sectional study wasperformed at ACS medical college Chennai for 14 monthsfrom May 2017 to June 2018. The study population included103 participants. Data on variables such as 6-minute walk test,spirometry, nocturnal oximetry, partial pressures of O2 andCO2 were assessed.Results: A total of 103 patients were included in the analysiswith 93.2% males and 3.9% current smokers and 87.4%ex-smokers. 52.4% had a normal chest X-ray. Around45.6% had hyperinflated lungs. In the 6 minutes-walktest, 32% participants had desaturation. 50.5% had positiveC-reactive protein levels indicating the presence of systemicinflammation. Right atrial/right ventricular dilatation wasnoted among 34% participants. Nocturnal desaturation with3 to 4 episodes/hour was present among 39% participants.Univariate analysis results show that post FEV 1, partialpressure of oxygen and carbon dioxide, presence ofdesaturation and RA/RV dilatation on echocardiography wereall statistically significant predictors of nocturnal oxygendesaturation in normoxemic patients with moderate to verysevere Chronic Obstructive Lung Disease.Conclusion: Screening the COPD patients for these daytimepredictors will enable in identifying the patients who havenocturnal desaturation. This in turn will aid in early initiationof home oxygen therapy.

Risk factors for intraoperative hypoxemia during monopulmonary ventilation: an observational study / Fatores de risco para hipoxemia intraoperatória durante ventilação monopulmonar: estudo observacional

Abstract Background Left double-lumen endotracheal tubes have been widely used in thoracic, esophageal, vascular, and mediastinal procedures to provide lung separation. Lacking clear objective guidelines, anesthesiologists usually select appropriately sized double-lumen endotracheal tubes based on their experience with 35 and 37 Fr double-lumen endotracheal tubes, which are the most commonly used. We hypothesized the patients with a left main bronchus of shorter length (<40 mm) had a greater chance of experiencing desaturation during one lung ventilation, due to obstruction in the orifice of the left upper lobe with the bronchial tube. Methods We included 360 patients with a left double-lumen intubated between September 2014 and August 2015. The patient's age, sex, height, weight, and underlying disease were recorded along with type of surgical procedure and the desaturation episodes. In addition, the width of the trachea and the width and length of the left bronchus were measured using computed tomography. Result Patients with a left main bronchus length of less than 40 mm who underwent intubation with a left double-lumen endotracheal tubes had significantly higher incidence of desaturation (Odds Ratio (OR: 8.087)) during one-lung ventilation. Other related factors of patients identified to be at risk of developing hypoxia were diabetes mellitus (OR: 5.368), right side collapse surgery (OR: 4.933), and BMI (OR: 1.105). Conclusions We identified that patients with a left main bronchus length of less than 40 mm have a great chance of desaturation, especially if other desaturation risk factors are present.

Resumo Justificativa Os tubos endotraqueais de duplo lúmen (Double-lumen tubes - DLTs) para intubação seletiva esquerda têm sido amplamente utilizados em procedimentos torácicos, esofágicos, vasculares e mediastinais para proporcionar a separação dos pulmões. Com a falta de diretrizes claras, os anestesiologistas geralmente selecionam os tubos com base em sua experiência com os tubos endotraqueais de duplo lúmen de 35 e 37 Fr, os mais comumente usados. Nossa hipótese foi que os pacientes com um brônquio principal esquerdo de menor comprimento (< 40 mm) apresentavam uma chance maior de sofrer dessaturação durante a ventilação monopulmonar, devido à obstrução do orifício do lobo superior esquerdo com o tubo brônquico. Métodos No total, 360 pacientes submetidos à intubação seletiva esquerda mediante o uso de tubo de duplo lúmen foram incluídos no estudo entre setembro de 2014 e agosto de 2015. Idade, sexo, altura, peso e doença de base foram registrados, junto do tipo de procedimento cirúrgico e os episódios de dessaturação. Além disso, a largura da traqueia e a largura e comprimento do brônquio esquerdo foram medidos por meio de tomografia computadorizada. Resultados Os pacientes com comprimento do brônquio principal esquerdo inferior a 40 mm, submetidos à intubação seletiva esquerda com tubos endotraqueais de duplo lúmen, tiveram incidência significativamente maior de dessaturação (Odds Ratio - OR: 8,087) durante a ventilação monopulmonar. Outros fatores relacionados aos pacientes e identificados como risco de desenvolver hipoxemia foram diabetes mellitus (OR: 5,368), cirurgia de colapso direito (OR: 4,933) e IMC (OR: 1,105). Conclusões Identificamos que os pacientes com comprimento do brônquio principal esquerdo inferior a 40 mm apresentam grande chance de dessaturação, principalmente se outros fatores de risco para dessaturação estiverem presentes.

Adaptação cardiovascular no Teste de Caminhada dos Seis Minutos em pacientes com DPOC: estudo transversal / Cardiovascular adaptation in the six-minute walk test in COPD patients: transversal study

OBJETIVO: Avaliar o comportamento da adaptação cardiovascular e da saturação periférica de oxigênio em indivíduos com DPOC submetidos no teste de caminhada dos seis minutos (TC6). MATERIAL E MÉTODOS: Trata-se de um estudo de corte transversal, que foram incluídas pessoas com diagnóstico de DPOC, confirmado pela espirometria e de ambos os sexos. A magnitude de sintomas foi avaliada pela escala de dispneia Medical Research Council (MRC) e questionário COPD Assessment Test (CAT). Aplicou-se o TC6 para avaliar a tolerância ao esforço. Para mensurar a frequência cardíaca máxima (FC máx) prevista para a idade foram utilizadas equações específicas para população brasileira. RESULTADOS: Avaliou-se 34 indivíduos com DPOC, 20 (58,8%) homens; relação VEF1/CVF foi 56,7%± 10,2% pós broncodilatador (BD). Quatorze 14 (41,2%) indivíduos apresentaram impacto clínico moderado; 16 (47,2%) dos avaliados apresentou grau 2 na escala do MRC. As médias das distâncias percorridas no primeiro e segundo TC6 foram 383,5 ± 13,6; 408,6 ± 85,7 metros, correspondendo a 70, 75%; 75,10% em relação ao valor previsto (p=0,001). As médias da FC máx ao final do primeiro e segundo TC6, foram 94,1 ± 21,9; 92,3 ± 17,9 bpm e a FC pós percentual da FC máx prevista pré e pós TC6 foram 61,1% ± 17,7%; 59,7% ± 21,5% e 14 (41,2%) pacientes apresentaram dessaturação de O2 no primeiro TC6; 9 (26,5%) no segundo teste. CONCLUSÕES: Pacientes com DPOC, apresentam aumento da FC identificado pelo esforço submáximo, por meio do percentual da FC max. Indivíduos com maior comprometimento da função pulmonar apresentaram dessaturação de O2. .

OBJECTIVE: To evaluate the behavior of cardiovascular adaptation and peripheral oxygen saturation in individuals with COPD submitted to the six-minute walk test (6MWT). MATERIAL AND METHODS: It was performed a descriptive study with person with a diagnosis of COPD confirmed by spirometry of both sexes. The Medical Research Council (MRC) dyspnea scale and the COPD Assessment Test (CAT) questionnaire were used to assess the magnitude of symptoms. The 6MWT was used to assess effort tolerance. To measure the maximum heart rate (HRmax) predicted for age, specific equations were used for the Brazilian population. RESULTS: 34 individuals with COPD were evaluated, 20 (58.8%) men; FEV1 / FVC ratio was 56.7% ± 10.2% after BD. Fourteen (41.2%) were classified as grade 2 and were classified as grade 2 (MRC scale). The means of the distances covered in the first and second TC6 were 383.5 ± 13.6; 408.6 ± 85.7 meters, corresponding to 70.7%; 75.1% in relation to the predicted value (p = 0.001). The mean maximum heart rate at the end of the first and second 6MWT were 94.1 ± 21.9; 92.3 ± 17.9 bpm and the heart rate post-percentage of the predicted maximum heart rate before and after the 6MWT were 61.1% ± 17.7%; 59.7% ± 21.5% and 14 (41.2%) patients presented O2 desaturation on the 6MWT; 9 (26.5%) in the second test. CONCLUSIONS: Patients with COPD throughout the 6MWT show increased heart rate and O2 desaturation in exercise activity.

Comparison of Three Nursing Positions for Reducing Gastric Residuals in Preterm Neonates: A Randomized Crossover Trial

Objective: To compare left lateral, right lateral, and pronenursing positions of neonate for reducing pre-feed gastricresiduals among ?34 weeks neonates.Design: Randomized crossover trial.Setting:Level-III NICU.Participants: Neonates ?34 weeks, receiving 50-150 mL/kg/day feeds through oro-gastric route.Intervention: Neonates were randomized to left lateral, rightlateral and prone positions. Intervention position was given foreight hours (4 feeds, 9AM to 5PM) followed by a wash-off period of16 hours. After 24 hours, each neonate crossed over to nextposition as per randomization card to complete three positions inthree consecutive days. Gastric residuals were collected justbefore next feed.Main outcome:Pre-feed gastric residuals.Results:Sixty three neonates were randomized. Fewer neonatesin right lateral position had gastric residuals compared to leftlateral position [OR 0.09 (95% CI 0.04, 0.21), P<0.001]. Neonatesin right lateral and prone positions had comparable gastricresiduals [OR 0.90 (95% CI 0.36, 2.22), P=0.82]. Gastricresiduals, as a proportion of last feed, were highest in left lateral[6% (2, 10), maximum 28%] position. Significantly higherproportion of neonates in right lateral position had episodes ofregurgitation compared to other positions. Oxygen saturation,heart rate, time to full feeds and duration of hospital stay werecomparable in the three groups.Conclusions: Left lateral position was associated with higher butclinically non-significant pre-feed gastric residuals as comparedto right lateral position. Right lateral position was associated withsignificantly increased regurgitation episodes

Augmentation of respiratory muscle activities in preterm infants with feeding desaturation / 소아과

PURPOSE: Frequent desaturation due to immature incoordination of suck-swallow-breathing in preterm infants can influence multiple organs such as the heart, lungs, and brain, which can then affect growth and development. Most notably in preterm infants, feeding desaturation may even affect pulmonary function during gavage feeding. Because respiratory muscle activities may reflect the work required during respiration, we evaluated the differences in these activities between full-term and preterm infants with feeding desaturation, and investigated the correlations with clinical variables. METHODS: Nineteen preterm infants with feeding desaturation (group 1) and 19 age-matched full-term infants (group 2) were evaluated. Oromotor function was evaluated using video recording. The root-mean-squre (RMS) envelope of the electromyography signal was calculated to quantify the activities of muscles involved in respiration. The differences in RMS between both groups and the correlation with clinical variables including gestational age (GA), birth weight (BW), and Apgar scores (AS) at 1 and 5 minutes after birth were evaluated. RESULTS: The RMS values of the diaphragm (RMS-D) and rectus abdominis (RMS-R) were significantly greater in group 1 compared to group 2, and the 1- and 5-min AS were significantly lower in group 1 compared to group 2. RMS-D and RMS-R were inversely correlated with GA, BW, 1- and 5-min AS in all infants. CONCLUSION: This study showed that respiratory muscle activities were augmented during feeding in preterm infants compared to full-term infants. Additionally, respiratory muscle activities were inversely correlated with all clinical variables.

Risk factors of oxygen saturation decrease during intrahospital transportation of intensive care unit patients in emergency department / 中华护理杂志

Objective To explore risk factors of oxygen saturation (SpO2) decrease during intrahospital transporta-tion (IHT) of intensive care unit (ICU) patients in emergency department,and provide theoretical basis for prevent-ing oxygen saturation decrease during intrahospital transportation. Methods A cross-sectional study design was adopted,from April to May,2017,we investigated 182 ICU patients who required IHT in an emergency department in a tertiary hospital in Shanxi Province by using self-designed Evaluation Form of Intrahospital Transportation for ICU Patients in Emergency Room. We divided patients into two groups based on whether their SpO2 decreased or not. Risk factors of SpO2 decrease were identified by univariate and multivariate Logistic regression analysis. Results Among 182 patients,117 had SpO2 decrease,and the rate of SpO2 decrease was 64.3%. Patient's age,MEWS score, disease type,escort personnel,and oxygen supply device were risk factors of SpO2 decrease. Conclusion SpO2 de-crease is the result of combination of multiple risk factors during IHT. We ought to enhance training of escort person-nel,assess patient's condition and SpO2 level accurately and make plan before transportation,choose qualified oxygen supply device to ensure patients can have effective oxygen supply during IHT,which prevent SpO2 decrease during IHT.

Role of Laryngeal Spasm in Negative Pressure Pulmonary Oedema.

Negative-pressure pulmonary edema (NPPE) is a clinical entity of anaesthesiologic relevance, peri-operatively caused by obstruction of the conductive airways (upper airway obstruction, UAO) due to laryngospasm in approx. 50% of the cases, its early recognition and treatment by the anaesthesiologist is mandatory. Laryngospasm, a brief closure of the vocal cords is not an uncommon peri-operative occurrence. If recognized and managed appropriately, the effects are transient and reversible. However, in rare cases where recognition and management are delayed, the consequences are associated with a high morbidity including desaturation, awareness, negative pressure pulmonary edema, and mortality.

Relationship Between Snoring Intensity and Severity of Obstructive Sleep Apnea

OBJECTIVES: The aim of this study was to determine the relationship between the intensity of snoring and severity of sleep apnea using Watch-PAT (peripheral arterial tone) 100. METHODS: A total of 404 patients (338 males and 66 females) who underwent home-based portable sleep study using Watch-PAT 100 for obstructive sleep apnea (OSA) from January 2009 through December 2011 were included in this study. Subjects were divided into 4 groups; no OSA (PAT apnea hypopnea index [pAHI] or =30/hour). Mean snoring intensity and percent sleep time with snoring intensity greater than 40, 50, and 60 dB were measured by Watch-PAT 100. Correlations of these parameters with apnea hypopnea index (AHI), respiratory disturbance index (RDI), and oxygen desaturation index were assessed. RESULTS: The mean age and body mass index were 46.5+/-14.8 years and 24.7+/-3.4 kg/m2, respectively. Mean AHI and RDI were 16.5+/-15.3/hour and 20.8+/-14.3/hour, respectively. The mean snoring intensity in the no, mild, moderate, and severe OSA groups was 44.0+/-2.7, 45.4+/-6.0, 47.7+/-5.0, and 50.5+/-5.6 dB, respectively (P<0.001). There was a positive correlation between snoring intensity and pAHI or PAT RDI (pRDI) (r=0.391 and r=0.385, respectively, both P<0.001). There was also a positive correlation between percent sleep time with the snoring intensity greater than 50 dB and pAHI or pRDI (r=0.423 and r=0.411, respectively, both P<0.001). CONCLUSION: This study revealed that the intensity of snoring increased with the severity of sleep apnea, which suggests that the loudness of snoring might be an indicator of the severity of OSA.

Tension pneumothorax during tracheoesophageal fistula repair: A case report

Tension pneumothorax (PTx) was diagnosed in a preterm baby during surgery for tracheoesophageal fistula (TEF). The PTx occurred around 90 minutes after skin incision, while the baby was breathing spontaneously with intermittent positive pressure ventilation (PPV) at low pressure. A sudden decrease in oxygen saturation (SpO2), hemodynamic compromise, and decreased breath sounds on the right side suggested a right-sided tension PTx. After prompt radiological confirmation, needle aspiration of air through the surgical site restored the patient's condition immediately. Although the sudden unexpected hypoxemia and circulatory problems may confuse anesthesiologists, prompt diagnosis and proper treatment are required for successful clinical outcomes in tension PTx.

Change of AHI and ODI in OSAHS patients with different sleep body positions / 中国耳鼻咽喉头颈外科

[ABSTRACT]OBJECTIVETo assess the sleep body position's effects on AHI and ODI during sleep in obstructive sleep apnea hypopnea syndrome (OSAHS) patients with different severity.METHODSThe clinical data of 113 subjects who had been diagnosed OSAHS or normal by polysomnography (PSG) between 2013 and 2014 in our department were retrospectively studied. They were divided into normal control group (AHI30/h, 40 patients). PSG data of AHI and ODI in different body position in each group were further analyzed.RESULTSIn normal group, The AHI and ODI in supine position were significantly higher than that in the left or right lateral position, and the difference between the left and right lateral position was not significant. In the mild to moderate OSAHS group, the AHI and ODI in supine were higher than that in the left lateral position slightly, while the data in supine was higher than that in the right lateral position significantly. In the severe group, the data between the supine and the left lateral position was not statistically different, while the supine position data was higher compared with that of the right lateral position. CONCLUSIONAHI and ODI were higher in supine position than that in lateral position, while the AHI and ODI in right lateral position is higher than that in left lateral position in OSAHS patients with different severity. The ODI and AHI are consistent in reflecting the severity of the OSAHS.

Association between morphometric variables and nocturnal desaturation in sickle-cell anemia / Associação entre variáveis morfométricas e dessaturação noturna na anemia falciforme

OBJECTIVE: to evaluate associations between morphometric variables, cervical circumference (CC), and abdominal circumference (AC) with the presence of nocturnal desaturation in children and adolescents with sickle-cell anemia. METHODS: all patients were submitted to baseline polysomnography, oral cavity measurements (maxillary intermolar distance, mandibular intermolar distance, and overjet), and CC and AC measurements. RESULTS: a total of 85 patients were evaluated. A positive correlation was observed between the height/age Z-score and CC measurement (r = 0.233, p = 0.031). The presence of nocturnal desaturation was associated with CC (59.2± 9.3 vs. 67.5 ± 10.7, p = 0.006) and AC measurements (27.0 ± 2.0 vs. 29.0± 2.1, p = 0.028). There was a negative correlation between desaturation and maxillary intermolar distance (r = -0.365, p = 0.001) and mandibular intermolar distance (r = -0.233, p = 0.037). CONCLUSIONS: the morphometric variables of CC and AC may contribute to raise suspicion of nocturnal desaturation in children and adolescents with sickle-cell anemia. .

OBJETIVO: avaliar associações entre variáveis morfométricas e circunferências cervical (CC) e abdominal (CA) com a presença de dessaturação noturna em crianças e adolescentes com anemia falciforme. MÉTODOS: todos os pacientes foram submetidos à polissonografia basal, medidas da cavidade oral (distância intermolar da maxila, distância intermolar da mandíbula e overje), CC e CA. RESULTADOS: foram avaliados 85 pacientes. Foi observada correlação positiva entre o escore Z altura/idade e a medida da circunferência cervical (r = 0,233 p = 0,031). A presença da dessaturação noturna associou-se com as medidas da circunferência cervical (59,2 ± 9,3 vs 67,5 ± 10,7; p = 0,006) e abdominal (27,0 ± 2,0 vs 29,0 ± 2,1; p = 0,028). Houve correlação negativa entre a dessaturação e a distância entre os segundos molares da maxila (r =-0,365, p = 0,001) e da mandíbula (r = -0,233, p = 0,037). CONCLUSÕES: as variáveis morfométricas e circunferências cervical e abdominal podem contribuir para a suspeita da dessaturação noturna em crianças e adolescentes com anemia falciforme. .

The incidence of oxygen desaturation during rapid sequence induction and intubation / 世界急诊医学杂志（英文）

@#BACKGROUND: Rapid sequence induction and intubation (RSII) is an emergency airway management technique for patients with a risk of pulmonary aspiration. It involves preoxygenation, administration of predetermined doses of induction and paralytic drugs, avoidance of mask ventilation, and laryngoscopy followed by tracheal intubation and keeping cricoid pressure applied till endotracheal tube cuff be inflated. Oxygen desaturation has been seen during RSII. We assessed the incidence of oxygen desaturation during RSII. METHODS: An institution-based observational study was conducted from March 3 to May 4, 2014 in our hospital. All patients who were operated upon under general anesthesia with RSII during the study period were included. A checklist was prepared for data collection. RESULTS: A total of 153 patients were included in this study with a response rate of 91.6%. Appropriate drugs for RSII, equipments for RSII, equipments for difficult intubation, suction machine with a catheter, a monitor and an oxygen backup such as ambu bag were not prepared for 41 (26.8%), 50 (32.7%), 51 (33.3%), 38 (24.8%) and 25 (16.3%) patients respectively. Cricoid pressure was not applied at all for 17 (11.1%) patients and 53 (34.6%) patients were ventilated after induction of anesthesia but before intubation and endotracheal cuff inflation. A total of 55 (35.9%) patients desaturated during RSII (SPO2<95%). The minimum, maximum and mean oxygen desaturations were 26%, 94% and 70.9% respectively. The oxygen desaturation was in the range of <50%, 50%–64%, 65%–74%, 75%–84%, 85%–89 % and 90%–94% for 6 (3.9%), 7 (4.6%), 5 (3.3%), 10 (6.5%), 13 (8.5%) and 14 (9.2%) patients respectively. CONCLUSION: The incidence of oxygen desaturation during RSII was high in our hospital. Preoperative patient optimization and training about the techniques of RSII should be emphasized.

Role of rumen ciliated protozoa in the synthesis of conjugated linoleic acid: A review / Papel de los protozoos ciliados ruminales en la síntesis de ácido linoleico conjugado: Revisión / Papel dos protozoários ciliados no rúmem para a síntese de ácido linoléico conjugado: Uma Revisão

Traditionally, ruminal ciliate protozoa have been studied with respect to the metabolism of dietary nutrients. Their role has focused on their predatory behavior, the paradigm of its retention in the rumen, and its apparent limited flow to the duodenum. On the other hand, Conjugated Linoleic Acid (CLA) and Vaccenic Acid (VA) are important because of their nutritional value. This review aims to characterize the biological alternatives used by rumen ciliate protozoa for the production of CLA, highlighting three aspects: 1) rumen protozoa are involved only in the initial stage of biohydrogenation to produce CLA isomers, 2) desaturation by protozoa has not been reported, while endogen synthesis by desaturation of VA in mammary glands and fatty tissues has been demonstrated as the main route of CLA in ruminants, 3) even though incorporation of VA and cis9, trans11-CLA in protozoa structure is related with CLA production, this is only important when protozoa flow from rumen to duodenum, producing 30 to 43% of CLA and a 40% of VA, respectively. It is concluded that rumen protozoa are fundamental in the lipid metabolism of ruminants.

Tradicionalmente, los protozoos ciliados ruminales han sido estudiados en relación con el metabolismo de nutrientes de la dieta suministrada al rumiante. Particularmente, su papel ha sido cuestionado debido a sus características predadoras, aunado al paradigma de la retención de los protozoos en el rumen y el aparente limitado flujo al duodeno por reciclaje de la proteína microbiana. De otro lado, los ácidos linoleico conjugado (CLA) y vacénico (VA) son dos productos de gran interés nutricional. Estas dos situaciones han generado interés en la investigación de esta representativa población de la microbiota ruminal. El objetivo de este trabajo fue caracterizar, a partir de la literatura científica, las alternativas biológicas utilizadas por los protozoos ciliados del rumen para la producción de CLA. Nosotros encontramos que: 1) los protozoos ruminales sólo participan en la parte inicial de la biohidrogenación, la “isomerización de ácidos grasos insaturados”, generando isómeros de CLA, 2) la desaturación en protozoos, no se demostró en estudios, y queda claro que la síntesis endógena por desaturación de VA, en glándula mamaria y tejidos grasos se establece como el mayor recurso de CLA en el rumiante, 3) aun cuando la incorporación de VA y cis9, trans11-CLA en la estructura de los protozoos está relacionada con la producción de CLA, esta sólo es importante hasta cuando se da el flujo de protozoos del rumen a duodeno donde son responsables del 30 al 43% del CLA y 40% del VA. Se concluye, que los protozoos ruminales son trascendentales en el metabolismo lipídico de rumiantes.

Tradicionalmente, os protozoários ciliados no rúmen têm sido estudados em relação ao metabolismo dos nutrientes na dieta fornecida ao ruminante. Em particular, o seu papel tem sido questionado devido às suas características predatórias, combinado com o paradigma da retenção de protozoários no rúmem e ao aparente fluxo limitado para o duodeno através da reciclagem da proteína microbiana. Por outro lado, o ácido linoléico conjugado (CLA) e o vacenico (VA) são dois produtos de grande interesse nutricional. Estas duas situações têm gerado interesse na investigação dessa representativa população da microbiota ruminal. O objetivo deste estudo foi caracterizar as alternativas biológicas utilizadas pelos protozoários ciliados do rúmem para a produção de CLA a partir da literatura científica. Nós encontramos que: 1) os protozoários ruminais só participam na parte inicial da biohidrogenação: a isomerização “de ácidos graxos insaturados”, gerando isômeros do CLA. 2) até hoje, não tem sido demonstrado a desaturação em protozoários e fica claro que a síntese endógena por desaturação do VA na glândula mamária e tecido adiposo se estabelece como a maior fonte de CLA no ruminante. 3) embora a incorporação de VA e cis9, trans11-CLA na estrutura do protozoário está relacionada com a produção de CLA, ésta só é importante ate quando há fluxo de protozoários do rúmem para o duodeno onde são responsáveis do 30 ate 43% do CLA e 40% do VA. A conclusão é que os protozoários ruminais são transcendentais no metabolismo lipídico dos ruminantes.

Experience of severe desaturation during anesthetic induction period in an obese adult patient with Prader-Willi syndrome: A case report / 대한마취과학회지

Prader-Willi syndrome is characterized by infantile hypotonia, childhood-onset obesity, short stature, mental retardation, hyperphagia, hypogonadism. After infantile hypotonia phase, patient is prone to morbid obesity due to hyperphagia. Complications associated with morbid obesity are recognized as the main risk factors for death the lifespan of patients with Prader-Willi syndrome. We experienced desaturation and bronchospasm during arteriovenous fistula surgery in an obese adult with Prader-Willi syndrome.

Feeding Desaturation and Effects of Orocutaneous Stimulation in Extremely Low Birth Weight Infants

PURPOSE: Feeding desaturation is a common problem among preterm infants which can result in prolonged hospital stays, long-term feeding difficulties and growth delay. The purpose of this study was to identify the characteristics of premature infants with feeding desaturation and to examine the effect of orocutaneous stimulation on oral feeding. METHODS: During the first phase of this study, 125 extremely low birth weight infants were reviewed retrospectively. Characteristics between infants with feeding desaturation (n=34) and those without feeding desaturation (n=91) were examined. During the second phase, 29 infants recruited from March, 2009 to May, 2010 were subjected to orocutaneous stimulation. The results of orocutaneous stimulation were compared to a control group (n=81). RESULTS: The first phase of the study revealed that extremely low birth weight infants with feeding desaturation were significantly lower in gestational ages at birth, and had lower 5 minute apgar scores, more gastroesophageal refluxes and bronchopulmonary dysplasia. Infants without feeding desaturation reached full enteral feeding significantly earlier and showed shorter duration of hospital stay. At the second phase, infants in the intervention group showed shorter days to achieve initiation of bottle feeding, shorter days in achievement of full bottle feeding, last episodes of feeding desaturation and length of hospital stay compared to the control group of similar characteristics. CONCLUSION: Orocutaneous stimulation among extremely low birth weight infants results in earlier achievement of full bottle feedings without episodes of feeding desaturation hence shortens the length of hospital stay.

Feeding Desaturation and Effects of Orocutaneous Stimulation in Extremely Low Birth Weight Infants

PURPOSE: Feeding desaturation is a common problem among preterm infants which can result in prolonged hospital stays, long-term feeding difficulties and growth delay. The purpose of this study was to identify the characteristics of premature infants with feeding desaturation and to examine the effect of orocutaneous stimulation on oral feeding. METHODS: During the first phase of this study, 125 extremely low birth weight infants were reviewed retrospectively. Characteristics between infants with feeding desaturation (n=34) and those without feeding desaturation (n=91) were examined. During the second phase, 29 infants recruited from March, 2009 to May, 2010 were subjected to orocutaneous stimulation. The results of orocutaneous stimulation were compared to a control group (n=81). RESULTS: The first phase of the study revealed that extremely low birth weight infants with feeding desaturation were significantly lower in gestational ages at birth, and had lower 5 minute apgar scores, more gastroesophageal refluxes and bronchopulmonary dysplasia. Infants without feeding desaturation reached full enteral feeding significantly earlier and showed shorter duration of hospital stay. At the second phase, infants in the intervention group showed shorter days to achieve initiation of bottle feeding, shorter days in achievement of full bottle feeding, last episodes of feeding desaturation and length of hospital stay compared to the control group of similar characteristics. CONCLUSION: Orocutaneous stimulation among extremely low birth weight infants results in earlier achievement of full bottle feedings without episodes of feeding desaturation hence shortens the length of hospital stay.

Is Obstructive Sleep Apnea a Risk Factor of Subclinical White Matter Damages?

BACKGROUND: Obstructive sleep apnea (OSA) has been reported to increase risk of ischemic stroke. This study was performed to investigate the prevalence and relationship of subclinical white matter damages (SD) in patients with OSA. METHODS: All subjects (n = 54) had brain MRI and nocturnal polysomnogram (PSG). SD are defined by nonsymptomatic lacunar infarcts > 3 mm or periventricular white matter changes (PVWC). We analyzed the difference between OSA patients with and without SD (SD and non-SD groups), and also with and without PVWC. Using apnea-hypopnea index (AHI), we classified OSA into mild (515). RESULTS: SD group (n = 31) showed significantly increased apnea-hypopnea index (AHI), apnea index (AI) and oxygen desaturation index (ODI) compared to non-SD (n = 23). Among the 37 patients without lacunar infarctions, 14 showed PVWC while the other 23 did not have any lesions. Compared to non-SD group, SD group showed increased AHI and ODI, and decreased lowest SaO2 (p < 0.05). Similarly, AHI and ODI were higher and the lowest SaO2 was lower in patients with PVWC than without PVWC (p < 0.05). Moderate to severe OSA group showed more frequent subclinical or periventricular white matter changes than mild group (p < 0.05). CONCLUSIONS: Severity of OSA showed a positive correlation with the occurrence of subclinical white matter damages. OSA may cause subclinical white matter damages.