Videolaryngoscope versus Macintosh laryngoscope for tracheal intubation in adults with obesity: A systematic review and meta-analysis.

STUDY OBJECTIVE: Videolaryngoscopy has become more common since the 2000s. Despite several anecdotal reports in the literature, it remains unclear whether videolaryngoscopy is superior to direct Macintosh laryngoscopy for tracheal intubation in adults with obesity. This systematic review and meta-analysis focused on prospective randomised trials comparing videolaryngoscopes with the Macintosh laryngoscope for tracheal intubation in adults with obesity. DESIGN: Systematic review, Meta-analysis SETTING: Operating room, Obesity patients MEASUREMENTS: Data on success rate, intubation time, and glottic visualisation during tracheal intubation were extracted from the identified studies. In a subgroup analysis, we also compared the parameters for videolaryngoscopes with a tracheal tube guide channel and those without a tracheal tube guide channel. Data from individual trials were combined, and the DerSimonian and Laird random-effect model was used to calculate either the pooled relative risk (RR) or the weighted mean difference (WMD) as well as the corresponding 95% confidence intervals (CI). MAIN RESULTS: Eleven articles describing 13 trials met the inclusion criteria. The performance of videolaryngoscopes was superior to that of the Macintosh laryngoscope for all outcomes. (Success rate; RR=1.11, 95% CI 1.04 to 1.18, p=0.001, I2=63%, Intubation time; WMD=-16.1, 95% CI -31.1 to -1.10, p=0.04, I2=97%, Glottic visualisation; RR=1.19, 95% CI 1.09 to 1.30, p<0.0001, I2=76%) In the subgroup analysis, the performance of both types of videolaryngoscopes (with and without a tracheal tube guide channel) was superior to that of the Macintosh laryngoscope, except for intubation time with the videolaryngoscopes without a tracheal tube guide channel. CONCLUSIONS: Videolaryngoscopes were superior to the Macintosh laryngoscope for tracheal intubation in adults with obesity. (GRADE score: low or very low.).

Mitochondrial cereblon functions as a Lon-type protease.

Lon protease plays a major role in the protein quality control system in mammalian cell mitochondria. It is present in the mitochondrial matrix, and degrades oxidized and misfolded proteins, thereby protecting the cell from various extracellular stresses, including oxidative stress. The intellectual disability-associated and thalidomide-binding protein cereblon (CRBN) contains a large, highly conserved Lon domain. However, whether CRBN has Lon protease-like function remains unknown. Here, we determined if CRBN has a protective function against oxidative stress, similar to Lon protease. We report that CRBN partially distributes in mitochondria, suggesting it has a mitochondrial function. To specify the mitochondrial role of CRBN, we mitochondrially expressed CRBN in human neuroblastoma SH-SY5Y cells. The resulting stable SH-SY5Y cell line showed no apparent effect on the mitochondrial functions of fusion, fission, and membrane potential. However, mitochondrially expressed CRBN exhibited protease activity, and was induced by oxidative stress. In addition, stably expressed cells exhibited suppressed neuronal cell death induced by hydrogen peroxide. These results suggest that CRBN functions specifically as a Lon-type protease in mitochondria.

[Endotracheal intubation in an adult patient fitted with a Leksell frame using a Pentax Airwayscope with a pediatric-type INTLOCK blade (ITL-P)].

Several previous reports have established the Pentax Airwayscope (Pentax AWS, S-100, HOYA-PENTAX, Tokyo, Japan) as an efficient tool for tracheal intubation in adult patients. The Pentax AWS is often successfully used with an INTLOCK blade; to date, however, INTLOCK blades have been released for neonatal and pediatric patients only. In this case, we performed tracheal intubation using a Pentax AWS attached to a pediatric-type INTLOCK blade (ITL-P) in an adult patient fitted with a Leksell Stereotactic frame (Elekta, Sweden). The patient weighed 45 kg and was 154 cm tall, and was scheduled for a tumor biopsy due to glioblastoma in the brain stem. The patient was preoperatively fitted with a Leksell frame on her head. The patient was not premedicated and was monitored with electrocardiography (ECG), noninvasive blood pressure, and pulse oximetry. Following pre-oxygenation, general anesthesia was induced using propofol 4.0 microg x ml with target-controlled infusion and remifentanil 0.25 microg x kg(-1) hr(-1). After loss of consciousness, we administered 30-mg rocuronium boluses. We initially attempted tracheal intubation first using a Macintosh laryngoscope and then a Pentax AWS, but we could not achieve tracheal intubation with either of these instruments. Upon switching to a Pentax AWS with an ITL-P, we successfully achieved tracheal intubation without any complications. Anesthesia was maintained uneventfully with 3.0 microg x ml(-1) propofol and remifentanil 0.10 to 0.25 microg x kg(-1) x hr(-1) in oxygen and air. Further study is needed to facilitate the effective use of the Pentax AWS and the ITL-P in such cases.

[Case of perioperative tracheal laceration by electrocautery].

Although tracheal laceration during surgical procedure is a rare complication, it can be life-threating. Its immediate recognition and treatment are important. A 72-year-old man with aortic valve regurgitation was scheduled for aortic valve replacement. At anesthetic induction an endotracheal tube was smoothly inserted and the tidal volume was set at 500 ml with ventilator rate of 12 min-1. After electrocautery maneuver of the upper sterna region, end-tidal carbon-oxide curve suddenly became flat. Immediately after the completion of median sternotomy air bubble was seen in the surgical field. An 8-mm longitudinal tracheal laceration at the fourth tracheal cartilage was identified. The tracheal laceration was repaired with interrupted suture and the mediastinal tissue was used to cover the suture line. Air leaks were no longer present. After surgical repair, the aortic valve replacement was performed. The postoperative courses of both tracheal laceration repair and aortic valve replacement were uneventful.