Background/ObjectiveInadvertent intraoperative hypothermia (core temperature <360 C) is a recognized risk in surgery and has adverse consequences. However, no data about this complication in China are available. Our study aimed to determine the incidence of inadvertent intraoperative hypothermia and its associated risk factors in a sample of Chinese patients.MethodsWe conducted a regional cross-sectional survey in Beijing from August through December, 2013. Eight hundred thirty patients who underwent various operations under general anesthesia were randomly selected from 24 hospitals through a multistage probability sampling. Multivariate logistic regression analyses were applied to explore the risk factors of developing hypothermia.ResultsThe overall incidence of intraoperative hypothermia was high, 39.9%. All patients were warmed passively with surgical sheets or cotton blankets, whereas only 10.7% of patients received active warming with space heaters or electric blankets. Pre-warmed intravenous fluid were administered to 16.9% of patients, and 34.6% of patients had irrigation of wounds with pre-warmed fluid. Active warming (OR = 0.46, 95% CI 0.26–0.81), overweight or obesity (OR = 0.39, 95% CI 0.28–0.56), high baseline core temperature before anesthesia (OR = 0.08, 95% CI 0.04–0.13), and high ambient temperature (OR = 0.89, 95% CI 0.79–0.98) were significant protective factors for hypothermia. In contrast, major-plus operations (OR = 2.00, 95% CI 1.32–3.04), duration of anesthesia (1–2 h) (OR = 3.23, 95% CI 2.19–4.78) and >2 h (OR = 3.44, 95% CI 1.90–6.22,), and intravenous un-warmed fluid (OR = 2.45, 95% CI 1.45–4.12) significantly increased the risk of hypothermia.ConclusionsThe incidence of inadvertent intraoperative hypothermia in Beijing is high, and the rate of active warming of patients during operation is low. Concern for the development of intraoperative hypothermia should be especially high in patients undergoing major operations, requiring long periods of anesthesia, and receiving un-warmed intravenous fluids.

Both 2% and 4% lidocaine administered topically by a spray-as-you-go technique can provide clinically acceptable intubating conditions for awake FOI in sedated patients with a difficult airway. As compared with 4% lidocaine, however, 2% lidocaine requires a smaller dosage and results in lower plasma concentrations.

SummaryThe anaesthetic management of children with craniofacial abnormalities often presents unique challenges because soft tissue and bony abnormities can affect the airway and influence airway management. We report four paediatric patients with predicted difficult airways due to craniofacial abnormalities. They all had a laryngeal view of Cormack-Lehane grade IV and were impossible to intubate using direct laryngoscopy. Fibreoptic intubation was also repeatedly attempted but was not successful. All the tracheal intubations were completed using a lightwand on the first attempt in less than 30 s. We consider that lightwand guided intubation technique may be a useful alternative approach to fibreoptic intubation technique in managing the difficult paediatric airway.

SummaryThis prospective self-controlled study was designed to evaluate the influences of head flexion on airway seal, quality of ventilation, and orogastric tube placement through the ProSeal TM laryngeal mask airway (ProSeal LMA TM ) in 80 anaesthetised, paralysed adult patients.After the ProSeal LMA was inserted and the cuff pressure was set at 5.9 kPa, ventilation quality, airway seal pressure, fibreoptic positions of the cuff and the drainage tube, orogastric tube placement and efficacy of intermittent positive pressure ventilation (IPPV) were assessed in two randomly selected positions: neutral and flexed position. When compared to the neutral head position, the head flexed significantly improved the airway seal pressure and the quality of ventilation of the ProSeal LMA (p < 0.05). Fibreoptic scores of the cuff position did not correlate with either the ability to obtain excellent or adequate ventilation through the ProSeal LMA or the ability to generate an airway seal pressure of ‡ 2 kPa. Orogastric tube placement via the drainage tube was successful on the first attempt in all patients in the neutral position compared with seven failures following three attempts in the flexed position (p < 0.05). There were no significant differences between the two head positions in the volume of air required to obtain an intracuff pressure of 5.9 kPa, fibreoptic score of the drainage tube position, and expiratory tidal volume and peak inspiratory pressure during IPPV (p > 0.05). In conclusion, head flexion improves airway seal and ventilation quality of the ProSeal LMA. However, placement of an orogastric tube via the drainage tube is impaired in the flexed position compared to the neutral position. Fibreoptic scoring of the ProSeal cuff position is not an accurate test to assess the airway seal and ventilation function. The ProSeal laryngeal mask airway (LMA TM ) is a laryngeal mask device with a modified cuff used to improve the seal around the glottis and a drainage tube to provide a channel for orogastric tube placement and to assist the diagnosis of incorrect positioning [1]. In anaesthetised patients, Brimacombe and Keller [2] demonstrated that the ProSeal and classic laryngeal mask airway are stable in different head positions, but that head flexion and rotation increase, and head extension decreases, airway seal pressure. However, this study was performed at different cuff pressures with the different head positions and did not assess ventilation quality and ease of the orogastric tube placement through the ProSeal LMA in the different head positions. It is generally recommended that inflation to an intracuff pressure of 5.9 kPa is preferred as this minimises pharyngeal mucosa pressure and prevents malposition [1].Although the fibreoptic scoring system described by Brimacombe and Berry [3] has been used to assess proper positioning and airway seal function of the classic

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