[Use of the laryngeal mask for airway control in difficult intubations in children]. / L'impiego della maschera laringea per il controllo delle vie aeree e le intubazioni difficili in pediatria.

LMA was introduced in clinical practice by Arthur Brain in 1983 as a valuable substitute of tracheal tube in adult who underwent general anaesthesia; since then its applications have been extensively studied. LMA is a relatively new non-invasive ventilatory device which has allowed a radical change in the management of modern general anaesthesia. In this study, the application of LMA is assessed during induction and maintenance of general anaesthesia in children affected by severe facial deformities that could render the placement of the tracheal tube difficult. Three patients were affected by complex malformative syndromes involving the maxillo-facial skeleton and one patient presented a massive teratoma, originating from the orbit. In all these cases, LMA provided a patient airway and a satisfactory ventilation during both induction and the repeated attempts of inserting the tracheal tube; in one case, since the orotracheal intubation failed, LMA has proved to be as effective as the tracheal tube during the maintenance of general anaesthesia. Therefore, LMA is recommended as an essential ventilatory device in the hands of paediatric anaesthesiologists.

[Assessment of lipid peroxidation in hyperbaric oxygen therapy: protective role of N-acetylcysteine]. / Valutazione della perossidazione lipidica in corso di ossigenoterapia iperbarica: ruolo protettivo della N-acetilcisteina.

OBJECTIVE: To verify and quantify lipidic peroxidation by means of tiobarbituric-acid reactive substance (TBARS) dosage in patients treated daily with HBO. To verify if a potentiated glutathione enzymatic system, with N-acetylcisteine (NAC) treatment, may determine higher HBO tolerance and reduced lipidic peroxidation. DESIGN: Randomised study on patients treated with 20 HBO 2.2 ATA (90' oxygen) sessions. SETTING: Hyperbaric Medical Centre. PATIENTS: Seventeen patients divided, at random, into two groups; group A: 10 patients treated with only HBO; group B: 7 patients treated with NAC antioxidant therapy (Fluimucil, Zambon Group, Italy) 1800 mg/day in addition to HBO. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: TBARS on blood sample at T0 (basal) T1 (at the end of the 1st HBO session) T2 (at the beginning of the 20th HBO session) T3 (at the end of the 20th). The group A TBARS analysis at the different study time has shown significant data (p < 0.01) as the difference between TBARS values of the two groups at T2 (p < 0.01). CONCLUSIONS: HBO induces a lipidic peroxidation even if the therapeutical protocol cannot determine lung or cerebral oxygen toxicity symptoms. The NAC administration, during HBO treatment, determines a protection against the HBO radicalic stress.