Videolaryngoscopes may improve intubating conditions in obese patients. A total of 110 patients with a body mass index > 35 kg∙m⁻² were prospectively randomized to tracheal intubation using non-channeled Glidescope Titanium or channeled King Vision videolaryngoscope. The primary outcome was the time to tracheal intubation. Secondary outcomes included: total success rate, number of attempts, the quality of visualization, peri-procedural and post-proceduralcomplications. Time to the first effective breath was shorter with the King Vision (median; 95% CI)—36; 34–39 s vs. 42; 40–50 in the Glidescope group (p = 0.007). The total success rate was higher in the Glidescope group—100% vs. 89.1% (p = 0.03). There was a higher incidence of moderate and difficult laryngoscopy in the King Vision group. No difference was recorded in first attempt success rates, total number of attempts, use of additional maneuvers, intraoperative trauma, or any significant decrease in SpO₂ during intubation. No serious complications were noted and the incidence of postoperative complaints was without difference. Although tracheal intubation with King Vision showed shorter time to the first breath, total success was higher in the Glidescope group, and all but one patients where intubation failed with the KingVision were subsequently intubated with the Glidescope.

Videolaryngoscopes may reduce cervical spine movement during tracheal intubation in patients with neck trauma. This manikin study aimed to compare the performance of disposable non-channeled and channeled blades of the King Vision™ videolaryngoscope in simulated cervical spine injury. Fifty-eight anesthesiologists in training intubated the TruMan manikin with the neck immobilized using each blade in a randomized order. The primary outcome was the time needed for tracheal intubation, secondary aims included total success rate, the time required for visualization of the larynx, number of attempts, view of the vocal cords, and subjective assessment of both methods. Intubation time with the channeled blade was shorter, with a median time of 13 s (IQR 9–19) vs. 23 s (14.5–37.5), p < 0.001, while times to visualization of the larynx were similar in both groups (p = 0.54). Success rates were similar in both groups, but intubation with the non-channeled blade required more attempts (1.52 vs. 1.05; p < 0.001). The participants scored the intubation features of the channeled blade significantly higher, while visualization features were scored similarly in both groups. Both blades of the King Vision™ videolaryngoscope are reliable intubation devices in a simulated cervical spine injury in a manikin model when inserted by non-experienced operators. The channeled blade allowed faster intubation of the trachea.

End-expiratory occlusion (EEO) and end-inspiratory occlusion (EIO) tests have been successfully used to predict fluid responsiveness in various settings using calibrated pulse contour analysis and echocardiography. The aim of this study was to test if respiratory occlusion tests predicted fluid responsiveness reliably in cardiac surgical patients with protective ventilation. This single-centre, prospective study, included 57 ventilated patients after elective coronary artery bypass grafting who were indicated for fluid expansion. Baseline echocardiographic measurements were obtained and patients with significant cardiac pathology were excluded. Cardiac index (CI), stroke volume and stroke volume variation were recorded using uncalibrated pulse contour analysis at baseline, after performing EEO and EIO tests and after volume expansion (7 mL/kg of succinylated gelatin). Fluid responsiveness was defined as an increase in cardiac index by 15%. Neither EEO, EIO nor their combination predicted fluid responsiveness reliably in our study. After a combined EEO and EIO, a cut-off point for CI change of 16.7% predicted fluid responsiveness with a sensitivity of 61.8%, specificity of 69.6% and ROC AUC of 0.593. In elective cardiac surgical patients with protective ventilation, respiratory occlusion tests failed to predict fluid responsiveness using uncalibrated pulse contour analysis.

To evaluate the predictive performance of the Eleveld target-controlled infusion model for propofol during deep hypothermia, characterise temperature-dependent changes in propofol pharmacokinetics, and explore the relationship between depth of anaesthesia monitoring and the perioperative stress response during deep hypothermic circulatory arrest. Prospective, single-centre, low-intervention study. Tertiary cardiac surgery centre. Thirty adult patients undergoing elective pulmonary endarterectomy with cardiopulmonary bypass and deep hypothermic circulatory arrest. Serial blood samples (T0-T13) were obtained to determine propofol serum concentrations and endogenous norepinephrine levels. Model performance of the Eleveld target-controlled infusion system was assessed using linear regression across temperature phases, and population pharmacokinetic analysis was performed using nonlinear mixed-effects modelling. Predictive performance deteriorated during cooling and improved during rewarming. A two-compartment model identified temperature as a significant covariate on propofol clearance, with marked reduction during hypothermia and relative increase during rewarming. Processed EEG monitoring demonstrated profound cortical suppression (mean suppression ratio 98.4%, PSI 0.4). Despite this, norepinephrine levels decreased during cooling and increased significantly during reperfusion, indicating activation of the stress response in the absence of cortical activity. No intraoperative awareness was detected. Deep hypothermia alters propofol pharmacokinetics, reducing clearance and impairing model performance, while rewarming increases clearance. Autonomic stress responses may occur despite profound cortical suppression, highlighting limitations of EEG-based depth of anaesthesia monitoring during deep hypothermic circulatory arrest. These findings support temperature-adaptive dosing and warrant confirmation in prospective randomised studies.

Pulmonary endarterectomy is an established treatment for selected patients with chronic thromboembolic pulmonary hypertension. And bleeding into the airway