Emergent use of tube tip in pharynx technique in“cannot intubate cannot oxygenate”situation:A case report

BACKGROUND A“cannot intubate,cannot oxygenate(CICO)”situation is a life-threatening condition that requires emergent management to establish a route for oxygenation to prevent oxygen desaturation.In this paper,we describe airway management in a patient with an extended parotid tumor that invaded the airways during CICO using the endotracheal tube tip in the pharynx(TTIP)technique.CASE SUMMARY A 43-year-old man was diagnosed with parotid tumor for>10 years.Computed tomography and nasopharyngeal fiberoptic examination revealed a substantial mass from the right parotid region with a deep extension through the lateral pharyngeal region to the retropharyngeal region and obliteration of the nasopharynx to the oropharynx.Tumor excision was arranged.However,we encountered CICO during anesthesia induction.An endotracheal tube was used as an emergency supraglottic airway device(TTIP)to ventilate the patient in a CICO situation where other tools such as laryngeal mask airway or mask ventilation were not suitable for this complicated and difficult airway.The patient did not experience desaturation despite sudden loss of definite airway.During tracheostomy,the pulse oximetry remained 100%with our technique of ventilating the patient.The arterial blood gas analysis revealed PaCO_(2)35.7 mmHg and PaO2242.5 mmHg upon 50%oxygenation afterward.CONCLUSION Using an endotracheal tube as a supraglottic airway device,patients may have increased survival without experiencing life-threatening desaturation.

Arabidopsis pollen-specific glycerophosphodiester phosphodiesterase-like genes are essential for pollen tube tip growth

In angiosperms,pollen tube growth is critical for double fertilization and seed formation.Many of the factors involved in pollen tube tip growth are unknown.Here,we report the roles of pollenspecific GLYCEROPHOSPHODIESTER PHOSPHO DIESTERASE-LIKE(GDPD-LIKE)genes in pollen tube tip growth.Arabidopsis thaliana GDPD-LIKE6(At GDPDL6)and At GDPDL7 were specifically expressed in mature pollen grains and pollen tubes and green fluorescent protein(GFP)-At GDPDL6 and GFP-At GDPDL7 fusion proteins were enriched at the plasma membrane at the apex of forming pollen tubes.Atgdpdl6 Atgdpdl7 double mutants displayed severe sterility that was rescued by genetic complementation with At GDPDL6 or At GDPDL7.This sterility was associated with defective male gametophytic transmission.Atgdpdl6 Atgdpdl7 pollen tubes burst immediately after initiation of pollen germination in vitro and in vivo,consistent with the thin and fragile walls in their tips.Cellulose deposition was greatly reduced along the mutant pollen tube tip walls,and the localization of pollen-specific CELLULOSE SYNTHASE-LIKE D1(CSLD1)and CSLD4 was impaired to the apex of mutant pollen tubes.A rice pollen-specific GDPD-LIKE protein also contributed to pollen tube tip growth,suggesting that members of this family have conserved functions in angiosperms.Thus,pollen-specific GDPDLIKEs mediate pollen tube tip growth,possibly by modulating cellulose deposition in pollen tube walls.