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Background: A traditional method for depth of intubation in adult patients is taping the endotracheal tube (ETT) at the upper incisors a distance of 21 or 23 cm for women and men respectively (21/23 method). A novel "topographical" measurement for estimating proper intubation depth has been suggested as a better depth predictor compared to the 21/23 method. Objectives:To compare the 21/23 method to topographical measurements.Methods: 100 ASA physical status I-II patients scheduled for elective surgery were enrolled. The 21/23 method was initially utilized for intubation and the ETT tip to carina distance was then fiberoptically measured. Anatomical (topographical) measurements were then obtained from each patient by adding the distance from the corner of the mouth to the mandibular angle to the distance from the mandibular angle to the center of the sternal notch and were recorded as the topographical intubation depth. Both measurements were assessed for percentage of ETTs that fell outside of our desired tip to carina range of 2-4 cm. Results:After the 21/23 method, 29% of ETTs fell outside our desired tip to carina range compared to 47% of ETTs with the topographical method (p=0.010). No correlation was found between the topographical measurements and airway length (upper incisors to vocal cords) (r=0.248). Conclusions:Topographical measurements were not re-confirmed as an accurate intubation method and were found to be less reliable than the 21/23 method. We maintain that regardless of ETT insertion method utilized, the gold standard to ensure accurate ETT placement is fiberoptic inspection.

Cyclodextrins encapsulate and electrostatically bind to lipophilic molecules. The exterior of cyclodextrins are water-soluble and maintain aqueous solubility despite encapsulation of non-aqueous soluble molecules. This unique ability to encapsulate lipophilic molecules and maintain water solubility confers numerous pharmacologic advantages for both drug delivery and removal. Cyclodextrins, a component part of supramolecular chemistry, may be in its infancy of anesthetic application but recent advances have been described as novel and revolutionary. A review of current research coupled with an understanding of cyclodextrin properties is necessary to fully appreciate the current uses and future potentials of these unique molecules.

This study quantified the occurrence of acute confusion in cardiac surgery patients at three German hospitals. A total of 867 patients, 22–91 years old, were examined each nursing shift postoperatively for 5 days for the presence of acute confusion using a modified version of the Glasgow Coma Scale and Confusion Rating Scale. The night shifts and the third postoperative day showed the most frequent periods of occurrence. Confusional state was noted in patients ranging from 10.5% for patients aged <70, to 40.7% for patients >80 years of age. Those found at increased risk were patients of increasing age and coexisting disease. Targeted nursing interventions for patients at increased risk of acute confusion may decrease this complication.

Background: Poorly controlled acute postsurgical pain can promote chronic opioid use and misuse long after the initial surgical procedure. Enhanced recovery after surgery (ERAS) guidelines have shown promise in reducing opioid exposure and minimizing opioid-related side effects. Aims:The aims of this evidence-based practice (EBP) project were to assess the ERAS literature to guide postoperative pain management practice change at an adult colorectal surgical unit, evaluate the practice change outcomes, and disseminate the findings.Methods: A Population, Intervention, Comparison, Outcome, and Time (PICOT) question was established to guide an ERAS literature search. Found articles were critically appraised using the FULD Critical Appraisal Tool. Following the critical appraisal, the steps of EBP were utilized to implement an ERAS guideline for adult colorectal surgical patients in a 281-bed medical center. Outcomes of the practice change were evaluated by comparing multimodal analgesic, regional anesthesia, and opioid pain medication use before and after guideline implementation.Results: Five articles were critically appraised for guideline development. After implementation, data demonstrated an increase in the use of multimodal analgesics and regional anesthesia and a decrease in the use of opioid pain medication. These findings were disseminated through multiple venues within the hospital, including a presentation to the stakeholders.Linking Evidence to Action: Evidence-based strategies to reduce postoperative pain are achievable while reducing perioperative opioid consumption. Engagement of key stakeholders and timely rollout of EBP changes are important for successful implementation. ERAS guidelines with a multimodal analgesia pathway are an effective way to reduce postoperative pain and perioperative opioid consumption.