Anatomical analysis of the distribution patterns of occipital cutaneous nerves and the clinical implications for pain management.

PURPOSE: Establishing the distribution patterns of occipital cutaneous nerves may help us understand their contribution to various occipital pain patterns and ensure that a proper local injection method for treatment is employed. The aim of this study was to demonstrate the detailed distribution patterns of the greater occipital nerve (GON), lesser occipital nerve (LON), and third occipital nerve (TON) using the modified Sihler's staining technique. METHODS: Ten human cadavers were manually dissected to determine the nerve distributions. Specimens from eight human cadavers were treated using the modified Sihler's staining. RESULTS: In all cases, distinct GON branches proceeded laterally and were intensively distributed in the superolateral area from their emerging point. Very thin twigs were observed at the middle-trisected area, which had a fan-like shape, in the middle-upper occipital region. CONCLUSION: The LON and TON distribution areas were biased to the lateral side below the superior nuchal line, although these nerves exhibited multiple interconnections or overlapping areas with the GON. Furthermore, a nerve rarified zone in the shape of an inverted triangle was identified in the middle occipital area. Our findings improve our understanding of the occipital nerve anatomy and will aid in the management of occipital pain in clinical practice.

Randomized Comparison of Actual and Ideal Body Weight for Size Selection of the Laryngeal Mask Airway Classic in Overweight Patients.

Size selection of the laryngeal mask airway (LMA) Classic based on actual body weight remains a common practice. However, ideal body weight might allow for a better size selection in obese patients. The purpose of our study was to compare the utility of ideal body weight and actual body weight when choosing the appropriate size of the LMA Classic by a randomized clinical trial. One hundred patients with age 20 to 70 yr, body mass index ≥25 kg/m(2), and the difference between LMA sizes based on actual weight and ideal weight were allocated to insert the LMA Classic using either actual body weight or ideal body weight in a weight-based formula for size selection. After insertion of the device, several variables including insertion parameters, sealing function, fiberoptic imaging, and complications were investigated. The insertion success rate at the first attempt was lower in the actual weight group (82%) than in the ideal weight group (96%), even it did not show significant difference. The ideal weight group had significantly shorter insertion time and easier placement. However, fiberoptic views were significantly better in the actual weight group. Intraoperative complications, sore throat in the recovery room, and dysphonia at postoperative 24 hr occurred significantly less often in the ideal weight group than in the actual weight group. It is suggested that the ideal body weight may be beneficial to the size selection of the LMA Classic in overweight patients (Clinical Trial Registry, NCT 01843270).

A randomized comparison of the i-gel with the self-pressurized air-Q intubating laryngeal airway in children.

BACKGROUND: Supraglottic airway devices with noninflatable cuff have advantages in omitting the cuff pressure monitoring and reducing potential pharyngolaryngeal complications. Typical devices without cuff inflation available in children are the i-gel and the self-pressurized air-Q intubating laryngeal airway (air-Q SP). To date, there is no comparative study between these devices in pediatric patients. AIM: The purpose of this randomized study was to compare the i-gel(™) and the self-pressurized air-Q(™) intubating laryngeal airway (air-Q SP) in children undergoing general anesthesia. METHODS: Eighty children, 1-108 months of age, 7-30 kg of weight, and scheduled for elective surgery in which supraglottic airway devices would be suitable for airway management, were randomly assigned to either the i-gel or the air-Q SP. Oropharyngeal leak pressure and fiberoptic view were assessed three times as follows: after insertion and fixation of the device, 10 min after initial assessment, and after completion of surgery. We also assessed insertion parameters and complications. RESULTS: Insertion of the i-gel was regarded as significantly easier compared to the air-Q SP (P = 0.04). Compared to the air-Q SP group, the i-gel group had significantly higher oropharyngeal leak pressures at all measurement points and significantly lower frequencies of gastric insufflation at 10 min after initial assessment and completion of surgery. The air-Q SP group had better fiberoptic views than the i-gel group at all measurement points. CONCLUSION: Our results showed that the i-gel had easier insertion and better sealing function, and the air-Q SP provided improved fiberoptic views in children requiring general anesthesia.

Clinical and radiographic features of adult-onset ankylosing spondylitis in Korean patients: comparisons between males and females.

The objective of this study was to investigate clinical and radiographic features and gender differences in Korean patients with adult-onset ankylosing spondylitis. Multicenter cross-sectional studies were conducted in the rheumatology clinics of 13 Korean tertiary referral hospitals. All patients had a confirmed diagnosis of ankylosing spondylitis according to the modified New York criteria. Clinical, laboratory, and radiographic features were evaluated and disease activities were assessed using the Bath ankylosing spondylitis disease activity index. Five hundred and five patients were recruited. The male to female ratio was 6.1:1. Average age at symptom onset was 25.4+/-8.9 yr and average disease duration was 9.6+/-6.8 yr. Males manifested symptoms at a significantly earlier age. HLA-B27 was more frequently positive in males. Hips were more commonly affected in males, and knees in females. When spinal mobility was measured using tragus-to-wall distance and the modified Schober's test, females had significantly better results. Radiographic spinal changes, including bamboo spine and syndesmophytes, were more common in males after adjustment of confounding factors. In conclusion, we observed significant gender differences in radiographic spinal involvement as well as other clinical manifestations among Korea patients with adult-onset ankylosing spondylitis. These findings may influence the timing of the diagnosis and the choice of treatment.