Propofol vs traditional sedative agents for endoscopic retrograde cholangiopancreatography:A meta-analysis

AIM:To investigate the efficacy and safety of propofol sedation for endoscopic retrograde cholangiopancreatography(ERCP).METHODS:Databases including PubMed,Embase,and the Cochrane Central Register of Controlled Trials updated as of October 2010 were searched.Main outcome measures were ERCP procedure duration,recovery time,incidence of hypotension and hypoxia.RESULTS:Six trials with a total of 663 patients were included.The pooled mean difference in ERCP procedure duration between the propofol and traditional sedative agents was-8.05(95%CI:-16.74 to 0.63),with no significant difference between the groups.Thepooled mean difference in the recovery time was-18.69(95%CI:-25.44 to-11.93),which showed a significant reduction with use of propofol sedation.Compared with traditional sedative agents,the pooled OR with propofol sedation for ERCP causing hypotension or hypoxia was 1.69(95%CI:0.82-3.50)and 0.90(95%CI:0.55-1.49),respectively,which indicated no significant difference between the groups.CONCLUSION:Propofol sedation during ERCP leads to shorter recovery time without an increase of cardiopulmonary side effects.Propofol sedation can provide adequate sedation during ERCP.

Shikani Optical Stylet–guided Intubation via the Intubating Laryngeal Airway in Patients With Scar Contracture of the Face and Neck

Objective To evaluate the feasibility of the Shikani Optical Stylet(SOS)-guided intubation through a new Intubating Laryngeal Airway(ILA)in anticipated difficult airways caused by scar contracture of the face and neck.Methods Thirty-three adult patients with anticipated difficult airways undergoing selective faciocervical scar plastic surgery under general anesthesia were enrolled in this study.After anesthesia induction,a size 2.5,3.5 or 4.5 ILA was inserted.Following good lung ventilation being verified,the SOS preloaded with an endotracheal tube was inserted via the ILA.Once the clear vocal cords came into view under the SOS,the endotracheal tube was advanced through glottis into the trachea.Results The ILA provided an effective airway in all patients.Intubation was successful at the first attempt on 22/33(66.7%)occasions and at the second attempt on 6/33(18.2%).Intubation failed in 5(15.1%)patients who suffered from severe limitation of head extension due to scar contracture of the neck.These patients’tracheas were finally intubated using a fibreoptic bronchoscope via the ILA.Conclusions The SOS-guided intubating method via the ILA is a feasible technique in patients with scar contracture of the face and neck.However,in patients with severe limitation of head extension,the use of SOS cannot be recommended.The SOS can be used as an alternative apparatus when the fibreoptic bronchoscope is not available.

Induction of Anesthesia with Dexmedetomidine and Sevoflurane for a Pediatric Difficult Airway

Difficult airway is a challenge frequently faced by anesthesiologists. For children recovering from burns with severe scarring contracture in the neck and chest wall, the best strategy is to maintain spontaneous breathing during the induction of anesthesia and to insert a laryngeal mask airway to secure the airway as early as possible.

How to Initiate and Perform Simulation-based Airway Management Training More Effectively and Efficiently in China？

INTRODUCTION While airway management is a fundamental skill set for many healthcare professionals, the difficult airway management has long been recognized as one of the most challenging tasks facing healthcare providers.As yet, failure to properly manage airway conditions remains a significant source of patients＆#39; morbidity and mortality.[1] To avoid or reduce medical errors and improve patient safety and outcomes, training for healthcare providers for airway management skills is essential.