Difficulty Of Passage Research Articles

The Image of Mafraq in the Geographers' and Travelers' Books and the Books of the Stations of Pilgrimage. (Since the Umayyad Era till the End of the Ottoman Era)

The cities and places located on the route of the pilgrims of the Levant were taken care of by Arab and Muslim geographers and travelers, their blogs included a description of their geographical nature and general conditions in terms of water resources and the availability of food, the fodder necessary to feed the animals, and the state of the roads that penetrate or pass next to it in terms of security and difficulty of passage and other things that the traveler should beware of such as thieves and bandits. The books of the pilgrimage also included brief statements aimed at serving the pilgrim and informing him of the route of the road and the conditions of the places located on it. Mafraq (its ancient name: Al-Faddain) occupied an important place before Islam by being located on the ancient Sultanic road (Trajan's road). Its flat terrain contributed to making it a corridor preferred by travelers away from the desert routes to the East, and The Straits of the Ajloun mountains to the West. This paper aims to trace the descriptions of Arab geographers and travelers about Mafraq (Al-Faddain) and note its presence in their writings and in the works of the pilgrimage stations, and to indicate their impressions of it and its geographical location.

Abstract 16621: Factors Influencing the Difficulty of Guidewire Passage in Duplex-Guided Endovascular Treatment for Femoropopliteal Chronic Total Occlusions

Introduction: Previous studies have shown the effectiveness of duplex-guided endovascular treatment (EVT) for femoropopliteal chronic total occlusions (FP-CTO). However, the factors that contribute to the difficulty of guidewire passage during duplex-guided EVT have not been clearly understood. Therefore, this study aimed to examine the factors associated with prolonged guidewire passage in the CTO segment using this method. Methods: In this single-center, retrospective analysis, data from patients who underwent duplex-guided EVT for FP-CTO from April 2018 to March 2023 were collected. The guidewire passage index (GPI), defined as the time required for guidewires to pass the CTO segment divided by the length of the CTO segment, was used. The study aimed to explore the correlation between the GPI and the personal backgrounds and lesion characteristics of the patients. Results: A total of 40 lesions in 35 patients (28 males, mean age: 75.8 ± 6.5 years) with consecutive de novo lesions were treated using duplex-guided EVT. The patients had a mean height of 162.0 ± 7.8 cm, weight of 58.9 ± 10.9 kg, body mass index (BMI) of 22.4 ± 3.4 kg/m 2 , and pre-EVT ankle brachial index (ABI) of 0.50 ± 0.19. The mean lesion length was 218.2 ± 67.8 mm, and the CTO length was 159.4 ± 85.0 mm. All procedures were successful, with an average time of 44 ± 48.2 min required for guidewires to pass the CTO segment and a GPI of 2.9 ± 2.7 min/cm. There was a negative correlation (–0.46) between the time required for guidewires to pass the CTO segment and age, while positive correlations were found between the time required for guidewires to pass the CTO segment and weight, BMI, lesion length, and CTO length (0.32, 0.44, 0.48, and 0.58, respectively). However, no associations were found between GPI and factors such as gender, hypertension, diabetes, dyslipidemia, renal insufficiency, smoking status, CTO length of 150 mm or more, Rutherford classification, Fontaine classification, or puncture site. Additionally, no correlations were found between GPI and age, height, weight, BMI, preoperative ABI values, lesion length, or CTO length. Conclusions: The patient background does not appear to have an impact on the difficulty of guidewire passage in duplex-guided EVT for FP-CTO.

Evaluating the impact of position, volume, and consistency on high-resolution esophageal manometry outcomes.

The Chicago classification primarily utilizes ten 5 mL liquid swallows in a supine position as the standard high-resolution esophageal manometry (HRM) protocol. HRM can be performed with varying volumes and consistencies and in an upright position. We aimed to determine the impact on HRM results by (1) position, (2) swallows of differing volume and consistency, and (3) perception of bolus passage. HRM was performed in healthy volunteers (HV) with the following protocol of swallows: liquids 10 × 5 mL, 5 × 10 mL, and 3 × 10 mL multiple rapid swallows; applesauce 5 × 5 mL and 5 × 10 mL; and bread 5 × 2 × 2 cm and 5 × 4 × 4cm. HV rated difficulty of each swallow on a 5-point Likert scale. All HVs performed the protocol in supine position first and then in "semi-upright" (sitting 70 degrees in a bed) and "upright" (sitting in a chair) in a randomized order. Thirty-seven HVs, median age 27 years, 64% female completed this study. Median distal contractile integral (DCI) and integrated relaxation pressure 4 s (IRP4) of 5 mL liquid swallows significantly differed (all p < 0.01) between position performed. Large volume swallows resulted in higher DCI and lower IRP4. IRP4 results were significantly increased for 2 × 2 cm pieces of bread compared to 5 mL water swallows. DCI results were higher for 2 × 2 cm pieces of bread compared to 5 mL water swallows. Distal latency was shorter in more upright positions. Among this cohort of HV, perceived difficulty of bolus passage was more likely to occur with solid boluses. The volume and consistency of a swallow and the position it is performed in, significantly alter HRM metrics. Interpretation of HRM studies should incorporate different normative values which are specific to the position and bolus type.

Outcomes of Congenital Nasolacrimal Duct Obstruction Surgery Converted into Balloon Dilation and Silicone Intubation due to Probing Difficulty.

Background To report the outcomes of balloon catheter dilatation and silicone intubation as a sequential secondary surgery under the same anesthesia, a stepwise approach for congenital nasolacrimal duct obstruction (NLDO) when probing and irrigation as primary procedure fails. Methods A retrospective study included children with NLDO who underwent probing and irrigation only, and those who underwent in the same surgery under anesthesia, adjunct balloon catheter dilation and silicone intubation due to difficulty of the probe passage or fluid regurgitation from the punctum. The primary outcome was surgical success defined as resolution of preoperative symptoms and signs at 1 month. Results A total of 105 NLDO cases were included. Eighty-four cases underwent probing and irrigation only, whereas 21 cases required balloon dilation and silicone intubation consecutively after the first procedure. Patient age at surgery was higher for those requiring balloon dilatation and intubation (30.3 ± 8.0 months) when compared to those with probing and irrigation only (22.4 ± 10.3 months, p < 0.001). The onset of symptoms, preoperative clinical findings regarding tearing and discharge and gender distribution of patients were comparable between the two groups. During the follow-up, the overall success rate for probing and irrigation only was 76.2% (64 out of 84 cases) and for balloon dilatation and silicone tube intubation was 90.5% (19 out of 21 cases). Conclusions The surgical team may prepare to proceed with secondary surgery under the same anesthesia after the initial attempt of probing and irrigation. This stepwise two-stage approach in patients with congenital NLDO failing primary surgery resulted in a high success rate with minimal interventions, avoiding repeated general anesthesia.

The Effect of E-Learning Sessions on the Development of Reading Comprehension: A Case of EFL Students’ Perceptions at Saudi Electronic University

This study investigated Saudi EFL university students’ perceptions toward the development of reading comprehension through e-learning sessions. A cross-sectional questionnaire was utilized and distributed to a sample of 140 participants at Saudi Electronic University. Descriptive statistics, independent sample paired t-test and one-way ANOVA were used to analyze the data. The findings revealed that EFL university students had positive perceptions of the use of online sessions to practice the reading comprehension skill. The majority agreed that reading comprehension strategies such as skimming and scanning were more appropriate to online sessions. E-learning helped these students to be more motivated and created an atmosphere conducive to independent learning. The participants appreciated the role of online sessions in enhancing their reading comprehension skills and facilitating the level of difficulty of any reading passage. Significant differences were identified relating to the respondents’ gender and academic year. Female students were more satisfied with e-learning than male students. It is recommended that in light of the rapid growth of e-learning in Saudi Arabia, educational institutions should provide online learning programs and develop well-structured courses for e-learning implementation.

S414 A Retrospective Review: Are We Under-Utilizing Barium Swallow Studies After a Normal EGD in Patients with Dysphagia?

Introduction: Upper endoscopy (EGD) is an effective tool in the initial evaluation of patients >40 years old presenting with dysphagia and concomitant heartburn, odynophagia, and weight loss. However, it can miss subtle esophageal strictures, motility disorders, and extrinsic abnormalities which may be diagnosed with barium swallow study, or esophagram. In this study, we assessed the utility of barium swallow exam in patients presenting with dysphagia who had a grossly normal EGD. Methods: A retrospective analysis was conducted at a tertiary hospital from January 2018 through March 2019. Patients presenting with dysphagia who underwent both an EGD and barium swallow study with a 13mm pill (either before or after EGD) were included. Patients with an abnormal EGD were excluded. We analyzed esophagram results in patients who had a grossly normal EGD, and data was examined with univariate analysis. Results: 67 total patients underwent both an EGD and barium swallow study, of which 27 had a grossly normal EGD. The mean age (SD) of our study population (N=27) was 56.1 years (15.5), with 16 males. Of the 27 patients, 9 (33.3%) had a normal barium swallow exam while 18 (66.7%) patients had an abnormal exam. 7 patients had findings consistent with oropharyngeal dysphagia, 7 revealed structural issues manifested by difficulty of passage of a 13mm pill suggesting gastroesophageal junction obstruction, 2 showed esophageal dysmotility characterized by tertiary contractions, and 2 patients were found to have gastroesophageal reflux disease on esophagram. Of note, 8 out of 27 patients underwent esophageal biopsies, of which 6 showed normal histology, however 3 of those patients were found to have structural abnormalities on esophagram. Esophageal biopsies were not taken in 19/27 patients, of whom 14 had abnormal findings on barium swallow study. Conclusion: Per ASGE guidelines, EGD is considered first-line for evaluation of dysphagia unless contraindicated. Barium swallow with a 13mm pill is another valuable diagnostic modality especially in patients with a normal EGD. Our study showed that barium swallow identified potential etiologies of dysphagia in 66.7% of patients with grossly normal EGD, which led to further work-up and/or treatment. We discovered structural abnormalities on barium swallow in 50% of patients with grossly and histologically normal EGD. Esophagram proved to be a helpful adjunct to EGD with biopsy in evaluating dysphagic patients, emphasizing its importance as a part of the diagnostic algorithm.Table 1.: Patient Demographics and Barium Swallow Study Results (N=27)

Revision of a Previous Capella Bypass due to dysphagia, GERD and Candy Cane Syndrome.

Capella ringed gastric bypass is a technical variant of gastric bypass which seeks to improve long-term outcomes with a greater restriction. Frequent complications are due to the band, due to its inclusion or slippage, without being able to reject others. Our purpose is to present the video of a revisional bariatric surgery made by laparoscopic approach in a patient with a previous open retrogastric retrocolic Capella gastric bypass. The patient presents dysphagia, gastroesophagic reflux disease (GERD), and pain, with a BMI of 36 kg/m2. Her supplementary tests show a hiatal hernia, GERD, and a Candy Cane Syndrome. The surgery was difficult due to multiple adhesions. Hiatal hernia was repaired and pillars were closed. The band was visualized intraoperatively close to the gastrojejunal anastomosis, although the high endoscopy did not detect neither stenosis nor difficulty of passage to the gastric pouch. It showed the retrogastric gastrojejunal anastomosis with a normal food loop and a 15-cm widened blind loop (Candy Cane Syndrome), which was resected. She had a left pneumonia and damage in left hepatic lobe (LHL). She was discharged after antibiotic treatment for 7 days. The patient has improved clinically, without dysphagia nor GERD. Her current BMI is 29.8 kg/m2. In conclusion, bariatric revisional surgery can lead to serious complications, but it is justified in patients withpoor quality of life. A ringed retrocolic retrogastric bypass poses more difficulties in revisional procedures. It is mandatory to know which technique was performed before. The duration of the procedure can result in more complications like liver damage.

Perspectives of intrauterine artificial insemination applicability in gilts

ABSTRACT: The application of the intrauterine artificial insemination (IUAI) technique allows optimization of a swine production system due to the reductions in volume and number of sperm cells in the insemination dose, and by reducing the time taken to perform the insemination. However, IUAI is not recommended for gilts due to the difficulty of intrauterine cannula passage through the cervix. This difficulty is associated mainly with the fact that the reproductive tract is smaller in gilts than in pluriparous females. However, few studies have evaluated the application of IUAI in gilts. In these studies, there are variations in approach concerning the definition of the success rate for cannula passage through the cervix, the type of cannula and the body characteristics of the gilts used, making it difficult to extrapolate the recommendation for the use of IUAI in gilts. Considering the evidence that such characteristics influence or even determine the success of the application of IUAI, there is a necessity for an understanding of the influence of these factors in the improvement and later application of the technique. Gilts represent about 15-20% of the breeding group, and the use of IUAI could optimize the processes of insemination on farms. The approach used in this review highlights the aspects that could aid in structuring further studies for improving IUAI in gilts, allowing its use on commercial farms.

Nanoparticles and nanothermia for malignant brain tumors, a suggestion of treatment for further investigations.

The current treatment for brain tumors, such as glioblastoma multiforme (GBM), has not been developed enough yet in order to fully heal them. The main causes are the lack of specificity of the treatments, the difficulty of passage of drugs through the blood-brain barrier, heterogeneity and tumor aggressiveness, and widespread dissemination in the brain. The application of nanoparticles (Nps) have been a breakthrough for both diagnostic imaging and targeted therapies. There have been numerous studies with different types of Nps in brain tumors, but we have focused on thermosensitive liposomes, which are characterized by releasing the chemotherapeutic agent included within its lipophilic membranes through heat. Furthermore, increasing the temperature in brain tumors through hyperthermia has been proven therapeutically beneficial. Nanothermia or modulated-electro-hyperthermia (MEHT) is an improved technique that allows to create hot spots in nanorange at the membrane rafts, specifically in tumor cells, theoretically increasing the selectivity of the damage. In scientific records, experiments that combine both techniques (thermosensitive liposomes and nanothermia) have never been conducted. We propose a hypothesis for further research.

Scleroderma and type 1 diabetes: a rare association

The association of type 1 diabetes and systemic scleroderma is rarely reported in the literature, the pathogenesis of this association is unknown, interferon seems to have a major role in being an immunomodulator and inhibitor of collagen production, and it is also involved in autoimmune pathology. Note that this association could be at the origin of a difficulty of passage of the insulin in the sites of injections, responsible for a major glycemic imbalance. We report the case of a 26-year-old patient, who had been diabetic for 6 years on insulin, who was referred for a glycemic imbalance, who had a clinical examination objectifying multiple morphea lesions on the roots of the thighs, arms, abdomen and thorax. A cutaneous biopsy was performed, showing a sclerodermiform appearance with significant fibrosis without sign of malignancy, result rather in favor of a scleroderma.

Abstract PR538

Background & Objectives: The appropriate pillow height for tracheal intubation with the Pentax-AWS Airwayscope® (AWS) has not been assessed. This randomised clinical trial aimed to compare pillow height for tracheal intubation with the AWS in patients undergoing elective surgery. Materials & Methods: This study was listed in the UMIN Clinical Trials Registry under registration number UMIN000018208. After obtaining approval from the Research Ethics Committee, 90 patients were assessed for study eligibility from September 2015 to January 2016. Of 90 patients, four refused to participate and six were excluded in accordance with eligibility criteria. 80 patients aged 20 to 85 years who were scheduled to undergo general anesthesia in the supine position were randomly assigned to one of two groups: intubation with a high pillow (HP group, 12-cm pillow height; 40 patients) or low pillow (LP group, 4-cm pillow height; 40 patients). Anesthesia was induced with propofol and remifentanil. Intubation time, number of attempts required for Intlock insertion and tracheal tube progression through the glottis, percentage of glottis opening, subjective difficulty of laryngoscopy and tube passage through the glottis using a visual analogue scale (VAS), and postoperative hoarseness and pharyngeal pain were assessed. P<0.05 was considered significant. Results: Intubation time was significantly shorter in the LP group than in the HP group (LP group: 27.9±12.3 s vs. HP group: 46.2±15.0 s; P<0.001). The number of Intlock insertions, Cormack classifications, and POGO scores did not differ between groups (P=0.14, P=0.69, P=0.38, respectively). The number of attempts for tracheal tube progression to the glottis was significantly smaller in the LP group than in the HP group (P=0.003). VAS scores for laryngoscopy and tube passage through the glottis were significantly smaller in the LP group than in the HP group (P=0.001 and P<0.001). Conclusion: Low pillow height facilitates tracheal intubation with the AWS by reducing intubation time, smoothing tracheal tube progression through the glottis, and diminishing postoperative hoarseness in anesthetised patients. Disclosure of Interest: None declared

Cricoid Pressure Impedes Tracheal Intubation With the Pentax-AWS Airwayscope®

Abstract Background It is unclear how cricoid pressure affects tracheal intubation with the Pentax-AWS Airwayscope® (AWS). We conducted a prospective randomized clinical trial in anaesthetized patients. Methods Sixty patients were allocated to either the cricoid pressure (CP) group (n+30) or the sham group (n+30). We compared the two groups with regard to intubation time, number of attempts required for insertion of the Intlock blade (disposable blade of the AWS) and tracheal intubation, percentage of glottic opening (POGO) score, and subjective difficulty of both laryngoscopy and passage of a tube through the glottis. Results Intubation time was significantly longer in the CP group (median 45[IQR40–59] s) than in the sham group (32[28–45] s) (P+0.003, 95% CI for median difference 5–24 s). The number required for insertion of the Intlock blade did not differ between the groups (P+0.08), but the number for tracheal intubation was significantly higher in the CP group (1 attempt in 14 patients, 2 in 7, 3 in 9) than in the sham group (1 attempt in 24 patients, 2 in 6; P+0.002). POGO score did not differ significantly between the groups (P+0.60), nor did the subjective difficulty of laryngoscopy (P+0.06). The visual analogue scale score for passage of a tube through the glottis was significantly higher in the CP group than in the sham group (P Conclusions Cricoid pressure impedes tracheal intubation using the AWS, and is associated with longer intubation time, which can be attributed to increased difficulty in the passage of a tube through the glottis. Clinical Trial registry number UMI18209.

Impact of pillow height on double-lumen endotracheal tube intubation with McGRATH MAC: a prospective randomized clinical trial

Study objectiveThis study aimed to compare the impact of pillow height on double-lumen tracheal tube (DLT) intubation with McGRATH MAC (McG) in patients undergoing elective surgery. DesignRandomized clinical trial. SettingOperating room. PatientsFifty adult patients scheduled for elective surgery under 1-lung ventilation with an American Society of Anesthesiologists physical status of 1 to 3. InterventionsDLT intubation with McG was performed with a high pillow (HP group; 25 patients) or low pillow (LP group; 25 patients) by anesthesiologists. MeasurementsIntubation time, number of laryngoscopy, number of tracheal intubation attempts to successful intubation, percentage of glottic opening score, and subjective difficulty of laryngoscopy and tube passage through the glottis were assessed. Main ResultsIntubation time was significantly shorter in the HP group compared with the LP group (HP: 32.1±14.9seconds vs LP: 49.4±11.2seconds, P<.001). The number of laryngoscopy were 1 (HP group, 22 patients; LP group, 17 patients), 2 (HP group, 3 patient; LP group, 7 patients), and 3 (HP group, 0 patient; LP group, 1 patient), with no significant difference between the 2 groups (P=.197). Although the percentage of glottic opening score did not significantly differ between HP and LP groups (HP: 95.6%±6.7% vs LP: 96.0%±12.3%, P=.08), the number of tracheal intubation attempts was significantly lower in the HP group compared with the LP group (P=.009). The visual analog scale score for laryngoscopy did not significantly differ between the 2 groups (P=.54). However, the visual analog scale for tube passage through the glottis was significantly higher in the LP group than in the HP group (P<.001). ConclusionsIntubation with an HP was associated with a better DLT intubation profile than with an LP with McG, possibly due to smoother tracheal tube progression through the glottis.

TCTAP C-002 Tips to Overcome the Difficulty of Stent Passage in LM to LAD Lesion with Heavy Calcification Presented with AMI

TCTAP C-002 Tips to Overcome the Difficulty of Stent Passage in LM to LAD Lesion with Heavy Calcification Presented with AMI

Cricoid pressure impedes tracheal intubation with the Pentax-AWS Airwayscope®: a prospective randomized trial

BackgroundIt is unclear how cricoid pressure affects tracheal intubation with the Pentax-AWS Airwayscope® (AWS). We conducted a prospective randomized clinical trial in anaesthetized patients. MethodsSixty patients were allocated to either the cricoid pressure (CP) group (n+30) or the sham group (n+30). We compared the two groups with regard to intubation time, number of attempts required for insertion of the Intlock blade (disposable blade of the AWS) and tracheal intubation, percentage of glottic opening (POGO) score, and subjective difficulty of both laryngoscopy and passage of a tube through the glottis. ResultsIntubation time was significantly longer in the CP group (median 45[IQR40–59] s) than in the sham group (32[28–45] s) (P+0.003, 95% CI for median difference 5–24 s). The number required for insertion of the Intlock blade did not differ between the groups (P+0.08), but the number for tracheal intubation was significantly higher in the CP group (1 attempt in 14 patients, 2 in 7, 3 in 9) than in the sham group (1 attempt in 24 patients, 2 in 6; P+0.002). POGO score did not differ significantly between the groups (P+0.60), nor did the subjective difficulty of laryngoscopy (P+0.06). The visual analogue scale score for passage of a tube through the glottis was significantly higher in the CP group than in the sham group (P<0.001). ConclusionsCricoid pressure impedes tracheal intubation using the AWS, and is associated with longer intubation time, which can be attributed to increased difficulty in the passage of a tube through the glottis. Clinical Trial registry numberUMIN000018209.

Utility of gum-elastic bougie for tracheal intubation during chest compressions in a manikin: a randomized crossover trial

PurposeThe utility of the gum-elastic bougie (GEB) as an assistive device for tracheal intubation during chest compressions has not been sufficiently validated. This study aimed to compare the utility of the GEB during chest compressions on an adult manikin. MethodsSeventeen novice physicians performed tracheal intubation on an adult manikin using the GEB with or without chest compressions. Intubation success rate, intubation time, subjective difficulty of laryngoscopy, and tube passage through the glottis were measured. P < .05 was considered as significantly different. ResultsAll novice physicians successfully secured the airway without chest compression with and without the GEB. In contrast, during chest compressions, 7 failed without the GEB, whereas only 1 failed with the GEB (P = .007). Intubation time was significantly longer with chest compressions regardless of GEB use (P < .001). Both laryngoscopy and tube passage through the glottis were perceived as significantly more difficult with chest compressions, regardless of GEB use (P < .001). Subjective difficulty of tube passage through the glottis during chest compression was perceived as significantly more easy by GEB application (P < .001). ConclusionsThese findings suggest that the GEB facilitates tracheal intubation during chest compressions performed by novice physicians in adult simulations.

Comparison of McGRATH MAC and Macintosh laryngoscopes for double-lumen endotracheal tube intubation by anesthesia residents: a prospective randomized clinical trial

Study ObjectiveThis study aimed to compare the utility of McGRATH MAC (McG) and Macintosh (McL) laryngoscopes for double-lumen endotracheal tube intubation in patients undergoing elective surgery. DesignRandomized clinical trial. SettingOperating room. PatientsFifty adult patients scheduled for elective surgery under 1-lung ventilation with American Society of Anesthesiologists physical status 1 to 3. InterventionsDouble-lumen endotracheal tube intubation was performed with the McG (McG group; 25 patients) or conventional McL (McL group; 25 patients) laryngoscope by anesthesia residents. MeasurementsThe number of attempts to successful intubation, intubation time, percentage of glottis opening score, and subjective difficulty of laryngoscopy and tube passage through the glottis were assessed. Main ResultsThe total numbers of intubation attempts were 1 (McG group, 24 patients; McL group, 16 patients), 2 (McG group, 1 patient; McL group, 8 patients), and 3 (McG group, 0 patient; McL group, 1 patient), with significant differences between the two groups (P = .018). Intubation time was significantly shorter in the McG group compared with the McL group (McG: 17.1 ± 4.6 seconds vs McL: 20.8 ± 5.9 seconds, P = .026). The percentage of glottis opening score was significantly higher in the McG group compared with the McL group (McG: 88.4% ± 13.7% vs McL: 71.4% ± 20.4%, P = .004). ConclusionsThe McG demonstrated a better intubation profile compared with the McL, possibly due to its ease of use for double-lumen endotracheal tube intubation.

Comparison of Pentax-AWS Airwayscope video laryngoscope, Airtraq optic laryngoscope, and Macintosh laryngoscope during cardiopulmonary resuscitation under cervical stabilization: a manikin study

The 2010 American Heart Association or European Resuscitation Council guidelines for cardiopulmonary resuscitation emphasize that rescuers should minimize interruption of chest compressions, even for endotracheal intubation. Cervical stabilization should also be maintained during traumatic cardiac arrest. The utility of the Pentax-AWS Airwayscope (AWS) video laryngoscope and Airtraq (ATQ) optic laryngoscope for airway management has been reported under cervical stabilization. We first evaluated ATQ utility during chest compression with or without cervical stabilization and then compared the AWS, ATQ, and Macintosh laryngoscope (McL) during chest compressions under cervical stabilization in a manikin. In the first trial, 19 novice doctors performed tracheal intubation with ATQ during chest compression with or without cervical stabilization. In the second trial, 21 novice doctors performed tracheal intubation on a manikin with cervical stabilization using AWS, ATQ, and McL with or without chest compression in a manikin. The rate of successful intubation, time to intubation, and subjective difficulty of use (visual analog scale) were recorded. In the first trial, intubation time during chest compression was significantly shortened under cervical stabilization compared to without cervical stabilization (P < 0.05). In the second trial, using McL, 3 participants failed to perform tracheal intubation without chest compression and 11 failed during chest compression (P < 0.05). Using ATQ, all intubations were successful without chest compression, but 5 failed during chest compression (P < 0.05). Intubation time was significantly prolonged by chest compression using McL or ATQ (P < 0.05). All participants successfully secured the airway with AWS regardless of chest compression, and chest compression did not prolong intubation time. Chest compression worsened the score on the visual analog scale of laryngoscopy in the McL trial (P < 0.05), but not in ATQ or AWS trials. Difficulty of tube passage through the glottis increased with chest compression with the McL and ATQ (P < 0.05) but not with AWS. The AWS was superior to McL and ATQ for endotracheal intubation during simulated cervical stabilization and chest compression.

Evaluation of tracheal intubation in several positions by the Pentax-AWS Airway Scope: a manikin study

In emergency situations, rescuers must occasionally secure the airway while the patient is in a restricted position rather than in the ideal supine position. We hypothesized that the Pentax-AWS Airway Scope (AWS) may be useful for emergent tracheal intubation in such positions. Thirteen non-anesthesia residents performed tracheal intubation on a simulated manikin in the supine (Supine), left-lateral decubitus (Left-LT), right-lateral decubitus (Right-LT), prone (Prone), and sitting (Sitting) position, respectively, to assess AWS performance. Intubations were successful in all five positions. The time needed to secure the airway did not differ significantly between the Left-LT and Supine positions. Doctors required significantly more time to secure the airway in the Prone, Sitting, and Right-LT positions than in the Supine position. Visual analog scale (VAS) scoring of the subjective difficulty of laryngoscopy was lower in the Supine position rather than in the Right-LT, Prone, and Sitting positions. The VAS score of subjective difficulty of tracheal tube passage through the glottis was significantly higher in the Sitting position than in the other four positions. Although tracheal intubations with AWS in all five positions tested were successful, intubation with the patient in the Sitting, Right-LT, and Prone positions was more difficult and required more time than that in the Supine position.

Federal Bills and Resolutions

The introduction of federal legislation, mandated by Article I, Section 7 of the United States Constitution, is in the form of bills and joint resolutions. This article reviews aspects of the lawmaking process in the context of constitutional amendments; commemorative legislation; pork-barrel measures, including logrolling; and a bill about the United coinage system. Throughout, the examples given show the difficulty of passage from bill to law, made deliberately arduous by the framers of the Constitution.