Effect of Cricoid Pressure Compared With a Sham Procedure in the Rapid Sequence Induction of Anesthesia: The IRIS Randomized Clinical Trial.

Importance: The use of cricoid pressure (Sellick maneuver) during rapid sequence induction (RSI) of anesthesia remains controversial in the absence of a large randomized trial.

Objective: To test the hypothesis that the incidence of pulmonary aspiration is not increased when cricoid pressure is not performed.

Design, Setting, And Participants: Randomized, double-blind, noninferiority trial conducted in 10 academic centers.

Prediction of difficult tracheal intubation: time for a paradigm change.

Background: It has been suggested that predicting difficult tracheal intubation is useless because of the poor predictive capacity of individual signs and scores. The authors tested the hypothesis that an accurate prediction of difficult tracheal intubation using simple clinical signs is possible using a computer-assist model.

Methods: In a cohort of 1,655 patients, the authors analyzed the predictive properties of each of the main signs (Mallampati score, mouth opening, thyromental distance, and body mass index) to predict difficult tracheal intubation.

Oxygen delivery during transtracheal oxygenation: a comparison of two manual devices.

Background: The Manujet™ and the ENK Oxygen Flow Modulator™ (ENK) deliver oxygen during transtracheal oxygenation. We sought to describe the ventilation characteristics of these 2 devices.

Methods: The study was conducted in an artificial lung model consisting of a 15-cm ringed tube, simulating the trachea, connected via a flow analyzer and an artificial lung.

Comparison of single-use and reusable metal laryngoscope blades for orotracheal intubation during rapid sequence induction of anesthesia: a multicenter cluster randomized study.

Background: Single-use metal laryngoscope blades are cheaper and carry a lower risk of infection than reusable metal blades. The authors compared single-use and reusable metal blades during rapid sequence induction of anesthesia in a multicenter cluster randomized trial.

Methods: One thousand seventy-two adult patients undergoing general anesthesia under emergency conditions and requiring rapid sequence induction were randomly assigned on a weekly basis to either single-use or reusable metal blades (cluster randomization).

Modification of the hepatic hemodynamic response to acute changes in PaCO2 by nitric oxide synthase inhibition in rabbits.

Background: Hypercapnia has been reported to modify liver circulation. The vascular regulations implicated in this response remain partly unknown.

Methods: Using anesthetized and ventilated rabbits, we designed this study to evaluate the hepatic artery and portal vein blood flow velocity adjustments (20 MHz pulsed Doppler) after changes in PaCO2 (by varying the inspiratory fraction of CO2 and to assess the proper role of pH, independent of PaCO2 changes, the role of portal vein CO2, and the effect of nitric oxide synthase inhibition on CO2-induced modifications of hepatic hemodynamics.

Effects of various osmolarity on human red blood cells in terms of potassium efflux and hemolysis induced by free radicals.

Objectives: To study in an in vitro model of erythrocytes exposed to free radicals the effects of hyperosmolarity and hypoosmolarity on the induced potassium efflux and hemolysis.

Design Setting: Erythrocytes were separated from plasma and suspended in 3 different phosphate buffer solutions (HYPO, ISO, and HYPER) containing, respectively, 100, 150 and 200 mmol/l of Na. Free radicals were generated from 2,2'-azobis(2-amidinopropane) hydrochloride (AAPH).

A comparison of two emergency cricothyroidotomy kits in human cadavers.

Background: We compared two emergency cricothyroidotomy kits designed to avoid lesions during insertion, one based on the Seldinger technique (ST), the other based on the concept of a mechanical detection of the posterior wall of the larynx, with regard to insertion time, success rate, and complication rate.

Methods: Cricothyroidotomy was performed under fiberoptic control in 40 human cadavers embalmed according to Thiel's technique. The set chosen for use was randomized: new technique (NT) or ST.

Comparison of three methods for oxidative stress-induced potassium efflux measurement.

The aim of the study was to compare the potassium efflux measurements (flame photometry (FP), specific electrode (SE) and atomic absorption photometry (AAP)) using a model of erythrocytes exposed to an oxidative stress in various conditions of osmolarity. Human erythrocytes were incubated in 3 different values of osmolarity and in the presence of 50mM AAPH, potassium efflux was measured by FP, SE and AAP at t=0 and every 30min for 2h. These methods were similar for the measurement of global potassium efflux.

Anaphylactic shock: the advantages of intra aortic balloon counter pulsation for the treatment of heart failure.

The authors report a patient with a history of angina pectoris who developed anaphylactic shock that was complicated by a heart failure due to focal heart ischaemia. Early coronary angiography confirmed the diagnosis of localised coronary hypoperfusion. Intra aortic balloon counter pulsation succeeded in the restoration of coronary blood flow and haemodynamic stability.

Rapid sequence induction: a survey of practices in three French prehospital mobile emergency units.

Objectives: This prospective study was conducted in three mobile emergency and intensive care units.

Methods: The patients were over 15 years of age and were not in cardiac arrest. The study was to compare practices in the three units with the guidelines drawn up by the Commission of Experts so as to define the main parameters for quality assurance.

Comparison of two techniques for retrograde tracheal intubation in human fresh cadavers.

Background: During retrograde tracheal intubation, the short distance existing between the cricothyroid membrane and vocal cords may be responsible for accidental extubation. The insertion of a catheter into the trachea before the removal of the guide wire may help to cope with this problem. This work was conducted to study the impact of such a modification on the success rate and the duration of the procedure.

Effects of an oxidative stress on human hemoglobin: a multiwavelength visible spectrometry study.

This study was carried out to investigate hemoglobin behavior and the role of cell membrane during oxidative stress of human red blood cells induced by a water-soluble radical initiator, 2,2'-azobis(amidino-propane) hydrochloride (AAPH) and compare the observed data to the one obtained with purified human haemoglobin solution. The different forms of hemoglobin were identified and quantified by multiwavelength visible spectrometry using multiple linear regression analysis. Hemolysis was quantified by the Drabkin method.

The influence of extracorporeal circulation on the susceptibility of erythrocytes to oxidative stress.

Extracorporeal circulation (ECC), a necessary and integral part of cardiac surgery, can itself induce deleterious effects in patients. The pathogenesis of diffuse damage of several tissues is multifactorial. It is believed that circulation of blood extracorporeally through plastic tubes causes a whole body inflammatory response and a severe shear stress to blood cells.

The protective effects of lidocaine on human erythrocytes stored for seven days at 04 degrees C.

Erythrocyte storage may result in cell damage due to an alteration of membrane integrity, which results in potassium efflux and hemolysis. Lidocaine has been shown to protect erythrocytes from oxidative stress by a possible membrane effect. We conducted this study to examine the effects of lidocaine on human erythrocyte storage.

Lidocaine has better antioxidant potential than ropivacaine and bupivacaine: in vitro comparison in a model of human erythrocytes submitted to an oxidative stress.

Background: Local anesthetic agents may exert antioxidant properties in various models. The aim of this work was to compare the antioxidant properties of lidocaine, bupivacaine and ropivacaine using an in vitro model of human erythrocytes submitted to an oxidative stress.

Methods: Blood was obtained from healthy volunteers.

Massive chloroquine intoxication: importance of early treatment and pre-hospital treatment.

Chloroquine intoxication, despite therapeutic improvements, remains a potentially serious condition. We report a case of a 25-year-old patient, having ingested 10 g of chloroquine, a dose commonly considered to be lethal. Thanks to appropriate early medical treatment, this patient's outcome was favourable.

[Acute herpetic hepatitis: clinico-pathological study of two cases].

Two cases of acute herpetic hepatitis affecting immunocompetent adults after surgery, are reported. They point out the relevance of liver biopsy for the diagnosis of these generally unrecognized infections. Liver biopsy allows not only diagnosis but also the identification of the virus on tissue sections with immunohistochemistry or in situ hybridization.