First clinical experience of tracheal intubation with the SensaScope, a novel steerable semirigid video stylet.

BACKGROUND: Problems with tracheal intubation are a major cause of anaesthesia-related morbidity and mortality. Difficulty with tracheal intubation is primarily a consequence of failure to see the vocal cords with conventional direct laryngoscopy. We report our experience with use of the SensaScope for tracheal intubation in routine clinical practice. METHODS: The SensaScope is a hybrid steerable semirigid S-shaped video stylet. Its handling and performance were assessed by anaesthetists with a minimum of 1 yr of experience. They performed four intubations each with the device in anaesthetized elective surgical patients. The view of the glottis with the Macintosh laryngoscope was compared with the view shown on the monitor by the SensaScope. The time taken to complete intubation, the final tracheal tube (TT) position and the degree of difficulty of the procedure were recorded. RESULTS: Thirty-two patients were studied. All Macintosh Cormack and Lehane grade 3 patients were converted to grade 1 or 2 with the SensaScope. Mean intubation time was 25 (12) s and correct mid-tracheal TT cuff position was achieved in all cases. The degree of difficulty was 3.0 (1.8) on a numerical scale ranging from 0 to 10. All operators rapidly became familiar with the device and mastered its technique of use. CONCLUSION: The SensaScope is a reliable and effective device for tracheal intubation under vision of the normal airway. It has great potential to facilitate management of difficult airway situations in anaesthetized and paralysed patients.

Measurement of intraocular pressure during laparoscopy and its relationship to central venous pressure.

UNLABELLED: STUDY OBJECTIVE. To determine the effect of different positional degrees on hemodynamics, especially central venous pressure and intraocular pressure, and a possible interrelationship, during laparoscopic surgery. SETTING. University teaching hospital (Canadian Task Force classification II-1). PATIENTS: Seven women undergoing elective gynecologic laparoscopy. INTERVENTIONS: The women were monitored for heart rate, partial pressure of oxygen, end-tidal carbon dioxide, arterial blood pressure, central venous pressure, end-tidal isoflurane concentration, and intraocular pressure in several body positions during general anesthesia. MEASUREMENTS AND MAIN RESULTS: Intraocular pressure depends on body position (r2 = 0.58) related to central venous pressure (r2 = 0.7). Heart rate and arterial blood pressure are also dependent on the body position, but to a lesser degree. CONCLUSION: Continuous monitoring of intraocular pressure may help detect alterations in central venous pressure during general anesthesia for laparoscopic surgery. Undesirable alterations caused by degree of Trendelenburg position may negatively affect patients with high cardiac or ophthalmic risk.

A new approach in the treatment of hypotension in human septic shock by NG-monomethyl-L-arginine, an inhibitor of the nitric oxide synthetase.

NG-monomethyl-L-arginine (L-NMMA) is an inhibitor of the enzyme nitric-oxide-synthetase. Nitric oxide (NO), produced by endothelial and vascular cells regulates physiological vascular tone, blood pressure and tissue perfusion via guanylate-cyclase and cGMP. In an advanced stage of therapy resistant septic shock in response to inflammatory mediators, NO is overproduced. This leads to vasodilatation, a fall in systemic blood pressure and an attenuated vasoconstriction-response to sympathetic-stimuli. Two episodes of severe and prolonged hypotension in a patient with sepsis were successfully treated twice by bolus therapy of L-NMMA within 4 weeks. On both occasions blood pressure was reversed to normal and the continuous use of high doses of catecholamines were stopped. In contrast to the immediate response of blood pressure, heart rate and central venous pressure remained stable. Cardiac output dropped to 68% and PaO2 increased. These findings indicate that NO-synthetase-inhibitors may be of value in the therapy of human septic shock.

[Rumen fluid studies in calves with abnormal and normal sucking behavior]. / Pansensaft-Untersuchung bei Kälbern mit gestörter und normaler Sauglust.

Ruminal fluid and blood samples were analysed in 39 calves with poor suckling behaviour and reduced milk intake (group 1) and in 21 calves with normal suckling behaviour (group 2). The pH level and chloride concentration was determined in the ruminal fluid as well as in the blood. In addition Gram stains and subsequent microscopical examinations of the ruminal fluids were carried out. Blood samples were submitted for blood gas analysis. Notable differences were found between the two groups. The pH level of the ruminal fluid was less than 5.5 in 29 of the 39 calves in group 1 (74.4%); in contrast, the pH was always above 5.5 in group 2. In group 1, 22 calves with a pH of less than 5.5 also revealed a metabolic acidosis of the blood. Mainly gram-positive bacteria were found in the ruminal fluid of 74.4% of the calves in group 1. On the other hand, 76.2% of the calves in group 2 revealed a mainly gram-negative flora. There was no difference in the chloride concentration, either in the blood or in the ruminal fluid and the values showed a high range of scatter.

[Nocardia mastitis in cattle. 1. Clinical observations and diagnosis in 7 particular cases]. / Die Nokardien-Mastitis des Rindes 1. Klinische Beobachtungen und Diagnose an 7 Einzelfällen.

Lately reports of nocardial mastitis have been increasing. Therefore the clinical aspects of 7 individual cases were investigated. Pathologic-anatomical changes of the udder were registered and bacteriological examination of tissue and milk probes were performed. All of the cows had a mastitis during previous lactation periods which had to be treated with antibiotics. The infected quarters recovered in no cases. Shortly after parturition 6 cows had a severe acute mastitis. The cows were treated intramammarily and parenterally with various antibiotics during several days. The infected quarter became indurated and strongly enlarged. These changes were not influenced by therapy, and the cows lost weight. 14 days after the outbreak of the illness, all 6 cows were culled. One cow had a chronic Nocardia mastitis with involution of the affected quarter. Though treated several times, this cow did not recover either. The histopathological examination of the affected quarters revealed an acute to chronic, necrotic to granulomatous mastitis. Nocardia asteroides was histologically and bacteriologically proven to be the causative agent. The reason for the frequent infections with Nocardia and the way of infection is not clear yet. Therapy with antibiotics brought no recovery in any cases. The infected cows should be removed from the herd or culled.

The influence of small bowel contamination on the pathogenesis of bowel obstruction.

Altered motility of the intestine after laparotomy, adynamic bowel segments, blind bowel loops following bypass operations, or diverticula may cause pathological growth of intestinal microflora and thus lead to contaminated small bowel syndrome (CSBS). As a result of malabsorption in the jejunum and ileum, loss of weight, growth arrest, diarrhea, steatorrhea, megaloblastic anemia, and hypoproteinemia may occur. In addition to these, the acute symptoms of small bowel contamination, intestinal obstruction and secretory diarrhea, are less well known. A stenosis in the terminal ileum was experimentally created in Göttingen minipigs and the bacterial flora of the small bowel assessed by quantitative cultures. After 3 months the number of aerobic and anaerobic bacteria in the pre- and poststenotic region had increased by a factor of 10(2)-10(5). The acute form of CSBS was diagnosed by microbiological examination of gastric samples in 14 children. After the children were treated with orally and intravenously administered antibiotics, the symptoms disappeared within 12-36 h. Reoperations for small bowel obstruction can be avoided by conservative treatment of CSBS with antibiotics.

[Clarification of teat stenoses in cattle by ultrasound]. / Die Abklärung von Zitzenstenosen beim Rind mittels Ultraschall.

Ultrasonography and radiography were used as an adjunct to clinical examination in the evaluation of 73 obstructed teats in 63 dairy cows. The images obtained with a 3.5 MHz and a 5 MHz linear array transducer were compared with radiographs and correlated with findings obtained at surgery. Ultrasonography and radiography allowed a correct assessment of the lesions in 68 respectively 58 teats. In five cases the obstructive lesions in the teat canal were not clearly discernible when ultrasonography was used. Radiography was the method of choice for the evaluation of the teat canal and small mucosal folds in the milk cistern. Ultrasonography was the method of choice for the detection of obstructive lesions at the base of the teat; all 14 of these cases were assessed correctly using ultrasonography versus three of 14 when radiography was used. Ultrasonography is a useful tool for the practitioner to evaluate obstructive teat lesions.