Bo Lin

Objective: This study evaluated the safety and efficacy of the Macintosh laryngoscope versus the visual rigid laryngoscope (VRL) for tracheal intubation under a low-dose muscle relaxant protocol in thyroid surgery, to provide clinical evidence for the selection of optimal intubation tools for this setting. Methods: In this single-center, randomized controlled trial, two experienced anesthesiologists performed tracheal intubation using either the Macintosh laryngoscope (Mac group, n = 47) or VRL (VRL group, n = 45) in patients undergoing elective thyroid surgery with Intraoperative neuromonitoring (IONM). The primary outcome was intubation time. Secondary outcomes included first-attempt intubation success rate, hemodynamic changes during the peri-intubation period, laryngoscopic view graded by the Cormack-Lehane classification, and intubation-related complications. Results: The intubation time was significantly shorter in the VRL group (mean ± SD, 33.27 ± 8.36 s) than in the Mac group (52.19 ± 9.83 s) ( P < 0.001). The intubation success rate and heart rates did not differ between groups ( P > 0.05). The mean arterial pressure (MAP) at intubation and the amplitude of MAP increase during intubation was lower in Group VRL than in Group Mac ( P < 0.005). No statistically significant differences were observed between the two groups in peripheral oxygen saturation (SpO ₂ ), Cormack-Lehane classification, or intubation-related complications ( P > 0.05). Conclusion: For thyroid surgery using a low-dose muscle relaxant protocol to enable IONM, the VRL provides significantly shorter intubation time and better hemodynamic stability at intubation compared with the Macintosh laryngoscope. No significant differences were observed between the two devices in intubation success rate, laryngoscopic view, or intubation-related complications.

Sepsis-associated acute kidney injury (SAKI), a common complication in intensive care units (ICUs), is linked to high morbidity and mortality. Sirtuin 2 (SIRT2), an NAD⁺-dependent deacetylase, has been shown to have distinct effects on autophagy regulation compared to other sirtuins, but its role in SAKI remains unclear. This study explored the potential of SIRT2 as a therapeutic target for SAKI. We found that inhibition of SIRT2 with the antagonist AGK2 improved the survival of septic mice. SIRT2 inhibition reduced kidney injury, as indicated by lower levels of KIM-1, NGAL, serum creatinine, blood urea nitrogen, and proinflammatory cytokines following cecal ligation and puncture. Pretreatment with AGK2 in septic mice increased autophagosome and autolysosome formation in renal tubular epithelial cells and upregulated LC3 II expression in the renal cortex. Consistent with in vivo findings, SIRT2 gene silencing promoted autophagy in LPS-treated HK-2 cells, whereas SIRT2 overexpression inhibited it. Mechanistically, SIRT2 inhibition increased FOXO1 acetylation, inducing its nuclear-to-cytoplasmic translocation, which promoted kidney autophagy and alleviated SAKI. Our study suggests SIRT2 as a potential target for SAKI therapy.

Objective: To assess the efficacy and safety of visual rigid laryngoscopy and video laryngoscopy and to provide clinical information for developing a more suitable intubation tool for elderly patients. Methods: In 75 consecutive elderly patients undergoing elective surgery in a single institution, tracheal intubation was randomly performed by 2 experienced anaesthesiologists using visual rigid laryngoscopy (Group I, n = 38) or video laryngoscopy (Group II, n = 37). The primary outcome was intubation time. Secondary outcomes were the first-attempt success rate of tracheal intubation, haemodynamic responses at 1, 3, and 5 min after intubation and the incidence of postoperative airway complications, including immediate complications and postoperative complaints. Results: The intubation times were 35.0 (30.0–41.5) s and 42.5 (38.0–51.3) s in Groups I and II, respectively (P < 0.001). The difference in direct complications between the two groups was statistically significant (P < 0.05). In contrast, there was no significant difference between the two groups regarding the follow-up of the main complaint 30 min and 24 h after tracheal extubation (P > 0.05). There was no difference in the intubation success rate between the 2 groups (P > 0.05). The haemodynamic responses at 1, 3, and 5 min after intubation were not significantly different (P > 0.05). Conclusion: Compared with that of video laryngoscopy, the intubation time of visual rigid laryngoscopy in elderly patients was shorter. At the same time, visual rigid laryngoscopy reduced the incidence of immediate complications. However, during endotracheal intubation, there was no significant difference in haemodynamics between the two groups. Clinical trial registration number: ChiCTR2100054174.