Ioan Florin Marchis

Implementing neonatal hearing screening has significantly reduced the age at which hearing impairments are detected in children. Nevertheless, objective electrophysiological assessments, such as auditory brainstem response (ABR) or auditory steady-state response (ASSR) testing, are often necessary for children older than six months. These evaluations should be conducted while the child is asleep to obtain accurate and interpretable results, as movement and muscle activity can introduce artifacts that compromise the quality of the recordings. In this narrative review, we evaluate sedation strategies in paediatric procedures, focusing on the efficacy, safety, and practicality of agents/routes for inducing sleep during ABR/ASSR testing. Sedation choices should prioritise patient safety, clinical context, and result reliability and be tailored to the individual’s age, health status, and procedural needs.

Background/Objectives: The implementing of neonatal hearing screening has significantly reduced the age at which hearing impairments are detected in children. Nevertheless, objective electrophysiological assessments, such as Auditory Brainstem Response (ABR) or Auditory Steady-State Response (ASSR) testing, are often necessary for children older than six months. To obtain accurate and interpretable results, these evaluations should be conducted while the child is asleep, as movement and muscle activity can introduce artifacts that compromise the quality of the recordings. Methods: This narrative review examines data from the literature presenting various sedation strategies employed to facilitate sleep in pediatric patients undergoing different types of procedures. It focuses on the efficacy, safety, and practicality of different sedative agents and administration routes. Results: Several sedation methods are utilized in clinical practice to achieve the necessary sleep state for ABR and ASSR testing in children. Sedatives, such as intranasal dexmedetomidine, oral midazolam, and combinations like ketamine-midazolam, have also been used, each with varying degrees of efficacy and safety profiles. General anesthesia is typically reserved for cases where less invasive sedation methods are contraindicated or have proven ineffective. Conclusions: While natural sleep is ideal for ABR and ASSR testing, sedation using agents that can be administered orally or intranasally provides a practical alternative, enabling testing outside the operating theatre. General anesthesia should be considered when non-invasive sedation is not feasible or contraindicated. The choice of sedation method should be individualized based on the child’s age, medical history, and specific needs, ensuring safety for the patient and reliability of the results.

Background/Objectives: Otosclerosis causes progressive hearing loss through abnormal bone remodeling within the otic capsule and predominantly affects young individuals. Surgical intervention can markedly enhance a patient’s quality of life and socio-economic status. Anesthetic management may involve either general anesthesia or monitored anesthesia care, with the latter enabling real-time assessment of hearing improvement while providing optimal surgical conditions and patient satisfaction. This study examines the efficacy and safety of continuous dexmedetomidine infusion and target-controlled remifentanil infusion for conscious sedation combined with local anesthesia in otosclerosis surgery. Methods: Seventy-four adult patients undergoing otosclerosis surgery were randomly assigned to either the dexmedetomidine group or the remifentanil group. Primary outcomes included patient satisfaction at 24 h post-surgery and surgeon satisfaction with operative conditions. Secondary outcomes comprised hemodynamic effects, the necessity for adjuncts to the proposed sedation protocols, and intra- and postoperative complications. Results: There was no statistically significant difference between the dexmedetomidine and remifentanil groups regarding patient satisfaction (p = 0.943) and surgeon satisfaction (p = 0.069). A strong correlation was observed between surgeons’ assessments and patients’ satisfaction Composite Scores (η² = 0.185, p = 0.003). Dexmedetomidine was more effective in significantly reducing arterial pressure and heart rate without undesirable clinical effects. Conclusions: No significant difference was found between the groups concerning patient and surgeon satisfaction. Dexmedetomidine infusion led to considerable reductions in arterial pressure and heart rate compared to remifentanil.

Difficulties or failures in securing the airway still occur and can lead to permanent disabilities and mortality. Patients with head and neck pathologies ... Jove

Airway management is a vital part of anesthesia practices, intensive care units, and emergency departments, and a proper pre-operative assessment can guide clinicians’ plans for securing an airway. Complex airway assessment has recently been at the forefront of anesthesia research, with a substantial increase in annual publications during the last 20 years. In this paper, we provide an extensive overview of the literature connected with pre-operative airway evaluation procedures, ranging from essential bedside physical examinations to advanced imaging techniques such as ultrasound (US), radiography, computed tomography (CT), and magnetic resonance imaging (MRI). We discuss transnasal endoscopy, virtual endoscopy, 3D reconstruction-based technologies, and artificial intelligence (AI) as emerging airway evaluation techniques. The management of distorted upper airways associated with head and neck pathology can be challenging due to the intricate anatomy. We present and discuss the role of recent technological advancements in recognizing difficult airways and assisting clinical decision making while highlighting current limitations and pinpointing future research directions.

The unexpected problematic airway represents a large proportion of anesthesia-related morbidity and mortality. The retromolar or paraglossal approach is an alternative to the majority of the rigid instruments used for tracheal intubation, which follow the midline to access the glottis. This single-center, prospective case-series study offers an option to conventional laryngoscopy in case of a poor glottic view, introducing an instrument (the rigid tube for laryngoscopy) that uses the retromolar approach to accomplish tracheal intubation. If after anesthesia induction, the modified Cormack-Lehane glottis view grade >2b, the intubation is carried further with the rigid tube. The tube follows the direction of the thyroid cartilage while advancing from the labial commissure, displacing the tongue to the contralateral side. Adjusting the position of the larynx with the nondominant hand by gently pushing the thyroid cartilage and following an imaginary line towards it while advancing it improves the time needed for proper glottis visualization. Once the epiglottis is in sight, the practitioner progresses slowly, lifting the epiglottis and aiming the tip of the tube more anteriorly. When the glottis appears in the visual field, the intubating tube introducer is placed in the trachea, and a lubricated cuffed intubating tube is advanced over the introducer after the rigid tube is extracted. This tool was tested on 30 patients with an unsatisfactory glottic view when using the Macintosh laryngoscope and obtained excellent results with respect to intubation time and complications. The reduced visual field is the main limitation of this method, which requires a training period for reasonable expertise. This simple, robust, and cheap instrument could be a rescue option in case of a difficult airway.

Tracheal intubation with the rigid tube for laryngoscopy - a new method [Retraction] Marchis IF, Radeanu D, Cosgarea M. Ther Clin RiskManage. 2019;15:309–313.The Editor-in-Chief and Publisher of Therapeutics and Clinical Risk Management wish to retract the published article.Concerns were raised to the Editor-in-Chief regarding the level of similarity between the published article and another article titled The Rigid Tube of Laryngoscopy – a New Intubation Technique by the same authors in the Proceedings of National ENT, Head and Neck Surgery Conference (17–20 May 2017, Sibiu, Romania).Following an investigation, it was found the level of similarity between the two articles was unacceptable and the authors had failed to notify Therapeutics and Clinical Risk Management of the previous publication. It was determined by the Editor-in-Chief the authors had not modified the article submitted to Therapeutics and Clinical Risk Management sufficiently enough for it to be considered new information and it was found to be aredundant publication.This retraction relates to this paper

Background: The rigid tube for laryngoscopy is an instrument used in ENT, for inspecting the larynx and its vicinity. We used it to facilitate intubation, in ENT patients. Methods: Twenty patients attending for surgery were included for study. Group 1 (n=10) had no airway pathology but at least two predictors of an anatomically difficult airway. Group 2 (n=10) had an obstructing airway pathology. After anesthesia induction, classical laryngoscopy was performed, and intubation grade registered. Using the retromolar approach the rigid tube advanced slowly, the epiglottis was lifted, and the vocal cords were visualized. The bougie was introduced through the rigid tube into the trachea, the rigid tube was extracted, and the intubating tube was placed in the trachea, over the bougie. Results: The mean (SD) maneuver duration was 59.4 (18.2) sec. The Cormack-Lehane view of the glottis at classical laryngoscopy was poor in four patients in Group 1 and six patients in Group 2. The lowest desaturation was 82%. No complications other than sore throat were noted. Conclusion: The rigid tube for laryngoscopy is a useful tool for intubation in ENT patients. We noticed an advantage against classical intubation in patients with base of tongue carcinoma, reduced mouth opening and protruding upper incisors with this instrument.