Thrust Maneuver Research Articles

Interrater reliability of different scoring systems for drug-induced sleep endoscopy

PurposeTo explore the interobserver reliability of drug-induced sleep endoscopy (DISE) for patients with obstructive sleep apnea syndrome (OSAS) of two classification systems.MethodsDISE examinations were recorded digitally for all patients and were evaluated independently by five examiners blinded to all patient data. Areas of obstruction were rated using VOTE (velum, oropharynx lateral wall, tongue base, epiglottis) classification and PTLTbE (palate, tonsils, lateral pharyngeal wall, tongue base, epiglottis) classification. Additionally, palatal coupling was assessed during the jaw thrust maneuver. Interobserver reliability was evaluated with Fleiss’ kappa for categorical data and linearly weighted kappa for ordinal data.ResultsIn total, 123 patients were included in this study, 92 males and 31 females, with a mean (SD) age of 50.7 (12.1) years and a body mass index (BMI) of 28.3 (5.0) kg/m2. The mean apnea-hypopnea index was 22.2 (18) per hour, and the Epworth Sleepiness Scale was 7.3 (2.3). In our cohort, the interobserver reliability for the VOTE classification ranged from 0.32 to 0.59 and for the PTLTbE classification from 0.23 to 0.49 over all assessed levels, indicating fair to moderate interobserver reliability. The weighted kappa for palatal coupling was 0.37. In the VOTE classification, the level with the best agreement was the velum, while in PTLTbE, the best agreement was observed for tonsillar obstruction.ConclusionThe interrater agreement was fair to moderate for both classifications, with no clear superiority for one classification. The large variability shows the need to objectively quantify upper airway collapse during DISE and natural sleep endoscopy.

Safety of propofol sedation administered by interventional radiologists for radiofrequency ablation in patients with hepatocellular carcinoma

PurposeTo evaluate the safety of propofol sedation administered by interventional radiologists during radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC).Materials and methodsPropofol sedation was administered by interventional radiologists in 72 patients (85 procedures, 93 tumors) during RFA for HCC between August 2018 and December 2020. Interventional radiologists equipped with adequate knowledge and skills in sedation and respiratory management were responsible for sedation. Sedation was carefully assessed based on vital signs, including end-tidal carbon dioxide, consciousness status, and bispectral index. The primary endpoint was the incidence of sedation-related complications, which were evaluated separately as respiratory and cardiovascular complications. Secondary endpoints were technical success rate, ablation-related complications, and local tumor control rate. Technical success was defined as completion of ablation in the planned area. Complications were evaluated using the Clavien–Dindo classification. Sedation-related complications, technical success rate, and ablation-related complications were evaluated on a procedure basis, and local tumor control was evaluated on a tumor basis.ResultsRespiratory and cardiovascular complications were observed in eight (8/85, 9.4%) and two (2/85, 2.4%) patients, respectively. Four patients required the jaw thrust maneuver due to glossoptosis, whereas a decrease in oxygen saturation to < 90% was recorded in the other four patients. However, these were temporary, and none required manual ventilation or endotracheal intubation. Bradycardia (< 50 bpm) was detected in two patients; one recovered immediately without treatment, whereas the other rapidly improved after atropine sulfate administration. No severe hypotension (< 80 mmHg) was observed. The technical success rate was 100% (85/85). Grade 3 ablation-related complications were identified in three patients (3/85, 3.5%). The local tumor control rate was 95.7% (89/93).ConclusionPropofol sedation can be safely administered by interventional radiologists during RFA for HCC. Although it requires special safety considerations, it may be a sedation option during hepatic RFA.

Comparison of Three Airway Maneuvers of Jaw Thrust, Two-Handed E-C Technique With Head in Neutral Position, and Two-Handed E-C Technique With Head Fully Extended: A Prospective, Randomized, Double-Blind Crossover Study.

Background Bag-mask ventilation is an essential life-saving skill. The E-C technique of mask holding is the most popular. In patients with suspected cervical injury, the jaw thrust maneuver is recommended instead of the E-C technique with head tilt-chin lift. Should jaw thrust fail to produce adequate chest rise, the operator is advised to switch to the E-C technique with the head tilt-chin lift maneuver with head extension as it is vital to move oxygen into the lungs. We hypothesized that the E-C clamp with the head in the neutral position without head tilt might permit adequate ventilation without producing excessive movement of the cervical spine, which in turn might translate as less strain to the cervical spine. Methods In this prospective, randomized, double-blind, crossover study, we evaluated the relative efficacy of three airway maneuvers in opening the airway in anesthetized and paralyzed adults: jaw thrust, two-handed E-C technique with head in the neutral position, and two-handed E-C technique with head fully extended. The tidal volume generated during mechanical ventilation using these three techniques was considered as the primary outcome. Seventy-two subjects were recruited for this trial and all three techniques of mask holding were performed in each of these subjects in a sequence as dictated by a randomization table. Results The jaw thrust technique provided a mean tidal volume significantly higher than the two-handed E-C technique, with the head in the neutral position (p<0.001). Similarly, the two-handed E-C technique with the head fully extended provided a mean tidal volume significantly higher than the two-handed E-C technique with the head in neutral position (p<0.011). The mean tidal volume obtained with jaw thrust and two-handed E-C technique with head fully extended were comparable (p=0.78). Conclusion The two-handed E-C technique with the head fully extended, and the jaw thrust technique both produce good and comparable tidal volumes. The two-handed E-C technique with the head in a neutral position provides adequate though lower tidal volumes as compared to the other two techniques.

Comparison of the Effect of the Jaw Thrust Maneuver, Chin Lift, Head Rotation, and Tongue Protrusion on the Obstruction of Different Levels of the Upper Airway During the Drug-Induced Sleep Endoscopy: A Cross-Sectional Study.

The online version contains supplementary material available at 10.1007/s12070-023-04470-1.

The effect of a spinal thrust manipulation's audible pop on brain wave activity: a quasi-experimental repeated measure design.

High velocity thrust manipulation is commonly used when managing joint dysfunctions. Often, these thrust maneuvers will elicit an audible pop. It has been unclear what conclusively causes this audible sound and its clinical meaningfulness. This study sought to identify the effect of the audible pop on brainwave activity directly following a prone T7 thrust manipulation in asymptomatic/healthy subjects. This was a quasi-experimental repeated measure study design in which 57 subjects completed the study protocol. Brain wave activity was measured with the Emotiv EPOC+, which collects data with a frequency of 128 HZ and has 14 electrodes. Testing was performed in a controlled environment with minimal electrical interference (as measured with a Gauss meter), temperature variance, lighting variance, sound pollution, and other variable changes that could have influenced or interfered with pure EEG data acquisition. After accommodation each subject underwent a prone T7 posterior-anterior thrust manipulation. Immediately after the thrust manipulation the brainwave activity was measured for 10 seconds. The non-audible group (N=20) consisted of 55% males, and the audible group (N=37) consisted of 43% males. The non-audible group EEG data revealed a significant change in brain wave activity under some of the electrodes in the frontal, parietal, and the occipital lobes. In the audible group, there was a significant change in brain wave activity under all electrodes in the frontal lobes, the parietal lobe, and the occipital lobes but not the temporal lobes. The audible sounds caused by a thoracic high velocity thrust manipulation did not affect the activity in the audible centers in the temporal brain region. The results support the hypothesis that thrust manipulation with or without audible sound results in a generalized relaxation immediately following the manipulation. The absence of a significant difference in brainwave activity in the frontal lobe in this study might indicate that the audible pop does not produce a "placebo" mechanism.

Effectiveness of the Abdominal Thrust Maneuver for Airway Obstruction Removal: Analysis of Data from the National Emergency Medical Services Information System.

Foreign body airway obstruction (FBAO) is a life-threatening emergency. Abdominal thrusts are recommended as first aid, but the success rate for this technique is unclear. Using information from a large database of emergency medical services (EMS) data in the United States, we evaluated the success rate of abdominal thrusts and identified patient characteristics that were associated with the success of the technique. A retrospective observational study was conducted using data from the National Emergency Medical Services Information System (NEMSIS) to ascertain the success of abdominal thrusts in patients with FBAO from nearly 14,000 EMS agencies. Success was defined by positive evaluations on subjective and objective EMS criteria. Analysis of 1,947 cases yielded a 46.6% success rate for abdominal thrusts in removing obstructions. The age distribution was bimodal, with peaks during infancy and old age. June had the highest incidence of FBAO. Incidents were most frequent during lunch and dinner times, and most cases occurred in private residences. The first-time success rate was 41.5%, and a lower level of impaired consciousness was associated with lower success rates. A lower incidence of cardiac arrest was noted in successful cases. The success rate was high (60.2%) for children (age ≤15 years), with differences in demographic characteristics and a lower rate of impaired consciousness and cardiac arrests, as compared with unsuccessful interventions in the same age group. Our study showed a 46.6% success rate for abdominal thrusts in patients with FBAO. The success group had a lower proportion of impaired consciousness and cardiopulmonary arrest than the failure group. Future studies should attempt to identify the most effective maneuvers for clearing airway obstruction.

Assessment of chiropractic intervention influence on pain and life quality in cervicogenic headache afflicted office workers: a review

Cervicogenic headache, characterized by referred pain perceived in the head but originating from the cervical spine, is a prevalent non-migraine headache impacting a significant proportion of the global population, particularly office workers. Recent studies have identified a co-occurrence of cervicogenic headaches with neck pain, often exacerbated by long hours of stationary sitting and computer use common in desk jobs. Despite the growing evidence supporting the effectiveness of chiropractic treatment in mitigating head and neck pain, a distinct gap persists in the literature concerning chiropractic interventions specifically targeting office workers suffering from cervicogenic headaches. This review aims to scrutinize the current literature on the effectiveness of chiropractic interventions on pain management and life quality improvement for office workers afflicted with cervicogenic headaches. Specifically, the review will delve into high-velocity, low-amplitude (HVLA) thrust maneuvers, a widely employed strategy in spinal manipulative therapy, an extension of chiropractic treatment. In the context of cervicogenic headaches, the link between the Rectus Capitis Posterior Minor (RCPM) muscle and the Dura Mater, and how neck strains affecting this connection can instigate headaches, will be explored. Through the comprehensive evaluation of existing literature and studies, this review seeks not only to elucidate the potential of chiropractic treatment in improving the life quality of office workers suffering from cervicogenic headaches, but also to stimulate further research in this essential yet under-explored area of study.

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.

Regularized direct method for low–thrust trajectory optimization: Minimum–fuel transfer between cislunar periodic orbits

Low–thrust propulsion systems of high specific impulse are advantageous in the fuel efficiency. The fuel expenditure is further reduced together with optimization techniques though fuel–optimal low–thrust trajectories result in a discontinuous bang–bang control structure that can cause numerical difficulties. The present paper introduces regularized formulations into the direct multiple shooting method of minimizing fuel expenditure for low–thrust spacecraft trajectories. Instantaneous velocity changes approximating low–thrust maneuvers are expressed by regularized variables based on the Levi–Civita or Kustaanheimo–Stiefel transformation. The new formulation removes singularities due to null thrust impulses from derivatives of an objective function and constraints. The method automatically and robustly finds fuel–efficient bang–bang control structures for multi–revolutional transfers between periodic orbits in the Earth–Moon circular restricted three–body problem.

The effect of capnography on the incidence of hypoxia during sedation for EGD and colonoscopy in mildly obese patients: a randomized, controlled study

BackgroundBy continually monitoring end-tidal carbon dioxide concentrations, capnography can detect abnormal ventilation or apnoea early. This randomized, controlled study explored the effect of early intervention with capnography on the incidence of hypoxia in mildly obese patients undergoing sedation for esophagogastroduodenoscopy (EGD) and colonoscopy.MethodsThis is a single-center, randomized, single-blind, parallel-assignment, controlled trial. Mildly obese patients (28 kg/m2 ≤ BMI < 40 kg/m2) undergoing sedation for EGD and colonoscopy were randomly assigned to either the standard or capnography group. Standard cardiopulmonary monitoring equipment was used in both groups, and additional capnography was performed in the capnography group. In the event of inadequate alveolar ventilation during sedation, five interventions were administered in sequence (a-e) : a: increasing oxygen flow (5 L/min); b: a chin lift or jaw thrust maneuver; c: placement of the nasopharyngeal airway and chin lift; d: mask positive-pressure ventilation, and e: ventilator-assisted ventilation with tube insertion. The primary outcome was the incidence of hypoxia (SpO2 < 90%, ≥ 10 s) in each group. The secondary outcomes included the incidence of severe hypoxia (SpO2 ≤ 85%), subclinical respiratory depression (90% ≤ SpO2 < 95%), interventions, minimum SpO2 during operation, patient satisfaction, endoscopist satisfaction, and other adverse events of anesthesia sedation.Results228 patients were included (capnography group = 112; standard group = 113; three patients were excluded) in this study. The incidence of hypoxia was significantly lower in the capnography group than in the standard group (13.4% vs. 30.1%, P = 0.002). Subclinical respiratory depression in the capnography group was higher than that of the standard group (30.4% vs. 17.7%, P = 0.026). There was only a 5.4% incidence of severe hypoxia in the capnography group compared with 14.2% in the standard group (P = 0.026). During sedation, 96 and 34 individuals in the capnography and standard groups, respectively, underwent the intervention. There was a statistically significant difference (P < 0.0001) in the number of the last intraoperative intervention between the two groups ( a:47 vs. 1, b:46 vs. 26, c:2 vs. 5, d:1 vs. 2, e:0 vs. 0 ). No significant differences were found between the two groups in terms of minimum SpO2 during operation, patient satisfaction, or endoscopist satisfaction rating. There was no statistically significant difference in adverse events of anesthesia sedation between the two groups.ConclusionCapnography during sedation for EGD and colonoscopy allows for the detection of apnea and altered breathing patterns in mildly obese patients before SpO2 is reduced. Effective intervention measures are given to patients within this time frame, which reduces the incidence of hypoxia and severe hypoxia in patients.Trial registrationEthical approval was granted by the Medical Ethics Committee (Chairperson Professor Tian Hui) of Qilu Hospital, Shandong University ((Ke) Lun Audit 2021 (186)) on 15/07/2021. The study was registered (https://www.chictr.org.cn) on 23/10/2021(ChiCTR2100052234). Designed and reported using CONSORT statements.

Proposal of a Full Digital Workflow for a Bite Fork to Assess Mandibular Advancement during Drug-Induced Sleep Endoscopy (DISE) for Obstructive Sleep Apnea

(1) Background. Drug-induced sleep endoscopy (DISE) is currently regarded as the gold standard diagnostic procedure to assess the site(s) of upper airway collapse in subjects affected by Obstructive Sleep Apnea Syndrome (OSAS). During DISE, a jaw thrust maneuver is performed to advance the mandible and to predict the effectiveness of outcomes of treatment with mandibular advancement devices (MADs). However, the maneuver is not predictable and could be influenced by specific patients’ anatomical/functional conditions. The aim of this work is to propose a full-digital workflow for customizing an individual mandibular advancement fork, usable by otorhinolaryngologists during DISE. (2) Materials. Two patients with a diagnosis of mild-to-moderate OSAS (AHI ≥ 5 to ≤30/h of sleep) underwent orthodontic examination to verify the usability of the MAD. Intra-oral scans and registration were performed, including bite registration with 65% of mandibular advancement. The latter measurement was used as a reference to design a 3D-printed fork for DISE, as well as for the future MAD. Both patients underwent DISE in the operating room in the presence of an anesthesiologist, otolaryngologist, orthodontic specialist and neurophysiopathology technician. (3) Results. In the intraoperative polysomnography recording, during sleep, the presence of obstructive apnea was confirmed based on respiratory parameters (PNG1, PNG2, PNG3) with associated desaturation and increased muscle activities on PNG4 (mylohyoid muscle), EMG1 (right masseter muscle) and EMG2 (left masseter muscle). With the advancement fork in place, the immediate improvement effect on all respiratory parameters with normal saturation values and the complete suppression of masseter muscles were observed. Accordingly, both patients were considered potential good-responders to the MAD treatment. (4) Conclusions. The preliminary data shown are encouraging and would suggest that the fork represents a stable reference for the otorhinolaryngologist to evaluate the airway patency within the physiological range of movement. The efficiency of the work-flow from data registration to the DISE procedure and laboratory process represent two significant advantages that justify the integration of a digital system in the management of patients affected by OSAS.

Comparison of airway maneuvers (manual in line stabilization, modified jaw thrust, and conventional maneuver) for orotracheal intubation during direct laryngoscopy

Background: During performing orotracheal intubation with direct laryngoscopy adequate laryngeal visualization depends on proper airway maneuvers. There are different types of airway maneuvers. Aims and Objectives: This study aimed to compare airway maneuvers; manual in line stabilization (MILS), jaw thrust, and conventional maneuver to assess better laryngeal visualization and ease of intubation among them and associated complications. Materials and Methods: This observational study was conducted in 90 adult patients. Patients divided into three groups. Laryngoscopy and intubation in Group M were done in MILS and in group J jaw thrust. In Group C, as conventional maneuver performed. Laryngeal visualization assessed using modified Cormack–Lehane grading and ease of intubation assessed using intubation time, number of attempts between these three groups. The data were compared using ANOVA test, Chi-square test. Results: While comparing between these groups better laryngeal visualization seen in jaw thrust group, while the MILS maneuver worsen the view. Conclusion: The present study concluded that jaw thrust maneuver improved the laryngeal visualization and conventional maneuver made intubation faster and easy.

Role Plays Interventional Approach towards Mothers of Toddlers Regarding Prevention of Choking and Pulmonary Aspiration

Background: Toddlers are exposed to a variety of risk factors which includes playing with small material like coins, marbles, rings, unsupervised play and eating, children with decreased consciousness which may leads to choking. Children's respiratory crises and cardiac arrest are frequently brought on by choking or the introduction of an outside object into the airway, especially in children within the 6 months and 3 years of age. Childhood injuries have recently been a public health concern due to the frequency of pulmonary aspiration and choking in children under two years old, as well as mother referrals to medical institutions. According to research conducted in the United States, choking on external items caused 2.9% of children under the age of 4 is prone to die.Aim and Objective: To assess effectiveness of role play regarding prevention of choking and pulmonary aspiration among the mothers of toddler and associate findings with demographic variables.Material and methods: This research were adopted a pre-post experimental research approach among mothers of toddler between the age group of 20-40. 135 mothers of toddler involved in this research. Data were analyzed using the IBM Corp. Released 2016. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp. Qualitative variables were described as numbers and percentages.Results: Before intervention minimum knowledge score was 6.54 and maximum knowledge score percentage was 27.25%. After intervention maximum knowledge score was 70.12%. the average knowledge score has increased by 10.28 and currently represents 42.97% of the total possible points.Conclusion: Choking is a medical condition in which acute blockage of upper respiratory tract occur by a solid particle such as coins, lollypop, hairclips, grapes, marbles, foreign objects accidentally which leads to respiratory crisis like asphyxia as well as cardiac arrest. Toddlers and elderly age group are prone for choking and pulmonary aspiration, and it occur when the unsupervised play and eating, children with decreased consciousness which may leads to choking. It is incorrect to refer to any circumstances in which an obstruction of the airways causes a people to die as a result of choking. The word "choking" excludes deaths caused by diseases other than those caused by strangling, drowning, and gagging, which are all distinct medical conditions. Thus, the prevention of choking and pulmonary aspiration can be done by increasing knowledge and awareness about common sign and symptoms which includes gagging, watery eyes, reddening of face, coughing as well as teaching about preventive measures are choking technique which includes back blow and abdominal thrust and Heimlich maneuver among the mothers of toddler. In this study, the effectiveness of role play regarding prevention of choking and pulmonary aspiration among the mothers of toddler is improved from 26.96% to 70.12%.

Anesthesiology trainees performing flexible scope intubation in spontaneously breathing patients in the left lateral position and the supine position: a prospective randomized trial

BackgroundFlexible scope intubation is an important airway management skill that requires hands-on training in a real airway. We compared flexible scope intubation by trainees between patients in the left lateral and supine positions.MethodsForty patients aged 20 to 80 years with American Society of Anesthesiologists physical status class I to III were scheduled for elective surgery under general endotracheal anesthesia in Ramathibodi Hospital from February 2020 to June 2020. Patients were randomly assigned to be intubated in one of two positions: supine (Group S) or left lateral (Group L). Trainees performed flexible scope intubation in sedated patients under the supervision of an attending anesthesiologist. Intubation success, time to successful intubation, number of attempts, airway adjustment maneuvers, and hemodynamic changes were compared between groups.ResultsPatient characteristics did not differ between groups except for Mallampati airway classification. The rate of successful intubation on the first attempt and intubation time did not significantly differ between groups. The proportion of patients who required a jaw thrust during intubation was significantly lower in Group L (10.5% vs. 85%; P < 0.01). Blood pressure and oxygen saturation declined in both groups after intubation. The relative risk of desaturation in patients in the left lateral position compared with the supine position was 0.44 (0.1649–1.1978).ConclusionThe rate of successful flexible scope intubation on the first attempt and intubation time did not differ between the groups. The proportion of patients who required a jaw thrust maneuver was significantly lower in patients in the left lateral position.Trial registrationhttps://www.thaiclinicaltrials.org/ (TCTR20200208001) on 08/02/2020.

Optimizing Mandibular Advancement Maneuvers during Sleep Endoscopy with a Titratable Positioner: DISE-SAM Protocol.

Mandibular advancement devices (MAD) are an effective alternative treatment to CPAP. Different maneuvers were performed during drug sleep-induced endoscopy (DISE) to mimic the effect of MAD. Using the Selector Avance Mandibular (SAM) device, we aimed to identify MAD candidates during DISE using a titratable, reproducible, and measurable maneuver. This DISE-SAM protocol may help to find the relationship between the severity of the respiratory disorder and the degree of response and determine the advancement required to improve the collapsibility of the upper airway. Explorations were performed in 161 patients (132 males; 29 females) with a mean age of 46.81 (SD = 11.42) years, BMI of 27.90 (SD = 4.19) kg/m2, and a mean AHI of 26.51 (SD = 21.23). The results showed no relationship between severity and MAD recommendation. Furthermore, there was a weak positive relationship between the advancement required to obtain a response and the disease severity. Using the DISE-SAM protocol, the response and the range of mandibular protrusion were assessed, avoiding the interexaminer bias of the jaw thrust maneuver. We suggest prescribing MAD as a single, alternative, or multiple treatment approaches following the SAM recommendations in a personalized design.

USE OF A EVOLUTIONARY ALGORITHM TO OPTIMIZE INTERPLANETARY TRANSFERS

In this paper, it was studied the optimization of the cost of interplanetary missions with emphasis on reducing fuel consumption. To achieve this goal, a genetic algorithm was implemented to optimize the total impulse of orbital transfer. It was implemented a case of sending a space vehicle from Earth to a another planet using a gravity assist maneuver (swing by), in this paper it was chose sending a spacecraft from Earth to Mars with a close approach to the Venus. The method employed can be used for impulsive interplanetary missions in general, and so the solution found can become an initial solution for numerical methods of optimization of low thrust maneuvers.

Evaluation of anesthesia quality with three methods: "propofol + fentanyl" vs. "propofol + fentanyl + lidocaine" vs. "propofol + fentanyl + lidocaine + ketamine" in patients referred to the scoping ward.

Introduction:Toleration of the complexity and pain of interventions such as endoscopy and colonoscopy is highly difficult for patients. Considering the disagreement on the method of injection of propofol, this study was performed to evaluate the quality of anesthesia using the three methods of propofol + fentanyl, propofol + fentanyl + lidocaine, and propofol + fentanyl + lidocaine + ketamine.Methods:This one-way blind clinical trial study included 99 patients who were admitted in three groups by block randomization method. In a group of patients that were sedated with propofol + fentanyl + lidocaine + ketamine, the dose of all drugs is reduced by half the amount of the other groups. Variables included age, sex, frequency of cough, apnea, need for jaw thrust maneuver, O2 saturation, duration of recovery, and procedural satisfaction. Data were analyzed using SPSS version 20.0. P value of < 0.05 was considered to be significant.Results:The three groups were similar in terms of demographic characteristics. The effects of the three sedation protocols on the variables showed that patient’s apnea, cough, O2 saturation, and also proceduralist satisfaction in the group of the patient that sedated with four drugs was significantly higher (P < 0.05) than other groups. But there was no significant difference between the three groups when comparing the recovery time and need for jaw thrust during the procedure.Conclusion:The findings of the present study showed that the use of combination of “propofol + fentanyl + lidocaine + ketamine” with lower doses, significantly results in higher quality sedation compared with higher doses of “propofol + fentanyl + lidocaine” or “propofol + fentanyl” for scoping procedures.

Design of Orbit Controls for a Multiple CubeSat Mission Using Drift Rate Modulation

For the low-cost improvement of laser communication, which is critical for various applications such as surveillance systems, a study was conducted on relative distance control based on orbital drift rate modulations for multiple CubeSats during formation flying. The VISION mission covered in this paper comprises two CubeSats to demonstrate laser communication technology in space. During the mission, the deputy CubeSat changes the relative distance to execute mission objectives within various scenarios. Impulsive controls decrease, maintain, and increase the relative distance between the CubeSats by changing the orbital drift rates. The simulation results indicated that the desired orbital operation can be conducted within a given ΔV budget. In addition, the errors in the orbit determination, thrust maneuvers, and time synchronization were analyzed to satisfy the mission requirements. The mass-to-area ratio should be matched to adjust the relative distance between satellites with different properties by drift rate modulation. The proposed orbit control method appropriately operated the VISION mission by adjusting the drift rate modulation. The results of this study serve as a basis for the development of complex orbit control simulations and detailed designs that reflect the characteristics of the thrust module and operational aspects.

Drug-induced Sleep Endoscopy: Are there Predictors for Failure of Oral Appliance Treatment?

Introduction In the literature, evidence is lacking on the predictive value of drug-induced sleep endoscopy (DISE) for oral appliance treatment (OAT). Objectives The aim of the present study is to evaluate whether DISE with concomitant mandibular advancement maneuver can predict failure of OAT. Methods An observational retrospective study including patients diagnosed with obstructive sleep apnea (OSA) who previously received OAT. Results of DISE were analyzed in a group with documented OAT failure (apnea-hypopnea index [AHI] > 10 events/hour or < 50% reduction) and a group with OAT benefit (AHI <10 events/hour or > 50% reduction). The upper airway was assessed using the velum, oropharynx, tongue base, epiglottis (VOTE) classification. Additionally, a mandibular advancement maneuver, manually protruding the mandible by performing a jaw thrust, was performed to mimic the effect of OAT. Results The present study included 50 patients with OAT failure and 20 patients with OAT benefit. A subgroup analysis of patients with OAT failure and an AHI < 30 events/hour included 26 patients. In the OAT failure group, 74% had a negative jaw thrust maneuver. In the subgroup with an AHI < 30 events/hour, 76.9% had a negative jaw thrust maneuver. In the OAT benefit group, 25% had a negative jaw thrust maneuver ( p < 0.001). Conclusions A negative jaw thrust maneuver during DISE can be a valuable predictor for OAT failure, independent of AHI. Drug-induced sleep endoscopy should be considered as a diagnostic evaluation tool before starting OAT.

Orbit design of a swarm for ultra-long wavelength radio interferometry with preliminary swarm and thruster sizing

Observing the universe in the Ultra-Long Wavelength (ULW) regime has been called the ‘last frontier in astronomy’—real imaging capabilities here are yet to be achieved. Obtaining an image of the sky in this frequency band can be done by employing a swarm of satellites that together act as an interferometer and collect the required imaging information pieces throughout the course of their operational life. Meeting the mission objective is challenging for such a swarm, since this imposes restrictions on the operational environment and the relative position and velocity vectors between the swarm elements. This work proposes an orbit solution in a Heliocentric Earth-Leading Orbit (HELO) for an autonomous CubeSat swarm with chemical thrusters. A distributed formation flying algorithm is used to aid the collection of the required imaging information pieces. Furthermore, the estimated total mission launch mass is reduced by optimising cost functions and finding favourable position and velocity at start of operational life, as well as by finding favourable thrust manoeuvre patterns. The results show that the mission objective—obtaining a 3D map of the Universe in ULW—can be achieved with 68 6U spacecraft (S/C). Moreover, the swarm can remain in a Radio Frequency Interference (RFI) quiet zone of >5 × 106 km, whilst not drifting further than ~ 6.6 × 106 km from Earth for an operational life of one year.