The effect of deep and awake extubation on emergence agitation after nasal surgery: a randomized controlled trial.

BACKGROUND: Post-anesthetic emergence agitation is common after general anesthesia and may cause adverse consequences, such as injury as well as respiratory and circulatory complications. Emergence agitation after general anesthesia occurs more frequently in nasal surgery than in other surgical procedures. This study aimed to assess the occurrence of emergence agitation in patients undergoing nasal surgery who were extubated under deep anesthesia or when fully awake. METHODS: A total of 202 patients (18-60 years, American Society of Anesthesiologists classification: I-II) undergoing nasal surgery under general anesthesia were randomized 1:1 into two groups: a deep extubation group (group D) and an awake extubation group (group A). The primary outcome was the incidence of emergence agitation. The secondary outcomes included number of emergence agitations, sedation score, vital signs, and incidence of adverse events. RESULTS: The incidence of emergence agitation was lower in group D than in group A (34.7% vs. 72.8%; p < 0.001). Compared to group A, patients in group D had lower Richmond Agitation-Sedation Scale scores, higher Ramsay sedation scores, fewer agitation episodes, and lower mean arterial pressure when extubated and 30 min after surgery, whereas these indicators did not differ 90 min after surgery. There was no difference in the incidence of adverse events between the two groups. CONCLUSIONS: Extubation under deep anesthesia can significantly reduce emergence agitation after nasal surgery under general anesthesia without increasing the incidence of adverse events. TRIAL REGISTRATION: Registered in Clinicaltrials.gov (NCT04844333) on 14/04/2021.

Magnetic resonance imaging and photothermal conversion properties of Gd-C nanocomposites for interstitial lymphography.

Dual-functional agents for magnetic resonance imaging (MRI) guided photothermal therapy (PTT) of lymph cancer are highly desired. Signal enhancement, selectivity between lymphatic nodes/vessels and blood vessels, and photothermal conversion property are the criteria for such dual-functional agent. In the current work, we demonstrated the potential of Gd-C nanocomposites as dual-functional agents for the MRI and PTT of lymph node cancer. Gd-C nanocomposites were synthesized via a hydrothermal carbonization approach with gadolinium chloride as Gd source and citric acid (CA) as C source. The particle size of the nanocomposites ranges from 40 to 100 nm which is smaller than the intercellular space of lymphatic vessels but much larger than that of the blood vessels. The nanocomposites were successfully applied to the MRI of cervical lymph nodes of rabbits. The signal enhancement of the lymph nodes reached the maximum value of 434% at 10 min after injection, without displaying any blood vessel. The Gd-C nanocomposites also exhibited strong photothermal conversion effect. Under the illumination of an 808 nm laser, the aqueous suspension containing 1.0 wt % Gd-C nanocomposites gave a maximum temperature rise of 28.2 °C and a light utilization efficiency of 30.4%. The results indicate that Gd-C nanocomposites have significant potential in MRI guided PTT of lymph cancer.

A randomized controlled comparison of non-channeled king vision, McGrath MAC video laryngoscope and Macintosh direct laryngoscope for nasotracheal intubation in patients with predicted difficult intubations.

BACKGROUND: King Vision and McGrath MAC video laryngoscopes (VLs) are increasingly used. The purpose of this study was to evaluate the performance of nasotracheal intubation in patients with predicted difficult intubations using non-channeled King Vision VL, McGrath MAC VL or Macintosh laryngoscope by experienced intubators. METHODS: Ninety nine ASA I or II adult patients, scheduled for oral maxillofacial surgeries with El-Ganzouri risk index 1-7 were enrolled. Patients were randomly allocated to intubate with one of three laryngoscopes (non-channeled King Vision, McGrath MAC and Macintosh). The intubators were experienced with more than 100 successful nasotracheal intubations using each device. The primary outcome was intubation time. The secondary outcomes included first success rate, time required for viewing the glottis, Cormack-Lehane grade of glottis view, the number of assist maneuvers, hemodynamic responses, the subjective evaluating of sensations of performances and associated complications. RESULTS: The intubation time of King Vision and McGrath group was comparable (37.6 ± 7.3 s vs. 35.4 ± 8.8 s) and both were shorter than Macintosh group (46.8 ± 10.4 s, p < 0.001). Both King Vision and McGrath groups had a 100% first attempt success rate, significantly higher than Macintosh group (85%, p < 0.05). The laryngoscopy time was comparable between King Vision and McGrath group (16.7 ± 5.5 s vs. 15.6 ± 6.3 s) and was shorter than Macintosh group (22.8 ± 7.2 s, p < 0.05) also. Compared with Macintosh laryngoscope, Glottis view was obviously improved when exposed with either non-channeled King Vision or McGrath MAC VL (p < 0.001), and assist maneuvers required were reduced (p < 0.001). The maximum fluctuations of MAP were significantly attenuated in VL groups (47.7 ± 12.5 mmHg and 45.1 ± 10.3 mmHg vs. 54.9 ± 10.2 mmHg, p < 0.05 and p < 0.01). Most device insertions were graded as excellent in McGrath group, followed by Macintosh and King Vision group (p = 0.0014). The tube advancements were easier in VLs compared with the Macintosh laryngoscope (p < 0.001). Sore throat was found more frequent in Macintosh group compared with King Vision group (p < 0.05). CONCLUSIONS: Non-channeled King Vision and McGrath MAC VLs were comparable and both devices facilitated nasotracheal intubation in managing predicted difficult intubations compared with Macintosh laryngoscope. TRIAL REGISTRATION: ClinicalTrials registration number NCT03126344 . Registered on April 24, 2017.