Suction Catheter Research Articles

Fluoroscopic removal of fractured, retained, embedded Z self-expanding metal stent using a guidewire lasso technique: A case report

BACKGROUNDThere are few reports of a fractured esophageal self-expanding metallic stent (SEMS) and the lasso retrieval technique, forming a guidewire loop by directing the guidewire back up the external stent for retrieval. CASE SUMMARYA 74-year-old man complained of dysphagia approximately 6 mo after radical resection of esophageal cancer. Benign anastomotic stenosis was diagnosed, and a 20 mm in diameter and 60 mm in length esophageal covered SEMS was inserted after repeated balloon dilatation. About 13.5 mo after stenting, dysphagia recurred and esophagography showed severe stenosis above the proximal stent and stent removal was performed. One-third of the stent was removed and the fractured stent remained in the proximal esophagus. A suction tube was introduced through the guidewire and then the guidewire was grabbed, acting like a “lasso” on tightening. The remaining fractured stent was successfully removed by slowly pulling back the guidewire, with no fragments of stent wires retained.CONCLUSIONThe guidewire lasso technique is a simple, effective method of removing esophageal SEMS in rare cases of stent fracture.

Simple smoke ventilation method for uniportal video-assisted thoracoscopic surgery.

Fogging of the thoracoscopic lens affects a surgeon’s ability to maintain a clear operating field. In uniportal video-assisted thoracoscopic surgery, the thoracoscopic lens tends to fog when the surgeon does not hold a suction instrument. Thus, a suction instrument needs to be held by the surgeon’s nondominant hand to remove surgical smoke, mist, and moisture. Here, we describe a simple, easy and cost-effective surgical smoke ventilation technique for uniportal video-assisted thoracoscopic surgery using a suction catheter to solve the problem. We present this technique and comment on its advantages, including decreased cost and improved surgical visualization.

The Yankauer suction tube sleeve technique.

The Yankauer suction tube sleeve technique.

Comparison of positive and negative pressure extubation after mechanical ventilation in intensive care unit patients

To investigate the effect of positive and negative pressure extubation on mechanical ventilation patients in the intensive care unit (ICU). A prospective randomized controlled study was performed, 105 ICU patients who successfully passed the spontaneous breathing test (SBT) after mechanical ventilation of Nanjing Jiangbei Hospital Affiliated to Nantong University from January 2019 to March 2021 were enrolled. According to random number table method, they were randomly divided into positive pressure extubation group (53 cases) and negative pressure extubation group (52 cases). During extubation, all patients were placed in semi-decubitus position (raising the head of bed at an angle range from 30 degree angle- 45 degree angle), the secretions from mouth, nose, throat and trachea were removed. In the negative pressure extubation group, the sputum suction tube was inserted into the tracheal tube and passed over the distal opening to carry out continuous negative pressure suction in the tracheal tube after disconnecting the ventilator. Meanwhile, after the tracheal tube balloon was evacuated, the sputum suction tube was pulled out together with the tracheal tube. In the positive pressure extubation group, the patients were guided to inspiratory forcibly under the original SBT mode. When the patients reached the inspiratory peak, the ballon was evacuated and the tracheal tube was removed. After extubation, all patients were given nasal catheter oxygen inhalation (oxygen flow 5 L/min). Arterial blood gas analysis indexes [pH value, arterial partial pressure of oxygen (PaO2) and arterial partial pressure of carbon dioxide (PaCO2)] were recorded 5 minutes and 1 hour after extubation in both groups. Vital signs (including tachypnea, tachycardia, elevated blood pressure and decreased oxygen saturation) and complications (including severe cough, airway hyperresponsiveness and pneumonia) were observed 30 minutes after extubation in both groups. Five minutes after extubation, blood gas analysis showed that the PaO2 of positive pressure extubation group was significantly higher than that of negative pressure extubation group [mmHg (1 mmHg ≈ 0.133 kPa): 123.4±30.2 vs. 111.0±21.1, P < 0.05], the pH value and PaCO2 in positive pressure extubation group were slightly lower than that of negative pressure extubation group [pH value: 7.411±0.042 vs. 7.419±0.040, PaCO2 (mmHg): 39.7±4.7 vs. 40.5±5.6], but the differences were not statistically significant (both P > 0.05). One hour after extubation, the pH value, PaO2 and PaCO2 in positive pressure extubation group were slightly lower than those in negative pressure extubation group, but the differences were not statistically significant. Within 30 minutes after extubation, the incedences of tachypnea, tachycardia, elevated blood pressure and oxygen desaturationin in positive pressure extubation group were significantly lower than those in negative pressure extubation group [tachypnea: 9.4% (5/53) vs. 28.8% (15/52), tachycardia: 15.1% (8/53) vs. 32.7% (17/52), elevated blood pressure: 11.3% (6/53) vs. 30.8% (16/52), oxygen desaturation: 7.5% (4/53) vs. 34.6% (18/52), all P < 0.05], the incidence of severe cough in positive pressure extubation group was significantly lower than that in negative pressure extubation group [9.4% (5/53) vs. 30.8% (16/52), P < 0.05], but there was no significant difference in the incidence of complications of airway hyperresponsiveness between the two groups [1.9% (1/53) vs. 5.8% (3/52), P > 0.05]. No pneumonia occurred in both groups within 48 hours after extubation. The positive pressure extubation method can ensure full oxygenation of patients undergoing mechanical ventilation in ICU, avoid hypoxia, and reduce the occurrence of hypoxia and severe cough, which is more conducive to the stability of vital signs.

Inter-Professional-Compassionate pain management during endotracheal suctioning: a valuable lesson from a Chinese surgical intensive care unit

Abstract Objective To compare the effects of a pain management program and routine suctioning methods on the level of pain presence and agitation in Chinese adults admitted to the intensive care unit. To disseminate the results from the implementation of the evidence-informed pain management interventions for reducing pain presence and agitation during endotracheal tube suctioning (ETS) and translate the key finding to clinical nursing practice. Methods A quasi-experimental study of a two-group post-test design was conducted in adults admitted after surgery to a surgical intensive care unit (SICU) of the Second Affiliated Hospital of Kunming Medical University, Yunnan, China in 2018. Fifty-two adults who met the study eligibility were included after consent, 26 in each group. Patients in the control group received usual care while patients in the intervention group received interventions to reduce agitation and pain-related ETS. The impacts of the intervention on the level of pain presence and agitation were measured at 5 measuring time points using the Chinese versions of Critical-Care Pain Observation Tool (CPOT) and Richmond Agitation Sedation Scale (RASS). Results The level of pain presence in the intervention group statistically significantly decreased during, immediately after, and 5 min after suctioning. The level of agitation in the intervention group significantly decreased during and immediately after suctioning. Conclusions The findings provide support for the positive pain-relieving effects of the evidence-informed pain-related ETS management interventions when compared with the usual ETS practice. The study interventions were sufficiently effective and safe to maintain patent airway clean and patent as standardized suctioning and helps pain relief. So, evidence-based pain-related ETS management intervention is worthy of recommending to utilize in SICU patients as well as other patients who required suctioning. It is worth noting that integrating pre-emptive analgesia prescription and administration with non-pharmacological intervention plays a critical role in achieving pain relief.

An Effective Method to Collect Bone Dust for Mastoid Cavity Obliteration.

To compare the volume of cortical bone dust collected and the time taken for bone dust collection by using a self-devised bone dust collector and that by manual method using a metal scoop in patients undergoing modified radical mastoidectomy with mastoid cavity obliteration. A prospective study was done in 62 patients of cholesteatoma. They underwent canal wall down mastoidectomy. Mastoid cavity was obliteration was done using cortical bone dust collected after dividing the patients randomly into 2 groups: (1) usinga collector device made using a mucous extractor fitted with a nylon mesh of size 1″ × 3″attached to the suction tube, (2) collected manually by using a metal scoop. The time taken for the collection of bone dust was recorded and the volume of bone dust collected was measured and recorded. We found that the time taken for the collection of bone dust was significantly lower and the volume of bone dust collected was higher using a mucous extractor as compared to that by manual collection using a metal scoop. The suction based mucous extractor performed better in terms of both time taken for collection and also in the volume of cortical bone dust that was collected as compared to manual collection using a metal scoop. Therefore, we conclude from our study that using the suction based mucous extractor is a more effective method of cortical bone dust collection for mastoid cavity obliteration.

Effect of minimally invasive premeasured suctioning on airway mucosal injury and suction-induced stress among mechanically ventilated neonates: A clinical challenge for nurses

PurposePerforming ETS to fragile neonates presents a clinical challenge and a dilemma facing nurses. The challenge is how to clear secretions successfully without causing complications. This study aimed to investigate the effect of Minimally Invasive Premeasured Suctioning (MIPS) on airway mucosal injury and suction-induced stress among mechanically ventilated neonates. Designand methods: A quasi-experimental, two groups, pre-post-test study was carried out in the NICU of University Specialized Hospital in Smouha, Alexandria. Sixty mechanically ventilated neonates were randomly assigned to two equal groups. A suction catheter was inserted into the Endotracheal Tube (ETT) until it reached the measured length then the negative pressure was applied. ResultsThe majority of neonates who received MIPS (83.3%) had no airway mucosal injury (clear secretion), while 44.4% of neonates in the deep suctioning group developed severe airway mucosal injury (bloody secretion). Moreover, 71.1% of neonates who received deep ETS developed a high-stress level compared to only 10% of the neonates in the MIPS group. ConclusionMeasuring the exact depth of suction catheter insertion effectively reduced airway mucosal injury and the subsequent level of stress among mechanically ventilated neonates.

Effect of Diameter and Fenestration Area of the Liposuction Cannula on the Viability of the Adipocytes.

Loss of volume is perhaps the most frustrating problem of fat grafting. The process of fat grafting depends on different variables such as harvesting, processing, and injection techniques. Results between studies that evaluate the effect of the cannula size on fat graft survival have been controversial. However, the role of the fenestration area of the cannula has not been described. Four custom-made cannulas with a single fenestration were used for this study. Cannulas vary in diameter and area of the fenestration. Healthy patients seeking primary liposuction of the abdomen for aesthetic reasons were included. Lipoaspiration was performed in a clockwise pattern, and the order of the cannulas was rotated. Negative pressure was maintained at 0.8 atm at all times. Ten ml of fat, obtained from the suction tube, was poured into 20-ml conical centrifugal tubes for further processing. One gram of lipoaspirate was extracted from each sample, and acridine orange stain was added. Adipocytes were extracted, extended in a frotis, and observed by a histologist (masked fashion) under fluorescence microscopy. Viability was reported in percentages per sample. The overall viability was 64.75% ± 18.58. The viability of the obtained samples ranged from 66.51± 20.66 % to 62.83 ± 18.1. In further analysis, comparing the viability according to the shaft diameter and fenestration area, there was no significant difference among groups. Neither the diameter of the cannula nor the size of the fenestrations are determining factors to affect the viability of the adipocytes. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Oropharyngeal suctioning and nasogastric tube insertion with a new mask for reduction of droplet dispersion: a proposal for a new preventive strategy during the coronavirus disease pandemic

Coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is spread via respiratory droplets in close contact [1]. Healthcare workers (HCWs) are at increased risk of COVID-19 as compared with the general community. The risk is highest among those working in the inpatient setting and nursing homes because their work requires close personal exposure to patients with SARS-CoV-2 [2]. Use of personal protective equipment (PPE), including gloves, masks, goggles or face shields, and gowns, can reduce nosocomial transmission, whereas inadequate PPE is considered to be a risk factor for acquiring COVID-19 [2,3].

The Binding Technique for Endoscopic Spontaneous Intracerebral Hemorrhage Evacuation

Recently many different endoscopic techniques have been used in spontaneous intracerebral hemorrhage evacuation. However, most of these techniques require expensive special equipment or a well-coordinated assistant. We present a simple and effective binding technique for endoscopic hemorrhage evacuation, which is especially useful during emergency treatment and suitable for use in less-developed areas. Our goal was to achieve easy and accurate hemostasis when using an endoscopic technique in which a single surgeon could operate 3 instruments (endoscope, suction tube, and bipolar forceps) with both hands simultaneously in the transparent tubular retractor. This modification, which we called the binding technique, was achieved by bundling the endoscope and suction tube with a sterile rubber band. We performed the binding technique for endoscopic removal of hematoma in 6 patients, including 3 basal ganglia hemorrhages, 2 brain lobe hemorrhages, and 1 cerebellar hemorrhage. The mean operative time was 117.5 minutes (range, 96-155 minutes). One patient died of postoperative delayed brainstem infarction. The Glasgow Outcome Scale score at 3 months was 5 in 3 patients, 3 in 2 patients and 1 (death) in 1 patient. The modified Rankin Scale score at 3 months was 0 in 3 patients, 4 in 2 patients, and 6 (death) in 1 patient. The binding technique is a modification that allows a single surgeon to achieve easy and accurate hemostasis in endoscopic surgery of intracerebral hematomas. This technique is easy to learn and suitable for emergency surgery, especially in less developed areas.

Evaluation of Aerosol and Splatter Production using Dental Handpieces and Ultrasonic Scalers during Dental Procedures: A Pilot Study

There have been many articles written about aerosols and splatter during dental procedures with the potential for disease transmission. Due to the global COVID-19 pandemic, aerosol production during dental procedures has been considered a potential disease transmission pathway. Since there is no documented cases of dental professionals acquiring SARS-Cov1 or COVID-19, we decided to see how much aerosol is produced by a Dental High speed drill and ultrasonic scaler. Also if the use of high volume suction can eliminate any aerosol transmission. A pilot study using Glo Germ in the water to evaluate under blacklight the aerosol pattern and spread produced by a high speed dental handpiece and an ultrasonic scaler was performed. The results found that high volume suction using an 8mm diameter suction tip eliminated aerosol spray spread with a high speed dental handpiece. Minimal aerosol spread was found with the use of a cavitron scaler.

Outcomes of Treating Tibial Shaft Fractures Using Intramedullary Nailing (IMN) versus Minimally Invasive Percutaneous Plate Osteosynthesis (MIPPO).

Background:Tibia shaft fractures are one of the most common long-bone fractures, second most common open sport-related injuries and they are estimated to occur in 4 percent of the senior population.Objective:Management of tibial fractures has been updating to achieve the best outcomes and avoid complications especially when talking about most common long bone fractures. Less invasive fixation techniques are the preferred ones to reduce surrounding soft tissue injury, improve healing process and decrease complications. Minimally invasive percutaneous plate osteosynthesis (MIPPO) and Intramedullary nailing (IMN) are the least invasive and most popular modalities used nowadays. This study compares outcomes and complications of both modalities.Methods:This is a retrospective cohort study conducted in orthopedics department at KAUH-Jordan. Patients were followed up for a mean of 15.3 months. Only MIPPO and IMN were used, and exclusively tibial shaft fractures were included. Open fractures were classified according to the Gustilo-Anderson classification. Results:Ninety patients with a mean age of 36.9 years (range, 9-79) were observed. Fifty nine of them were treated with IMN; nine of them had complications. Thirty one patients were treated with MIPPO and only three developed complications. Three patients treated with IMN had non-union, whereas none of MIPPO patients developed non-union. Only perioperative blood loss was more when MIPPO was used taking into consideration the amount in the suction tube, amount of fluid irrigation and soaked gauze.Conclusion:In treating tibial shaft fractures, MIPPO appears to cause fewer complications and provides better healing environment therefore attributes to lower non-union rates than IMN. Larger sample size might be needed to provide better results.

A Flexible Cystoscope Based on Hydrodynamic Cavitation for Tumor Tissue Ablation.

Hydrodynamic cavitation is characterized by the formation of bubbles inside a flow due to local reduction of pressure below the saturation vapor pressure. The resulting growth and violent collapse of bubbles lead to a huge amount of released energy. This energy can be implemented in different fields such as heat transfer enhancement, wastewater treatment and chemical reactions. In this study, a cystoscope based on small scale hydrodynamic cavitation was designed and fabricated to exploit the destructive energy of cavitation bubbles for treatment of tumor tissues. The developed device is equipped with a control system, which regulates the movement of the cystoscope in different directions. According to our experiments, the fabricated cystoscope was able to locate the target and expose cavitating flow to the target continuously and accurately. The designed cavitation probe embedded into the cystoscope caused a significant damage to prostate cancer and bladder cancer tissues within less than 15 minutes. The results of our experiments showed that the cavitation probe could be easily coupled with endoscopic devices because of its small diameter. We successfully integrated a biomedical camera, a suction tube, tendon cables, and the cavitation probe into a 6.7 mm diameter cystoscope, which could be controlled smoothly and accurately via a control system. The developed device is considered as a mechanical ablation therapy, can be a solid alternative for minimally invasive tissue ablation methods such as radiofrequency (RF) and laser ablation, and could have lower side effects compared to ultrasound therapy and cryoablation.

A comparative study of the effect of dexamethasone versus its use with clonidine on postoperative sore throat and hoarseness of voice

Regardless of some preventive measures, postoperative sore throat (POST) and hoarseness of voice are most undesirable and most frequent complication in the post-operative period [1,2]. Postoperatively it seems reasonable that most of the signs and symptoms are the result of mucosal injury which leads to inflammation caused by the process of air way instrumentation, also its postulated etiology has been associated with mucosal dehydration or edema, tracheal ischemia secondary to the pressure of endotracheal tube cuffs, aggressive oropharyngeal suctioning and mucosal erosion from friction between delicate tissues and the endotracheal tube (ETT) [4,5]. Aim, the primary outcome was to compare between the effects of Dexamethasone alone versus its use with Clonidine on post-operative sore throat. The secondary outcome was to compare between the effects of Dexamethasone alone versus its use with Clonidine on post-operative hoarseness of voice. Method, this prospective controlled randomized double- blind study was carried on 126 patients divided into two groups the Dexa group 63 and Dexaclonidine group 63. Randomization were done by using closed envelop technique opened immediately before induction by an anaesthetist who was unaware of the study protocol and responsible for preparing the study drugs. Patient in Dexaclonidine group received oral 150 microgram Clonidine tablet one hour before induction, whereas patients in the Dexa group received placebo which is multivitamin tablet with the same shape and size of Clonidine. Both Clonidine and placebo were covered with nontransparent paper. Patients in both groups were received 5 ml of normal saline containing Dexamethasone (8 mg) iv at 30 min before anaesthetic induction. Sedation with midazolam was given (0.05 mg/kg) IV 15 minutes before surgery for the two groups. On arrival to operating room patients were cannulated and monitored with electrocardiography, non-invasive blood pressure, pulse oximetry and capnography. Anaesthesia was induced with intravenous propofol (2 mg/kg) and fentanyl (1–1.5 micro g/kg) after approximately 5 min of preoxygenation and face mask ventilation. Rocuronium (0.6–0.8 mg/ kg) was administered to facilitate endotracheal intubation after using of nerve stimulator (train of four) to ensure complete muscle relaxation before intubation, an endotracheal tube were inserted (ETTs) after Cormack-Lehane scoring (13) of internal diameter 7.0 and 7.5 were used for females and males, respectively by Direct laryngoscopy with either a Macintosh blade size 3 or 4. The ETTs were inserted so that the vocal cords were located between the two indicator marks on the proximal part of the tube shaft. Intubations were confirmed by capnography and chest auscultation for equality of air entry on both sides. None of the patients received topical lidocaine or lidocaine jelly during the intubation procedure. The lungs were ventilated with 50% air 50% oxygen; ventilation was adjusted to maintain an end tidal carbon dioxide of 35–45 mmHg. Anaesthesia was maintained with isoflurane and intermittent bolus dose of rocuronium. Isoflurane concentration was adjusted to minimal alveolar concentration (MAC) 1–1,5% according to haemodynamics. After the end of surgery, residual neuromuscular relaxation was reversed by Neostigmine (0.03_0.07 mg/ kg) and Atropine (0,02–0,1 mg/kg). Oropharyngeal suction was gently performed under direct vision by soft suction catheter with sideway port to avoid trauma to the tissues before extubation, one end of the catheter was attached to an aspirator or collection canister and the unattached end was placed directly into a tube to extract secretions safely without injury to the mucous membranes. Conclusion From this study including that addition of clonidine to dexamethasone was more superior in reducing POST &amp; hoarseness of voice than dexamethasone alone, resulted in more haemodynamic stability in both intra operative and early post-operative period. Result From this study, there was statistically significant difference between the two studied groups regarding the sore throat and hoarseness of voice incidence and grade (P value &lt; 0.05). so, Addition of clonidine to dexamethasone was more superior in reducing POST &amp; hoarseness of voice than dexamethasone alone.

Preloading of the suction catheter on I-gel: A stitch in time saves nine!!

Preloading of the suction catheter on I-gel: A stitch in time saves nine!!

Biodiversity assessment of Phlebotomine (Diptera: Psychodidae) in an environmental impacted area in Rio de Janeiro State, Brazil.

ABSTRACTFrom October 1994 to September 1996, in the municipality of Mangaratiba, Rio de Janeiro State, phlebotomines were captured on the walls of the houses by means of a manual suction tube and light traps, in the household, the peridomicile and in the forest. As it is an area undergoing a real expansion and an increment in the local tourism, with the purpose of assessing changes in the phlebotomine fauna caused by environmental changes in the region, new captures were made in the same location from October 2015 to September 2016, this time using only light traps. In the two phases of the study, a total of 6,681 phlebotomines were captured. The results indicated that Ny. intermedia and Mg. migonei are fully adapted to this anthropic environment, while Pi. fischeri was more abundant and eclectic, and was probably attracted to exercise hematophagy. Nyssomyia intermedia can be suggested as the main vector of the etiological agent of the American Tegumentary Leishmaniasis in the studied areas. Pintomyia fischeri can also transmit Leishmania braziliensis, both in the environment altered by human action, and in the wild environment. Phlebotomines were captured in greater numbers between 6 and 8 pm in the peridomicile and between 9 and 11 pm in the household. The highest densities of phlebotomines were recorded in December, January and February. Despite almost 20 years between the two studies in the municipality of Mangaratiba, there was no change in the profile of the phlebotomine fauna in general; however, there was a greater density of species of medical importance in areas that suffered environmental impacts.

Enhanced access and isolation by simple modifications of dental armamentarium.

A good armamentarium facilitates the efficient working of the dentist which in turn improves the quality of treatment rendered to the patient. The present invention of the unit consisting of the flexible mirror attached to the suction and the dual suction tip aims at improving the clinical efficiency of dental treatments provided. This compact unit is designed to improve the visualization and isolation of the operating field. It is also easy to fabricate and alleviates the very relevant shortcomings of clinical work.

Chapter 8 - Intraoperative mapping and monitoring during brain tumor surgeries

Many different methodologies and paradigms are available to guide surgery of supratentorial tumors with the aim to preserve quality of life of the patients and to increase the extent of tumor resection. Neurophysiologic monitoring techniques (such as different evoked potentials) may help to continuously assess functional integrity of the observed systems and warn about vascular injury. For neurophysiologic mapping methods, the focus is not only to preserve cortical sites, but also to prevent injury to subcortical pathways. Therefore, cortical mapping is not enough but should be combined with subcortical mapping to identify tracts. This may be done by alternating resection and stimulation, or by continuous mapping via an electrified surgical tool such as a stimulating suction tip. Increasingly refined techniques are evolving to improve mapping of complex motor networks as well as language and higher cortical functions. Finally, in deciding between an awake vs asleep intraoperative setting, various factors need to be considered, such as the surgical goal, patient expectation and cooperation, treating team expertise, and neurooncologic aspects including histopathology. Therefore, the choice of protocol depends on the clinical context and the experience of the interdisciplinary team treating the patients.

Laparoscopic cholecystectomy for the treatment of acute cholecystitis in a Vietnamese male patient with ankylosing spondylitis combined with chronic obstructive pulmonary disease: A rare case report.

IntroductionAnkylosing spondylitis (AS) presents with difficulty in intubation, restricted ventilatory abnormalities, and frequent cardiac involvement. However, with improvements in anaesthesiology and surgical expertise, laparoscopic cholecystectomy can be extended to individuals with kyphoscoliosis caused by AS.Case presentationWe report the case of a 68-year-old man who had severe AS for more than 30 years following necrosis acute cholecystitis. Signs of severe AS included the patient's inability to lie down and difficulty in breathing. We utilised four trocars but changed the placement positions and used suction tubes during laparoscopic cholecystectomy. The patient was discharged from the hospital after 14 days.DiscussionSevere AS is not a contraindication to laparoscopic surgery. However, patients with AS or kyphosis must be carefully assessed for respiratory dysfunction, cardiac impairment, difficult airway, and other special conditions. Anaesthesiologists and surgeons should collaborate with surgical decisions in patients with severe respiratory limitations.ConclusionLaparoscopic cholecystectomy can be performed effectively in patients with severe AS. With the use of a laparoscopic hook and suction equipment, it is possible to easily dissect the Calot triangle during acute cholecystitis.

Bionomy of Mosquitoes in Bamboo Internodes in an Atlantic Forest Remnant of the State of Rio De Janeiro, Brazil.

Living bamboo stalks are one of the most specialized habitats for mosquito oviposition and immature development. Most of the mosquito species that breed in these habitats are sylvatic, and some are of importance for public health as possible vectors of pathogens. Perforated internodes are a very specialized environment due to the difficulty of access. Furthermore, due to their relatively simple fauna, they represent a valuable model for ecological studies that may be applicable to more complex environments. This study aims to assess the mosquito bionomics of species raised in bamboo internodes. Therefore, the diversity of mosquito species and the influence of abiotic variables (pH and temperature) on the distribution of mosquitoes that breed in this habitat were analyzed. The study area is a fragment of Atlantic Forest within the Association of da Armada (ATA) in Nova Iguaçu, state of Rio de Janeiro, Brazil. Immature mosquitoes were sampled with suction tubes (mouth aspirators) between August 2017 and July 2018. A total of 3,170 larvae were collected in 5 bamboo plants, each with 8 stalks perforated. Of these, 688 larvae reached the adult stage, representing 10 genera and 19 species. The most common species were Culex neglectus (43%), Trichoprosopon digitatum (22%), Culex iridescens (8%), Sabethes identicus (7%), and Orthopodomyia albicosta (7%). The richness of the immatures collected in the ATA was 19 species, with a diversity of 1.10 and Shannon evenness of 0.57. A diverse composition of Culicidae in bamboo stalks was found, although dominance was low.