SummaryWe studied 128 patients undergoing nasal intubation to see whether the nostril side used influenced peri-operative nasal complications. In the apparently normal nostril, there is no significant difference between either nostril in difficulty of intubation ( p . 0.8). Similarly, there is no significant difference in the incidence of bleeding at intubation ( p . 0.2), at extubation ( p . 0.5) and once the patient has returned to recovery ( p . 0.1). Postoperative nostril patency is also similar between groups ( p . 0.85). Standard teaching of nasal intubation recommends that, in the first instance, the right nostril should be used when patency appears equal on both sides of the nose [1]. This is because the tracheal tube is designed such that the flat side of the bevel is on the left side of the tip. However, there is no evidence that the risk of trauma to the nose, or difficulty with intubation, is any greater using the left nostril. Many case reports of potentially serious complications of nasal intubation have in fact involved the right nostril [2±4].Our study aimed to elucidate whether the left nostril was more difficult to intubate than the right and whether the complications, in terms of bleeding and postoperative nostril patency, were different between the two sides. MethodAfter approval from the Hospital Research Ethics Committee, we studied 128 patients who were undergoing elective dental surgery that required nasal intubation. Patients were ASA classification 1 or 2. They had no history of nasal disease, including epistaxis, no coagulation problems, and were not taking medication likely to increase bleeding. None of the group had hypertensive disease. Patients were not studied if there was apparent unilateral decrease in nostril patency, determined by breathing through each nostril individually.A standard anaesthetic technique was used. Premedication with diclofenac 100 mg rectally was given up to 30 min before surgery. Induction and maintenance of anaesthesia was performed using a combined propofol (500 mg)/alfentanil (2 mg) infusion, with atracurium 0.3 mg.kg 21 given to facilitate intubation. Ventilation throughout anaesthesia was provided using an oxygen/ nitrous oxide mixture.The nostril side for intubation was chosen randomly and no vasoconstrictor spray was used. Intubation was performed using a Portex`Ivory' cuffed nasotracheal tube lubricated with water-soluble jelly. A tube with an internal diameter of 6.5 mm was used for men and 6 mm for women. The tube was passed through either nostril with the slant of the bevel facing to the left. The ease of passing the tube through the nostril was noted. Once the tip of the tube had passed into the oropharynx, direct laryngoscopy was performed and the presence of blood in the pharynx was noted. This was classified as either (1) blood absent, (2) blood staining on the cuff only (mild bleeding) or (3) blood pooling on the posterior pharyngeal wall (severe bleeding). The tube was then passed into the trachea under direct vision, the cuff was inflated ...

Introduction Cardiac surgery with cardiopulmonary bypass (CPB) is a recognized trigger of systemic inflammatory response, usually related to postoperative acute lung injury (ALI). As an attempt to dampen inflammatory response, steroids have been perioperatively administered to patients. Macrophage migration inhibitory factor (MIF), a regulator of the endotoxin receptor, is implicated in the pathogenesis of ALI. We have previously detected peak circulating levels of MIF, 6 hours post CPB. Experimental data have shown that steroids may induce MIF secretion by mononuclear cells. This study aims to correlate levels of MIF assayed 6 hours post CPB to the intensity of postoperative pulmonary dysfunction, analysing the impact of perioperative steroid administration. MethodsWe included patients submitted to cardiac surgery with CPB, electively started in the morning, performed by the same team under a standard technique except for the addition of methylprednisolone (15 mg/kg) to the CPB priming solution for patients from group MP (n = 37), but not for the remaining patients -group NS (n = 37). MIF circulating levels were assayed at the anesthesia induction, 3, 6, and 24 hours after CPB. A standard weaning protocol with fast track strategy was adopted, and indicators of organ dysfunction and therapeutic intervention were registered during the first 72 hours postoperative.Results Levels of MIF assayed 6 hours post CPB correlated directly to the postoperative duration of mechanical ventilation (P = 0.014, rho = 0.282) and inversely to PaO 2 /FiO 2 ratio (P = 0.0021, rho = -0.265). No difference in MIF levels was noted between the groups. The duration of mechanical ventilation was higher (P = 0.005) in the group MP (7.92 ± 6.0 hours), compared with the group NS (4.92 ± 3.6 hours). ConclusionCirculating levels of MIF assayed 6 hours post CPB are correlated to postoperative pulmonary performance. Immunosuppressive doses of methylprednisolone did not affect circulating levels of MIF and may be related to prolonged mechanical ventilation. ResultsFourteen patients (12 males, 56.9 ± 10 years) with severe HF (LV EF 30 ± 6%) were enrolled. All patients had triple-vessel disease and 64% had previous myocardial revascularization. A total of 30 × 10 6 BM-MNC were injected at 15 sites. All patients were discharged from hospital 48 hours after the procedure. The estimated LV ischemic area on MIBI SPECT was measured by percentual of myocardial defect reverse, 14.8 ± 15% of LV mass at baseline that was reduced to 5 ± 11% (P = 0.009) at 8 weeks after S2 procedure. EF increased 16% (P = 0.03) at 8 weeks. The number of PVC was reduced at 24 hours (483 ± 4598 versus 236 ± 6243, P = not significant) and at 8 weeks (483 ± 4598 versus 191 ± 1236, P = not significant). No MA were documented at 24 hours or at 8 weeks. QT dispersion decreased from 63 ± 24 ms at baseline to 54 ± 16 ms (P = 0.3) at 2 months of follow-up.Conclusion BM-MNC transplantation into myocardium of patients with severe heart failure was safely performed and short term follow-up...