Intubation Time Research Articles

Effects of preoperative oral care on bacterial colonisation and halitosis in patients undergoing elective surgery: A randomised controlled study

ObjectivesTo evaluate the effects of single-dose chlorhexidine oral care on bacterial colonisation and halitosis in patients undergoing elective surgery. Research methodologyWe conducted a two-arm parallel, single-blinded, randomised controlled trial. The intervention group (n = 102) received preoperative oral care with 0.12% chlorhexidine gluconate, and the control group (n = 105) received standard care. The data of the microbiological cultures between the groups were compared at the time of tracheal intubation, at extubation and 30 min after surgery. The presence of halitosis was measured using a survey questionnaire administered to the anaesthesia nurses assigned to the patients. ResultsAt baseline, no significant differences were found between the intervention and control groups for bacterial colonisation or halitosis. After the intervention, there was no significant difference in microbiological culture, including gram-positive, gram-negative bacilli and cocci results, between the two groups (p > 0.05). The presence of halitosis in the intervention group was significantly lower than in the control group during intubation (p < 0.0001) and at 30 min after surgery (p < 0.02). Regression analysis indicated that receiving oral was protective towards halitosis, while poor oral health was a risk factor. ConclusionsPreoperative oral care using a single dose of chlorhexidine significantly improved the patients’ halitosis in the perioperative period, but no significant effect was found on bacterial colonisation. Further studies are needed regarding the safe use of chlorhexidine for oral care. Implication for clinical practiceOral hygiene using chlorhexidine could be beneficial in improving halitosis for anaesthesia personnel who take care of intubated adult patients undergoing elective surgery with general anaesthesia.

Low Patient Weight and Long Intubation Time Are Key Factors for Pain during Colonoscopy.

Although the clinical usefulness of colonoscopy has been established, the procedure remains painful for many patients. This study was designed to clarify the factors predicting colonoscopy-related pain. We evaluated 283 consecutive patients who completed a first-ever, total colonoscopy without sedatives or analgesics. The severity of pain symptoms was evaluated by a numeric rating scale (NRS) in a questionnaire immediately after the colonoscopy. Patient backgrounds and endoscopic findings were analyzed to evaluate their association with pain. Out of 283 patients, 53 scored their pain 0-1 on the NRS while 48 scored it 6-10. We defined the colonoscopies of the former and latter patients as painless and painful, respectively, and compared the two. Multivariate analyses revealed that low body weight (OR 4.95, 95%CI 1.89-12.99) and longer intubation time (OR 3.63, 95%CI 1.46-9.03) were significant risk factors for painful colonoscopy. To identify factors contributing to the increased intubation time, we divided subjects into short- and long-intubation-time groups based on a median insertion time of 7 min. Older age (OR 2.28, 95%CI 1.31-3.98), previous abdominal surgery (OR 1.93, 95%CI 1.13-3.32) and findings of invasive cancer (OR 10.90, 95%CI 1.34-88.90) were significant factors for longer intubation time.

S1257 Selective Common Bile Duct Cannulation Time During Endoscopic Retrograde Cholangiopancreatography: Effects of Dexamethasone

S1257 Selective Common Bile Duct Cannulation Time During Endoscopic Retrograde Cholangiopancreatography: Effects of Dexamethasone

Minimally invasive valve surgery including patients of combined simultaneous surgery: a retrospective study

ObjectiveThis study investigated the perioperative safety and advantages of performing a minimally invasive valve surgery (MIVS) and conducting a preliminary examination of the combined simultaneous surgery (CSS).MethodsA total of 29 patients (16 men and 13 women; mean age, 58.41 ± 13.08 years) who underwent MIVS at our center from July 2021 to March 2022 were selected. Among them, 16 patients underwent aortic valve surgery (AVS), 13 patients underwent mitral valve surgery (MVS), and four patients additionally underwent CSS.ResultsThe MIVS time ranged from 165 to 420 min, with a mean of 230.54 ± 54.61 min; the cardiopulmonary bypass (CPB) time ranged from 54 to 164 min, with a mean of 120.24 ± 25.98 min; the aortic cross-clamp (ACC) time ranged from 36 to 118 min, with a mean of 78.66 ± 21.01 min and an automatic heart resuscitating rate was 89.66%; the mean tracheal intubation time was 6.30 ± 3.87 h, and the median total postoperative drainage was 317.5 (35, 1470) ml. No difference was observed between preoperative and postoperative left ventricular ejection fraction (LVEF) (61.90% ± 6.28% vs. 60.21% ± 5.52%, P = 0.281). The difference in postoperative drainage (419.20 ml ± 377.20 ml vs. 588.75 ml ± 673.63 ml, P = .461), tracheal intubation time (6.66 h ± 4.27 h vs. 4.63 h ± 1.11 h, P = .359), intensive care unit (ICU) stay (3.96 ± 8.62 days vs. 2.00 ± 0.816 days, P = .658), and postoperative hospital stay (9.96 ± 8.45 days vs. 8.25 ± 1.26 days, P = .694) between MIVS and CSS was not significant.ConclusionMIVS in our center may be safe and effective. Additionally, CSS may be a feasible option that could be performed after a thorough preoperative evaluation and multidisciplinary discussion.

Monitoring tissue perfusion during extracorporeal circulation with laser speckle contrast imaging

Objective: The laser speckle contrast imaging (LSCI) system is a method to evaluate microcirculation. The primary aim of our study&#x0D; is to evaluate the relationship between LSCI and perfusion markers in coronary artery bypass grafting (CABG). Our second aim is to&#x0D; investigate the relationship between LSCI and extubation time in the intensive care unit.&#x0D; Patients and Methods: Fifteen patients aged 43-80 years who will undergo on-pump CABG were included in the prospective study.&#x0D; Mean arterial pressure (mmHg), heart rate (min-1), PO2 (mmHg), PCO2 (mmHg) and lactate (mmol/L) levels were measured preinduction,&#x0D; post-induction, 10th minute of the extracorporeal circulation, post-crossclamp, and post-operatively. At the same time&#x0D; points, LSCI values from the skin were measured and recorded. The intubation times of the patients were also recorded.&#x0D; Results: There was no significant change in systemic tissue perfusion markers (P&gt;0.05). LSCI perfusion values decreased significantly&#x0D; from induction and remained low until the end of surgery (P

Extra corporeal membrane oxygenation therapy in acute respiratory distress syndrome due to Coronavirus-2019 (COVID-19): a retrospective study

Aims: Extra corporeal membrane oxygenation (ECMO) has been used as a supportive treatment in ARDS due to COVID-19. Although different results have been reported in the literature regarding its efficacy, ECMO is recommended as a salvage therapy for severe forms of the disease after standard therapy fails. In our study,we aimed to evaluate the survival outcomes of patients supported with ECMO for COVID-19.&#x0D; Methods: Our study was conducted by scanning the data of consecutive adult patients hospitalized in our intensive care unit due to COVID-19. The ECMO process was planned according to the Extracorporeal Life Support Organization (ELSO) and Berlin criteria.&#x0D; Results: 51 patients hospitalized for acute respiratory failure due to COVID-19 were taken to ECMO. Demographic data of patients; 39 (76.5%) men and 12 (23.5%) women. 46 (90.2%) of the patients died. The mean intubation time before ECMO is 3.9 days, and the mean time for non-invasive mechanical ventilation is 5.8 days. The mean PaO2 value before ECMO was79.09 mmHg, the mean PCO2 value was 63.62 mmHg and the mean PaO2/FiO2 ratio was 82.80.&#x0D; Conclusion: The use of ECMO by considering prognostic factors and guidelines is seen as factors that increase the chance of success.Despite the fact that the patients were admitted to ECMO in accordance with the guidelines in our study, the high mortality rate suggests that there is a need for investigation of other supportive treatments and studies to reduce ECMO complications.

Cap-assisted colonoscopy can increase the rate of sessile serrated lesion detection at the left lateral decubitus position: A retrospective case-control study.

We investigated the effectiveness of cap-assisted colonoscopy conducted with the patient in the left lateral decubitus position at both the colonoscope's insertion and withdrawal timepoints compared to the effectiveness of colonoscopy without a cap conducted in the supine position at withdrawal. This was a case-control study, based on historical comparisons of patients over 2 time periods. The first group of patients underwent colonoscopies with a transparent cap and the patient was in the left lateral decubitus position at both the insertion and withdrawal timepoints from April to June 2019. The subsequent group underwent colonoscopies without a cap and with the patient in the supine position at withdrawal from July to September 2019. The rates of successful intubation, cecal intubation time, and number, size, shape, and location of the detected adenomas and sessile serrated lesions were compared between the 2 groups. Data from 644 colonoscopies (cap-assisted colonoscopy + left lateral decubitus position, n=320; other colonoscopies, n=324) were analyzed. The demographic characteristics and technical performances were similar. The SSL detection rate was significantly higher with cap-assisted colonoscopy and the left lateral decubitus position than with other colonoscopies (3.4% vs 0.93%, P=.029). The adenoma detection rates in the 2 groups were similar (31% and 28%, respectively, P=.43).Cap-assisted colonoscopy in the left lateral decubitus position may increase the detection rate of sessile serrated lesions compared to colonoscopy without a cap and supine position at withdrawal.

Comparison of video laryngoscope, video stylet, and flexible videoscope for transoral endotracheal intubation in patients with difficult airways: a randomized, parallel-group study

BackgroundThe 2022 ASA guidelines recommend the video laryngoscope, video stylet, and flexible videoscope as airway management tools. This study aims to compare the efficacy of three airway devices in intubating patients with difficult airways.MethodsA total of 177 patients were selected and randomized into the following three groups: the video laryngoscope group (Group VL, n = 59), video stylet group (Group VS, n = 59), and flexible videoscope group (Group FV, n = 59). The success rate of the first-pass intubation, time of tracheal intubation, level of glottic exposure, and occurrence of intubation-related adverse events were recorded and analyzed.ResultsAll patients were successfully intubated with three devices. The first-pass intubation success rate was significantly higher in Groups VS and FV than in Group VL (96.61% vs. 93.22% vs. 83.05%, P < 0.01), but it was similar in the first-pass intubation success rate between Groups VS and FV(P > 0.05). The number of patients categorized as Wilson-Cormack-Lehane grade I-II was fewer in Group VL than in Groups VS and FV (77.97% vs. 98.30% vs. 100%, P = 0.0281). The time to tracheal intubation was significantly longer in Group FV(95.20 ± 4.01) than in Groups VL(44.56 ± 4.42) and VS(26.88 ± 4.51) (P < 0.01). No significant differences were found among the three groups in terms of adverse intubation reactions (P > 0.05).ConclusionsIn patients with difficult airways requiring intubation, use of the video stylet has the advantage of a relatively shorter intubation time, and the flexible videoscope and video stylet yield a higher first-pass intubation success rate and clearer glottic exposure than the use of the video laryngoscope.Trial registrationChinese Clinical Trial Registry. No: ChiCTR2200061560, June 29, 2022.

Retrospective Analysis of Our Experience with Percutaneous Tracheostomy in Our Intensive Care Unit

Aim: Percutaneous tracheostomy (PT) application has advantages such as being able to be applied at the bedside in a short time and less bleeding. It is frequently preferred in intensive care units with indications such as prolonged artificial respiration requirement, facilitating weaning, and providing emergency airway. It is an alternative method to surgical tracheostomy. In this study, we aimed to retrospectively evaluate the percutaneous tracheostomy cases we performed in the Intensive Care Unit (ICU) in the last three years.&#x0D; Material and Methods: Patients who underwent percutaneous tracheostomy in the 3rd Level our Hospital between January 2018 and December 2022 were examined. Demographic data of the patients, diagnosis of hospitalization, Acute Physiology and Chronic Health Evaluation II Score (APACHE II score), hospitalization time, intubation time, time from intubation to tracheostomy, early and late complications of tracheostomy were retrospectively analyzed.&#x0D; Results: Ninety-seven patients were analyzed. The mean age of the patients was 77.6±10.9 (range, 41-100) years and the female-male ratio was 40/57. The most common hospitalization diagnosis was neurological reasons (54.6%). The patients were intubated for 20.3±7.9 (range, 7-48) days and the total length of stay in the ICU 65.3±30.3 (range, 17-175) days. The number of patients who developed complications related to the PT procedure was 17 (12.9%).&#x0D; Conclusion: Percutaneous tracheotomy, which is performed in the ICU with indications such as the need for prolonged mechanical ventilation, facilitating weaning, and providing an emergency airway, is a simple, minimally invasive procedure with a low complication rate.

Tongue retraction using a McIvor blade improves airway condition during fiberoptic intubation: a randomized controlled trial

Airway clearance is crucial for successful fiberoptic intubation. We hypothesized that tongue retraction using a McIvor blade could facilitate fiberoptic intubation. This randomized clinical trial aimed to compare intubation time and airway condition between the jaw thrust maneuver and tongue retraction with the McIvor blade during fiberoptic intubation. Ninety-four adult patients scheduled for elective surgery were randomly assigned to one of two groups. During fiberoptic intubation, airway clearance was secured by applying the jaw-thrust maneuver (J group) or by tongue retraction using the McIvor blade (M group). We assessed the total intubation time, number of attempts for tube advancement, and airway clearance at the soft palate and epiglottis levels. The total intubation time was significantly shorter in the M group than in the J group (p = 0.035). The number of attempts to advance the tube was significantly lower in the M group (p = 0.033). Airway clearance at the soft palate level was significantly better in the M group than in the J group (p = 0.027). Retracting the tongue with the McIvor blade demonstrated a better condition for fiberoptic intubation and shortened total intubation time compared with the jaw-thrust maneuver.Clinicalregistiration: CRIS; http://cris.nih.go.kr (KCT0002392) registered 28/07/2017.

An analysis of a new rapid difficult airway response team in a vertically built children's hospital.

Intrahospital transport is associated with adverse events. This challenge is amplified during airway management. Although difficult airway response teams have been described, little attention has been paid to patient transport during difficult airway management versus the alternative of managing patient airways without moving the patient. This is especially needed in a 22-floor vertical hospital. Development of a rapid difficult airway response team and an associated difficult airway cart will allow for the ability to manage difficult airways in the patient's primary location. A retrospective chart review of all rapid difficult airway response activations from December 18, 2019 to December 31, 2021 was performed to determine the number of airways secured in the patient's primary location (primary outcome). Secondary outcomes included length of time until airway securement, airway device used, number of attempts, complications, use of front of neck access, and mortality. There were 96 rapid difficult airway response activations in a 2-year period, with 18 activations deemed inappropriate. Of the 78 indicated rapid difficult airway response deployments, all activations resulted in a secure airway, and 76 (97.4%) of cases had an airway secured in the patient's primary location. The mean time to airway securement was 17.1 min (standard deviation 18.8 min). The most common methods of airway securement were direct laryngoscopy (42.3%, 33/78) and video laryngoscopy (29.5%, 23/78). The mean number of attempts by the rapid difficult airway response team was 1.4. There were no documented cases requiring front of neck access. The Cormack-Lehane airway grade at time of intubation was I-II in 83.3% (65/78) of activations. Rapid difficult airway response activation resulted in 16 cases of cardiac arrest and 4 patient deaths within 48 h. A rapid difficult airway response team allows a large majority of patients' airways to be managed and secured in the patient's primary hospital location. Future directions include reducing time to airway securement and identifying factors associated with cardiac arrest.

Management of respiratory failure in immune checkpoint inhibitors-induced overlap syndrome: a case series and review of the literature

BackgroundCheckpoint inhibitor-induced overlap syndrome ([OS] myocarditis, and myositis with or without myasthenia gravis) is rare but life-threatening.Cases presentationHere we present a case series of four cancer patients that developed OS. High troponinemia raised the concern for myocarditis in all the cases. However, the predominant clinical feature differed among the cases. Two patients showed marked myocarditis with a shorter hospital stay. The other two patients had a prolonged ICU stay due to severe neuromuscular involvement secondary to myositis and myasthenia gravis. Treatment was based on steroids, plasmapheresis, intravenous immunoglobulin, and immunosuppressive biological agents.ConclusionThe management of respiratory failure is challenging, particularly in those patients with predominant MG. Along with intensive clinical monitoring, bedside respiratory mechanics can guide the decision-making process of selecting a respiratory support method, the timing of elective intubation and extubation.

Predictors of Post-Operative Hospital Length of Stay Following Complete Repair of Tetralogy of Fallot in a Pediatric Cohort in the North of England

We sought to estimate the median post-operative length of stay (PLOS) and predictors of PLOS following tetralogy of Fallot (ToF) repair at a specialist surgical center in the North of England. The local National Congenital Heart Disease Audit dataset was used to identify patients aged < 2 years who underwent surgical repair for ToF between 1 January 1986 and 13 May 2022. Coefficients representing the median change in PLOS (days) according to predictors were estimated using Quantile regression. There were 224 patients (59.4% male, median age = 9 months, interquartile range (IQR) 5–13 months) with a median PLOS of 9 days (IQR 7–13). In the univariable regression, age (months) and weight (kg) at operation (β = − 0.17, 95% CI: − 0.33, − 0.01) and (β = − 0.53, 95% CI: − 0.97, − 0.10), previous (cardiac or thoracic) procedure (β = 5, 95% CI:2.38, 7.62), procedure urgency (elective vs urgent) (β = 2.8, 95% CI:0.39, 5.21), bypass time (mins) (β = 0.03, 95% CI:0.01, 0.05), cross-clamp time (mins) (β = 0.03, 95% CI:0.01, 0.06) and duration of post-operative intubation (days) (β = 0.81, 95% CI:0.67, 0.96), were significantly associated with PLOS. Previous procedure and intubation time remained significant in multivariable analyses. Some patient and operative factors can predict PLOS following complete ToF repair. Information on PLOS is important for health professionals to support parents in preparing for their child's discharge and to make any necessary practical arrangements. Health commissioners can draw on evidence-based guidance for resource planning. The small sample size may have reduced the power to detect small effect sizes, but this regional study serves as a foundation for a larger national study.

A prediction model of risk factors of poor wound healing after craniocerebral surgery.

To explore the independent risk factors of poor wound healing after craniocerebral surgery, and to generate a risk prediction model. A single-center retrospective observational analysis of 160 patients who underwent craniocerebral surgery in The 904th Hospital of the Joint Logistics Support Force of the PLA from February 2018 to February 2021 was carried out. Patients were divided into Group-A (n=70) and Group-B (n=90) according to postoperative wound healing outcome. Logistic regression was used to analyze the independent risk factors, and a nomogram prediction model was constructed using R software. The receiver operating characteristic (ROC) curve was used to test the predictive ability of the model, and the fitting effect was verified by Hosmer Lemeshow. The duration of operation, surgical site infection, diabetes mellitus, and the time of intubation in Group-B were significantly lower than Group-A (P<0.05). Serum albumin (ALB) and hemoglobin (HGB) in Group-B were significantly higher than those in Group-A (P<0.05). Logistic regression analysis showed that long operation duration, surgical site infection, duration of drainage tube, ALB <35g/L, and abnormal HGB were independent risk factors for poor wound healing (P<0.05). The area under the ROC curve (AUC) predicted by the model was 0.932, 95%CI (0.862~1.000). The Hosmer-Lemeshow goodness of fit test showed that the expected probability calculated by the model matched the actual probability (P>0.05). Long operation duration, surgical site infection, duration of drainage tube, ALB <35g/L, and abnormal HGB were risk factors for poor wound healing. The nomograph model based on these factors showed good discrimination, calibration, and clinical effectiveness in predicting poor wound healing.

Feasibility study of intubation in lateral position using Viva-sight double-lumen tube combined with video laryngoscope in patients undergoing pulmonary lobectomy

BackgroundDouble-lumen tube (DLT) intubation in lateral decubitus position is rarely reported. We designed this study to evaluate the feasibility of VivaSight double-lumen tube (VDLT) intubation assisted by video laryngoscope in lateral decubitus patients. MethodsPatients undergoing elective video-assisted thoracoscopic surgery (VATS) for lung lobectomy were assessed for eligibility between January 2022 and December, 2022. Eligible patients were randomly allocated into supine intubation group (group S) and lateral intubation group (group L) by a computer-generated table of random numbers. The prime objective was to observe whether the success rate of VDLT intubation in lateral position with the aid of video laryngoscope was not inferior to that in supine position. ResultsA total of 116 patients were assessed, and 88 eligible patients were randomly divided into group L (n = 44) and group S (n = 44). The success rate of the first attempt intubation in the L group was 90.5%, lower than that of S group (97.7%), but there was no statistical difference (p > 0.05). Patients in both groups were intubated with VDLT for no more than 2 attempts. The mean intubation time was 91.98 ± 26.70 s in L group, and 81.39 ± 34.35 s in S group (p > 0.05). The incidence of the capsular malposition in the group L was 4.8%, less than 36.4% of group S (p < 0.001). After 24 h of follow-up, it showed a higher incidence of sore throat in group S, compared to that in group L (p = 0.009). ConclusionOur study shows the comprehensive success rate of intubation in lateral decubitus position with VDLT assisted by video laryngoscope is not inferior to that in supine position, with less risk of intraoperative tube malposition and postoperative sore throat. Trial registrationChinese Clinical Trail Register (ChiCTR2200062989).

A randomized crossover comparison of the bébé VieScope and direct laryngoscope for pediatric airway management by nurses in medical simulation settings

ABSTRACT Background Airway management in life-threatening emergencies is essential for children, and endotracheal intubation is the gold standard. It protects against regurgitation and enables mechanical ventilation. New types of airway management equipment are being developed and implemented to meet the needs of medical personnel. Research design and methods This prospective, randomized, cross-over simulation trial evaluated the success of endotracheal intubation in three scenarios: normal airway (scenario-A), tongue edema (scenario-B), and continuous chest compression (scenario-C), using the bébé Vie Scope™ laryngoscope (VieScope) and the Macintosh blade laryngoscope (MAC) as a comparative tool performed by nurses with limited tracheal intubation experience. Results The results of the study showed that in scenario-A, there were no significant differences in the first attempt success rate or endotracheal intubation time between VieScope and MAC. However, VieScope was associated with better visualization of the glottis. In scenarios B and C, VieScope was significantly more effective than MAC in terms of first-pass success rate, time to intubate, Cormack-Lehane grade, POGO score, and ease of endotracheal intubation. Conclusions Bébé VieScope may be useful for endotracheal intubation in pediatric patients, particularly in cases of tongue edema and ongoing chest compression, providing a higher first-pass success rate than conventional laryngoscopes.

Direct versus indirect epiglottis elevation in cervical spine movement during videolaryngoscopic intubation under manual in-line stabilization: a randomized controlled trial

BackgroundDuring videolaryngoscopic intubation, direct epiglottis elevation provides a higher percentage of glottic opening score than indirect epiglottis elevation. In this randomized controlled trial, we compared cervical spine movement during videolaryngoscopic intubation under manual in-line stabilization between the two glottis exposure methods.MethodsVideolaryngoscopic intubation under manual in-line stabilization was performed using C-MAC® D-blade: direct (n = 51) and indirect (n = 51) epiglottis elevation groups. The percentage of glottic opening score was set equally at 50% during videolaryngoscopic intubation in both groups. The primary outcome measure was cervical spine movement during videolaryngoscopic intubation at the occiput–C1, C1–C2, and C2–C5. The secondary outcome measures included intubation performance (intubation success rate and intubation time).ResultsCervical spine movement during videolaryngoscopic intubation was significantly smaller at the occiput–C1 in the direct epiglottis elevation group than in the indirect epiglottis elevation group (mean [standard deviation] 3.9 [4.0] vs. 5.8 [3.4] °, P = 0.011), whereas it was not significantly different at the C1–C2 and C2–C5 between the two groups. All intubations were successful on the first attempt, achieving a percentage of glottic opening score of 50% in both groups. Intubation time was longer in the direct epiglottis elevation group (median [interquartile range] 29.0 [24.0–35.0] vs. 22.0 [18.0–27.0] s, P < 0.001).ConclusionsWhen performing videolaryngoscopic intubation under manual in-line stabilization, direct epiglottis elevation can be more beneficial than indirect epiglottis elevation in reducing cervical spine movement during videolaryngoscopic intubation at the occiput–C1.Trial registrationClinical Research Information Service (number: KCT0006239, date: 10/06/2021).

Surgical treatment of left-sided infective endocarditis with symptomatic neurological complications before surgery in China.

We aimed to investigate surgical treatment of left-sided infective endocarditis with symptomatic neurological complications before surgery. This was a retrospective study of patients with left-sided infective endocarditis and symptomatic neurological complications before surgery undergoing cardiac surgery between January 2006 and November 2022 at our hospital. Eight hundred thirty-two patients were divided into group with symptomatic neurological complications before surgery (n = 112) and without symptomatic neurological complications before surgery (n = 720). There were 48 operative deaths (5.4%). Univariate and multivariate analyses showed that symptomatic neurological complications before surgery is statistically significantly associated with in-hospital mortality following cardiac surgery and prolonged intubation time. Our study showed that symptomatic neurological complications before surgery are associated with increased in-hospital mortality following cardiac surgery and prolonged intubation time.

Comparison of Early Outcome of Off-pump and Conventional Coronary Artery Bypass Graft Surgery in Patients with Left Main Coronary Artery Disease with Left Ventricular Dysfunction

Left Main (LM) coronary artery disease and left ventricular dysfunction both are important predictors of in-hospital mortality. To avoid the harmful effects of cardio pulmonary bypass (CPB), many cardiac surgeons are using Offpump Coronary Artery Bypass (OPCAB) as an effective alternative to conventional CABG (CCAB) even in these sub-groups of patients. This study performed in the National Institute of Cardiovascular Diseases (NICVD) evaluated the early outcomes of OPCAB in terms of mortality and major post-operative morbidities and compared them with that of CCAB in patients with left main coronary artery diseases with left ventricular (LV) dysfunction. Total 120 patients with left main coronary artery disease with reduced left ventricular ejection fraction (&lt;_40%) were allocated into two groups: a) 60 patients who underwent OPCAB and b) another 60 patients who underwent conventional CABG between January 2012 and December 2017. All risk factors and co-morbidities were homogenously distributed between the two groups. Majority of the patients had triple vessel disease. Nearly three-quarters (73.3%) of patients in OPCAB group and 80% in CCAB group received 3 grafts (p=0.470). The mean total operative time (p&lt; 0.001), intubation times (p&lt;0.001), blood losses (p &lt; 0.001); requirements for blood and blood products (p &lt; 0.0010), intensive care unit stays (p&lt;0.001) and hospital stays (p&lt; 0.001) were all significantly lower in the OPCAB group. OPCAB is a safe and effective operative revascularization procedure for patients with left main coronary artery disease with left ventricular dysfunction and is associated with reduced morbidity.&#x0D; Bangabandhu Sheikh Mujib Med. Coll. J. 2022;1(1):04-08

Comparison of Intubating Conditions on the basis of Neuromuscular Monitoring versus Clinical Assessment Guided Tracheal Intubation: A Randomized Interventional Study

Background: Laryngoscopy and endotracheal intubation have been associated with marked hemodynamic responses and hazards. This study was undertaken with the purpose to compare the intubating conditions when the suitable time for intubation was judged by either clinical assessment or train-of-four monitoring.&#x0D; Methods: 60 patients without any difficult airway predictors, posted for surgery under general anaesthesia, were randomised into two groups. In Group A patients, the trachea was intubated after train of four counts became zero in adductor pollicis muscle, whereas in Group B patients, intubation was done after clinically judging jaw muscle relaxation. The primary objective was to compare Intubating conditions and mean duration of time between the administration of a neuromuscular blocker and endotracheal intubation. The secondary objectives included number of attempts, changes in hemodynamic parameters. Results were analysed by the Analysis of variance and chi-square tests.&#x0D; Results: In all Group A patients excellent and good intubating conditions were observed, whereas 25 out of 30 patients (83%) in Group B showed excellent and good intubation conditions. The mean time required for intubation was significantly longer in Group A compared to Group B (369 ± 79 s vs. 191 ± 5 s). HR and mean arterial pressure were significantly higher in Group B as compared to Group A after laryngoscopy and tracheal intubation (P &lt; 0.05).&#x0D; Conclusion: Better intubating conditions and more haemodynamic stability are seen after attaining complete relaxation of laryngeal muscles, as detected by neuromuscular monitoring of adductor pollicis muscle.