Preoperative STOP-BANG questionnaire to predict difficult airway in undiagnosed obstructive sleep apnea patients undergoing elective gynecological surgeries under general endotracheal anesthesia: A prospective observational study.

Background: STOP-BANG questionnaire is an established tool for obstructive sleep apnea (OSA) screening. Its utility in predicting difficult airway has not been evaluated. We intend to assess difficulty in airway management and associated perioperative complications in patients with undiagnosed OSA using the STOP-BANG questionnaire. Materials and Methods: We performed a prospective observational study on 250 patients with the American Society of Anesthesiologists Physical Status Class I-II, aged 18-65 years STOP-BANG score were recorded. Occurrences of difficult mask ventilation (DMV), laryngoscopy, and intubation were assessed using mask ventilation grade, intubation difficulty score intubation difficult score (IDS), and modified Cormack-Lehane grading during induction of anesthesia. Hypoxic events, hemodynamic disturbances, laryngospasm, and bronchospasm were also recorded. Results: Overall, 250 patients completed the study (Group H: n = 102, with STOP-BANG questionnaire ≥3 and Group L: n = 148, with STOP-BANG criteria < 3). A total of 67 (26.8%) cases of DMV and 63 (25.2%) cases of difficult tracheal intubation (DIT) were encountered overall. The proportion of patients with DMV during induction was 59.8% in Group H versus 4.05% in Group L (P < 0.001). A higher incidence of difficult intubation was observed in Group H (56.9% vs. 11.5%, P < 0.001). More patients in Group H had airway complications such as bleeding and injury to the posterior pharyngeal wall or teeth (P < 0.001). Complications such as hypoxia, hypertension, and tachycardia were observed to be higher in Group H (P < 0.001). Conclusion: STOP-BANG questionnaire is an effective bedside preoperative tool that helps in identifying unanticipated difficult airway.

Résumé Contexte: Le questionnaire STOP-BANG est un outil établi pour le dépistage de l'apnée obstructive du sommeil (AOS). Son utilité pour prédire les voies respiratoires n'a pas été évaluée. Nous avons l'intention d'évaluer les difficultés de gestion des voies respiratoires et les complications périopératoires associées chez les patients souffrant d'AOS non diagnostiquée à l'aide du questionnaire STOP-BANG. Matériels et méthodes: Nous avons réalisé une étude observationnelle prospective sur 250 patients avec le score STOP-BANG de classe I-II de l'American Society of Anesthesiologists, âgés de 18 à 65 ans ont été enregistrés. Les occurrences de ventilation au masque difficile (DMV), de laryngoscopie et d'intubation ont été évaluées en utilisant le grade de ventilation au masque, la difficulté d'intubation score (IDS) et le classement de Cormack-Lehane modifié lors de l'induction de l'anesthésie. Événements hypoxiques, troubles hémodynamiques, laryngospasme, et le bronchospasme ont également été enregistrés. Résultats: Au total, 250 patients ont terminé l'étude (Groupe H : n = 102, avec questionnaire STOP-BANG ≥3 et Groupe L : n = 148, avec critère STOP-BANG < 3). Un total de 67 (26,8%) cas de DMV et 63 (25,2%) cas de DIT ont été rencontrés global. La proportion de patients avec DMV lors de l'induction était de 59,8 % dans le groupe H contre 4,05 % dans le groupe L (P < 0,001). Une incidence plus élevée d'intubation difficile a été observée dans le groupe H (56,9 % contre 11,5 %, P < 0,001). Plus de patients du groupe H ont eu des complications des voies respiratoires telles que saignement et lésion de la paroi postérieure du pharynx ou des dents (P < 0,001). Des complications telles que l'hypoxie, l'hypertension et la tachycardie ont été observé comme étant plus élevé dans le groupe H (P < 0,001). Conclusion: Le questionnaire STOP-BANG est un outil préopératoire efficace au chevet du patient qui aide dans l'identification des voies respiratoires difficiles imprévues. Mots-clés: Intubation difficile, ventilation difficile du masque, score de difficulté d'intubation, apnée obstructive du sommeil, questionnaire STOP-BANG.

ATM is required for SOD2 expression and homeostasis within the mammary gland.

PURPOSE: ATM activates the NF-κB transcriptional complex in response to genotoxic and oxidative stress. The purpose of this study was to examine if the NF-κB target gene and critical antioxidant SOD2 (MnSOD) in cultured mammary epithelium is also ATM-dependent, and what phenotypes arise from deletion of ATM and SOD2 within the mammary gland. METHODS: SOD2 expression was studied in human mammary epithelial cells and MCF10A using RNAi to knockdown ATM or the NF-κB subunit RelA. To study ATM and SOD2 function in mammary glands, mouse lines containing Atm or Sod2 genes containing LoxP sites were mated with mice harboring Cre recombinase under the control of the whey acidic protein promoter. Quantitative PCR was used to measure gene expression, and mammary gland structure was studied using histology. RESULTS: SOD2 expression is ATM- and RelA-dependent, ATM knockdown renders cells sensitive to pro-oxidant exposure, and SOD mimetics partially rescue this sensitivity. Mice with germline deletion of Atm fail to develop mature mammary glands, but using a conditional knockout approach, we determined that Atm deletion significantly diminished the expression of Sod2. We also observed that these mice (termed AtmΔ/Δ) displayed a progressive lactation defect as judged by reduced pup growth rate, aberrant lobulo-alveolar structure, diminished milk protein gene expression, and increased apoptosis within lactating glands. This phenotype appears to be linked to dysregulated Sod2 expression as mammary gland-specific deletion of Sod2 phenocopies defects observed in AtmΔ/Δ dams. CONCLUSIONS: We conclude that ATM is required to promote expression of SOD2 within the mammary epithelium, and that both ATM and SOD2 play a crucial role in mammary gland homeostasis.