Effects of acupuncture on sensory symptoms and motor signs in patients with restless legs syndrome: A crossover randomized controlled trial.

BACKGROUND: Rapid effects of acupoint injection (acuinjection) at 4 acupoints (4P) (ST36, GB41, SP6, and BL60) on legs presenting sensory symptoms and motor signs in restless legs syndrome (RLS) were first described in a case report. This study aimed to confirm the beneficial effects of acuinjection. METHODS: A randomized, controlled, single-blinded, prospective crossover study was conducted during 2018 to 2021. Adult volunteers (age ≥ 20 years) with RLS symptoms for > 2 weeks were included. Eight adults were enrolled and randomized to receive acuinjection (Verum group) or sham injection (Sham group). The effects of acuinjection on discomfort and periodic leg movement (PLM) were evaluated using the suggested immobilization test in a crossover design. The acupoint used was 4P, and normal saline solution (0.1-0.25 mL) was injected in both groups. Leg discomfort was measured using the visual analog scale (VAS), and PLM was measured using an electromyogram. To compare the VAS scores between the groups, repeated measures analysis of variance was used, and the Student t test was used to assess the mean discomfort score (MLDS: average of the 6 VAS scores) and PLM index (PLMI) (defined as the degree of PLM/hour). RESULTS: A significant difference in the VAS score was observed; however, no significant difference was noted in the PLMI between the groups. The MLDS was significantly lower in the Verum group than in the Sham group. CONCLUSION: Acuinjection at 4P remarkably inhibited leg discomfort in patients with RLS. Despite the drastic PLM suppression in 1 patient by acuinjection, a statistically significant inhibition of PLM was not confirmed. The results of our study can be applied easily and safely in clinical situations where it is necessary to temporarily reduce or eliminate RLS symptoms.

Use of a Tracheal Tube as a Nasally Inserted Supraglottic Airway in a Case of Near-Fatal Airway Obstruction Caused by Epiglottitis.

Airway management is critical during near-fatal obstruction of the upper airway in epiglottitis; however, this is challenging because of the sitting posture and agitated mental status of the patient. Moreover, there is currently no established protocol for safe airway management in patients with epiglottitis. Here, we describe the use of a conventional tracheal tube as a nasolaryngeal airway to maintain airway patency at the site of airway narrowing in the supine position, which enabled alleviation of imminent airway obstruction in a patient with epiglottitis. For definitive airway establishment, tracheostomy was then safely performed in the supine position.

Adjusting Pediatric Endotracheal Tube Depths Relative to the Cricoid by Using Longitudinal Ultrasound Images of the Saline-Inflated Cuff in the Trachea: Two Case Reports.

Cuff positions of endotracheal tubes should be confirmed to ensure safe anesthesia. However, determining the cuff positions relative to the cricoid by using chest radiography or fiberoptic bronchoscopy is difficult. We identified the cephalad edges of saline-inflated pediatric endotracheal tube cuffs relative to the cricoid on longitudinal ultrasound images over the larynx and trachea in 2 children. Thereafter, we adjusted the endotracheal tube depths and confirmed the cuff positions relative to the cricoid. Longitudinal ultrasound images over the larynx and trachea can help confirm the distance from the caudal edge of the cricoid to the saline-inflated cuff.

[Sniffing Position and i-gel Rotation Approach for i-gel Insertion under General Anesthesia].

BACKGROUND: Insertion assistance techniques, such as the sniffing position (SP) and i-gel? rotation approach (RA), are recommended in the i-gel supraglottic airway device insertion manual. The usefulness of these techniques was evaluated, in this study, under general anesthesia. METHODS: In 50 adult patients, the i-gel was inserted with the patient in the mild-SP with 5 degrees head extention at first attempt. When resistance was encountered during insertion or airway patency was not obtained after insertion, the i-gel was re-inserted with the patient in the full-SP with maximum head extention during second attempt. When re-insertion failed, the i-gel was inserted with the patient in the full-SP and by using the i-gel RA during third attempt. RESULTS: Airway patency was established in the mild-SP in 36 of 50 patients, in the full-SP in 11 of the remaining 14, and in the full-SP with the i-gel RA in the remaining 3. The average insertion time was 24.0 s during the first attempt, 22.2 s during the second, and 18.2 s during the third. No major complications were observed. CONCLUSIONS: Both the full-SP and the i-gel RA can be used for i-gel insertion.

[Preoperative predictive airway procedual factors influencing successful fiberoptic oral intubation under general anesthesia].

BACKGROUND: Although preoperative airway assessment is important for airway management, preoperative predictive factors influencing successful fiberoptic oral intubation (FOI) have not been well investigated. Here, we assessed the factors for successful FOI. METHODS: In 30 adult patients, we assessed gender, age, snoring habit, body mass index, Mallampati classification, upper-lip-bite-tests, and length around necks. First we attempted FOI under general anesthesia in a neutral position. When a gap was observed between the epiglottis and posterior pharyngeal wall, we advanced the instrument into the gap. We added airway procedures without observing the gap until it was visible and intubation successful. Multiple regression analysis was performed to determine factors for successful FOI with scores of the factors. RESULTS: Intubation was successful in 0 at neutral position, in 16 at head tilt, in 5 at sniffing position and in the residual 9 at jaw thrust. Snore was the most influencing factor for successful FOI, according to determined linear regression analysis. CONCLUSIONS: We require additional airway procedures and assistance to succeed in FOI in patients who snore.

[Investigation of the amount of blood loss in patients with ruptured and unruptured ectopic pregnancies: a 3-year comparative study].

BACKGROUND: Anesthesiologists should carefully monitor clinical symptoms and hemodynamics of ectopic pregnant patients. METHODS: We retrospectively investigated the backgrounds, vital signs, and amount of blood loss during surgery of ectopic pregnant patients who visited our hospital between July 2009 and June 2012. RESULTS: Ultrasonic examinations revealed a ruptured ectopic pregnancy (REP) in 17 patients and unruptured ectopic pregnancy (UEP) in 19 patients. All operations were uneventful. One UEP patient became hemodynamically unstable immediately after arriving at the operating room because of a sudden rupture. The differences in patients' ages, heights, weights, gestational ages, and human chorionic gonadotropin levels were not statistically significant between the REP and UEP groups. Clinical symptoms (abdominal pain or atypical genital bleeding) were observed in 14 of 17 REP patients and in 5 of 19 UEP patients (relative risk 3.1, odds ratio 13.1). The amount of blood loss was 79 g in the UEP patients, 356 g in the 14 hemodynamically stable REP patients, and 1,762 g in the 3 hemodaynamically unstable REP patients. The clinical symptoms were related to the existence of ruptures. CONCLUSIONS: It is important to monitor clinical symptoms in addition to hemodynamics for sudden hemodynamic changes in ectopic pregnancy.

[A comparison of patient-controlled epidural analgesia and intravenous fentanyl analgesia for laparoscopic ovarian cystectomy].

BACKGROUND: Laparoscopic ovarian cystectomy (LOC) can be performed in conjunction with patient-controlled epidural analgesia (PCEA) or intravenous fentanyl analgesia (IFA). Therefore, we evaluated the postoperative pain associated with both analgesia methods. METHODS: We retrospectively evaluated the postoperative pain associated with PCEA and IEA. We calculated the combined remifentanil and fentanyl effect-site concentrations (ESC) in 43 patients at 1-2 hours after operations involving PCEA (n = 24, group E) or IFA (n = 19, group F). We also evaluated the supplementary analgesics required and the incidences of decreased respiratory rate and desaturation. RESULTS: The patients' backgrounds were similar in both groups. The ESC was below 1.0 ng x ml(-1) in group E and 1.0-2.0 ng x ml(-1) in group F. In group E, five patients received supplementary local bolus injections, one received an NSAID, and one received a morphine injection, while four received NSAIDs and one received a morphine injection in group F. Thus, supplementary analgesics used for 7/24 patients in group E and 5/19 patients in group F (P = 1.000). No complications were noted in either group. CONCLUSIONS: Both PCEA and IFA regimens can effectively manage postoperative pain with relatively low amounts of supplementary analgesics.

[Incidence of insertion difficulty using Proseal LMA and the efficacy of recommended insertion maneuvers].

BACKGROUND: According to the instruction manual, the sniffing position (SP) and the slight lateral approach (SLA) are the recommended insertion methods using Proseal laryngeal mask airway (PLMA). However, the efficacy of these methods has not been assessed. METHODS: The incidence and the reason of the insertion with difficulty were assessed in 50 adult patients. And then, the efficacy of these methods in the patient with insertion difficulty was studied. RESULTS: Establishment of the airway was unsuccessful in 10 patients at first attempt. The commonest reason of unsuccessful attempt was failure to slide PLMA into the pharynx. The insertion was successful and patent airway was obtained using Full-SP and SLA in 8 of the 10 patients. CONCLUSIONS: It was suggested that Full-SP and SLA were useful to place PLMA in patients with insertion difficulty.

[First clinical impressions of ProSeal laryngeal mask].

ProSeal laryngeal mask airway (PLMA, LMA-ProSeal) is a newly developed laryngeal mask airway intended to overcome two major disadvantages of the conventional laryngeal mask airway, i.e., poor protection of the airway from gastric regurgitation and low sealing effect around the laryngeal inlet. The new PLMA can provide air-tight sealing by a second cuff positioned at the back of the mask and a bypass channel for the alimentary tract by a second tube (drain tube) opening at the tip of the mask. However, clinical feature of this new device has been assessed by few authors. Forty adult patients (19 males and 21 females) under general anesthesia immobilized with vecuronium were included in this study. A PLMA size 4 was inserted with (n = 10) or without (n = 30) an introducer at first (n = 37), second (n = 2) or third (n = 1) attempt and clear airway was obtained in all patients. After placing the PLMA in 10 patients (5 males and 5 females) sealing pressure was measured at cuff pressure of 0, 20, 40 and 60 cmH2O and at completely deflated cuff state. Averaged seal pressure at the 60 cm H2O cuff pressure was 22.7 +/- 8.0 cmH2O in the all 40 patients. Averaged seal pressure was higher in female than in male at all cuff pressure. The average seal pressure was 15.1 cmH2O even when the cuff was deflated completely. A lubricated 16-French gastric tube was inserted easily through the drain tube in all patients except one in which the mask was found to be deflected backward. There were no significant complications related to the PLMA. We concluded that the PLMA can provide high sealing pressure and isolate the airway from the alimentary tract. Further study including adverse effect of the high sealing effect should be required.