Chong-Sung Kim

GlideScope® video laryngoscope: a randomized clinical trial in 203 paediatric patients†

BACKGROUNDnThe GlideScope intubating device has been reported to provide a comparable or superior laryngoscopic view compared with direct laryngoscopy in adults. This study compared the use of the GlideScope with direct laryngoscopy for the laryngoscopic view and intubation time in children.nnnMETHODSnThe laryngoscopic view in 203 children was scored using both the Macintosh laryngoscope and the GlideScope using Cormack and Lehane (C&L) grades. After scoring each laryngoscopic view with and without BURP, the patients were randomly allocated to two groups. The trachea was intubated using direct laryngoscopy (Group DL, n=100) or the GlideScope (Group GS, n=103). We compared C&L grades for the two views in the same patient, and also the time to intubate for each group.nnnRESULTSnThe GlideScope improved the view without BURP in the patients with C&L grade 2 (16/26, P<0.01) and with C&L grades 3 and 4 (7/11, P<0.05). The view with BURP was also improved by the GlideScope in C&L grade 2 (4/9, P<0.05) and with C&L grades 3 and 4 (4/5, P=0.059). The mean time for tracheal intubation was 36.0 (17.9) s in the GS group and 23.8 (13.9) s in the DL group (P<0.001).nnnCONCLUSIONSnIn children, the GlideScope provided a laryngoscopic view equal to or better than that of direct laryngoscopy but required a longer time for intubation.

Positioning internal jugular venous catheters using the right third intercostal space in children.

Background:u2002 Central venous catheters are used for pressure measurement, and drug and fluid therapy in children. Several reports have described serious complications related to catheter positioning. We evaluated the possibility of using the right third intercostal space as an anatomic landmark for determining the optimal insertion depth of a central venous catheter from the right internal jugular vein.

Head rotation, flexion, and extension alter endotracheal tube position in adults and children

PurposeThe purpose of this study was to evaluate the effect of head rotation in adults and children on endotracheal tube (ETT) position and to confirm previous results regarding the influence of head flexion and extension on ETT position.MethodsAfter inducing anesthesia in 24 young adults and 22 children (aged 1–9xa0yr), ETTs were secured on the right corner of each of their mouths. Using a fiberoptic bronchoscope, the distance from the carina to the tip of the ETT was measured with each patient’s head and neck placed in a neutral position, flexed, extended, rotated to the right, and rotated to the left.ResultsIn all patients, flexing the head resulted in the ETT moving towards the carina, and extension resulted in the tube being displaced in the opposite direction. In adults, head rotation to the right resulted in withdrawal of the ETT in all but one patient; displacement was 0.8xa0±xa00.5xa0cm (meanxa0±xa0SD) (Pxa0<xa00.001). Head rotation to the left resulted in the endotracheal tube being displaced in an unpredictable direction by 0.1xa0±xa00.6xa0cm. In children, head rotation to the right resulted in withdrawal of the ETT in all patients; displacement was 1.1xa0±xa00.6xa0cm (Pxa0<xa00.001). Head rotation to the left also resulted in partial withdrawal in all patients; displacement measured 0.6xa0±xa00.4xa0cm (Pxa0<xa00.001).ConclusionsIn adult patients under general anesthesia, head rotation towards the side of ETT fixation resulted in partial withdrawal of the tube tip away from the carina, whereas head rotation to the opposite side displaced the tube in an unpredictable manner. In children, head rotation to either side resulted in withdrawal of the ETT away from the carina.RésuméObjectifL’objectif de cette étude était d’évaluer l’effet de la rotation de la tête chez l’adulte et l’enfant sur le positionnement de la sonde endotrachéale et de confirmer les résultats précédents concernant l’influence de la flexion et de l’extension de la tête.MéthodeAprèsxa0l’induction de l’anesthésie chez 24 jeunes adultes et 22 enfants (âgés de 1 à 9 ans), les sondes endotrachéales ont été fixées au coin droit de leurs bouches. À l’aide d’un bronchoscope à fibre optique, la distance entre la carène et le bout de la sonde a été mesurée avec la tête et le cou de chaque patient positionnés de façon neutre, en flexion, en extension, tournés vers la droite et tournés vers la gauche.RésultatsChez tous les patients, la flexion de la tête a provoqué le mouvement de la sonde endotrachéale vers la carène, et l’extension a provoqué le déplacement de la sonde dans la direction opposée. La rotation de la tête vers la droite a provoqué le retrait de la sonde chez tous les patients adultes, sauf un; le déplacement était de 0,8xa0±xa00,5xa0cm (moyennexa0±xa0ET) (Pxa0<xa00,001). La rotation de la tête vers la gauche a provoqué un déplacement de la sonde de 0,1xa0±xa00,6xa0cm dans une direction imprévisible. Chez les enfants, la rotation de la tête vers la droite a provoqué le retrait de la sonde chez tous les patients; le déplacement était de 1,1xa0±xa00,6xa0cm (Pxa0<xa00,001). La rotation de la tête vers la gauche a également provoqué un retrait partiel de la sonde chez tous les patients; le déplacement était de 0,6xa0±xa00,4xa0cm (Pxa0<xa00,001).ConclusionChez les patients adultes sous anesthésie générale, la rotation de la tête vers le côté où la sonde était fixée a provoqué un retrait partiel de la pointe de la sonde par rapport à la carène, alors que la rotation dans la direction opposée a provoqué un déplacement de la sonde dans une direction imprévisible. Chez les enfants, la rotation de la tête de part et d’autre a provoqué un retrait de la sonde endotrachéale par rapport à la carène.

Delayed emergence process does not result in a lower incidence of emergence agitation after sevoflurane anesthesia in children.

Background:u2002 Emergence agitation (EA) is more frequent after sevoflurane anesthesia than other inhalational agents but the etiology remains unclear. We investigated whether the EA after sevoflurane anesthesia is related to rapid emergence.

Prediction of fluid responsiveness in mechanically ventilated children undergoing neurosurgery

BACKGROUNDnThe purpose of this study was to evaluate the clinical usefulness of static and dynamic variables for the prediction of fluid responsiveness in children under general anaesthesia.nnnMETHODSnThirty-three mechanically ventilated children received 10 ml kg(-1) colloid for 10 min while stable during surgery. Arterial pressure, heart rate, central venous pressure (CVP), and pleth variability index (PVI), in addition to variation in systolic pressure, pulse pressure (including Δdown and Δup), respiratory aortic blood flow velocity (ΔVpeak), and inferior vena cava diameter were measured before and after volume expansion. Patients were classified as responders to fluid loading if their stroke volume index (SVI) increased by at least 10%.nnnRESULTSnThere were 15 volume responders and 18 non-responders. Of the variables examined, ΔVpeak (r=0.516, P=0.004) and PVI (r=0.49, P=0.004) before volume expansion were significantly correlated with changes in SVI. The receiver-operating characteristic (ROC) curve analysis showed that PVI and ΔVpeak predicted fluid responsiveness. Areas under the ROC curves of PVI and ΔVpeak were statistically larger than that of CVP (P=0.006 and 0.014, respectively). However, those of other variables were similar to that of CVP.nnnCONCLUSIONSnΔVpeak and PVI can be used to predict fluid responsiveness in mechanically ventilated children under general anaesthesia. The other static and dynamic variables assessed in this study were not found to predict fluid responsiveness significantly in children.nnnCLINICAL TRIAL REGISTRATIONnClinicalTrials.gov, NCT01364103.

Comparison between ultrasound-guided supraclavicular and infraclavicular approaches for subclavian venous catheterization in children—a randomized trial

BACKGROUNDnUltrasound (US)-guided subclavian vein (SCV) catheterization via the supraclavicular (SC) or infraclavicular (IC) approaches can be useful in children. The purpose of this study was to compare the efficacy of these approaches.nnnMETHODSnThis prospective, randomized study included 98 children who were <3 years old, and who were divided into two groups: the SC group (n=49) and the IC group (n=49). All SCV catheterizations were guided by US and performed by a single experienced anaesthesiologist. Data regarding puncture time, number of attempts, successful guidewire insertion, catheter insertion time, and complications were analysed.nnnRESULTSnThe median puncture time was longer in the IC group than the SC group (48 vs 36 s, P=0.02). Multiple attempts (number of attempts >3) were more frequently required in the IC group than the SC group (24.5 vs 6.1%, P=0.01). The incidence of guidewire misplacement was higher in the IC group than that of the SC group [10 (20.4%) vs 0 (0%), P=0.001]. Catheterization was successfully performed in all patients. No pneumothoraces or arterial punctures occurred in either group.nnnCONCLUSIONnDuring SCV catheterization under US guidance in paediatric patients, the SC approach yielded a shorter puncture time and decreased the incidence of guidewire misplacement when compared with the IC approach.

Isoflurane preconditioning protects motor neurons from spinal cord ischemia: Its dose-response effects and activation of mitochondrial adenosine triphosphate-dependent potassium channel

We examined in a rabbit model of transient spinal cord ischemia (SCI) whether isoflurane (Iso) preconditioning induces ischemic tolerance to SCI in a dose-response manner, and whether this effect is dependent on mitochondrial adenosine triphosphate-dependent potassium (K(ATP)) channel. Eighty-six rabbits were randomly assigned to 10 groups: Control group (n=8) received no pretreatment. Ischemic preconditioning (IPC) group (n=8) received 5 min of IPC 30 min before SCI. The Iso 1, Iso 2 and Iso 3 groups (n=10, 9, 8) underwent 30 min of 1.05, 2.1 and 3.15% Iso inhalation commencing 45 min before SCI. The Iso 1HD, Iso 2HD and Iso 3HD groups (n=9, 9, 8) each received a specific mitochondrial K(ATP) channel blocker, 5-hydroxydecanoic acid (5HD, 20mg/kg), 5 min before each respective Iso inhalation. The 5HD group (n=8) received 5HD without Iso inhalation. The sham group (n=9) had no SCI. SCI was produced by infra-renal aortic occlusion via the inflated balloon of a Swan-Ganz catheter for 20 min. The Iso 1, Iso 2 and Iso 3 groups showed a better neurologic outcome and more viable motor nerve cells (VMNCs) in the anterior spinal cord 72 h after reperfusion than the control group (p<0.05). Iso 3 group showed a better neurologic outcome and more VMNCs than Iso 1 group (p<0.05). And, the Iso 1, Iso 2 and Iso 3 groups showed a better neurologic outcome and higher VMNC numbers than the corresponding Iso 1HD, Iso 2HD and Iso 3HD groups (p<0.05). This study demonstrates that Iso preconditioning protects the spinal cord against neuronal damage due to SCI in a dose-response manner via the activation of mitochondrial K(ATP) channels.

Minimum alveolar concentration of sevoflurane for laryngeal mask airway removal in anesthetized children

BACKGROUND:In children, it is preferable to remove the laryngeal mask airway (LMA) when the patient is still anesthetized. We sought to determine the optimal minimum alveolar concentration of sevoflurane that would allow removal of the LMA in children without airway complications. METHODS:We studied 25 unpremedicated children between 7 mo and 10 yr of age, ASA Status I, undergoing urologic or plastic surgery. General anesthesia was induced with sevoflurane and oxygen given via mask. The LMA was inserted and anesthesia was maintained with sevoflurane in oxygen. The LMA was removed at the end of surgery when the end-tidal sevoflurane concentration had reduced to a predetermined level, determined by the up-and-down method, with 0.2% as a step size. A removal accomplished without coughing, teeth clenching, gross purposeful movement, breath holding or laryngospasm, during or within 1 min after removal, was considered to be successful. RESULTS:The minimum alveolar concentration of sevoflurane at which 50% of LMA removals were successful was 1.84% (95% confidence limits, 1.45%–1.96%), and the 95% effective dose for successful removal was 2.17% (95% confidence limits, 2.02%–3.48%). CONCLUSIONS:LMA removal may be accomplished without coughing, moving, or any other airway complication at 1.84% end-tidal sevoflurane concentration in 50% of anesthetized children.

Practical anatomic landmarks for determining the insertion depth of central venous catheter in paediatric patients

BACKGROUNDnVarious methods have been recommended to decide a proper insertion depth of central venous catheter (CVC). The carina is recommended as a useful target level for the CVC tip position. We evaluated the sternal head of a right clavicle and the nipples as anatomic landmarks for determining the optimal depth of CVC in paediatric patients.nnnMETHODSnNinety children, <5 yr, undergoing catheterization through the right internal jugular vein were enrolled. The insertion depth was determined as follows. The insertion point was designated as Point I. The sternal head of the right clavicle was called Point A and the midpoint of the perpendicular line drawn from Point A to the line connecting both nipples was called Point B. The insertion depth of CVC was determined by adding the two distances (from I to A and from A to B) and subtracting 0.5 cm from this. A chest radiography was taken and the distance of the CVC tip from the carina level was measured by the Picture Archiving and Communicating System.nnnRESULTSnThe mean distance of the CVC tip from the carina level was 0.1 (1.0) (P=0.293) cm above the carina (95% CI 0.1 cm below the carina-0.3 cm above the carina). There was no specific relationship between the distance of the CVC tip from the carina level and the patients age, height, and weight.nnnCONCLUSIONSnThe CVC tip could be placed near the carina by using the external landmarks without any formulae, images, and devices in children in our study.

Clinical trial of esmolol‐induced controlled hypotension with or without acute normovolemic hemodilution in spinal surgery*

Background: Drug‐induced controlled hypotension (CH) combined with acute normovolemic hemodilution (ANH) is being widely used for blood conservation in surgical patients. The purpose of this study was to investigate the efficacy and safety of esmolol‐induced CH combined with ANH (hematocrit down to 28%).