The intubating laryngeal mask airway was used in 31 adult patients in whom tracheal intubation was known or suspected to be difficult. The intubating laryngeal mask airway was successfully inserted in 30 patients and provided a clinically patent airway. In the remaining one patient it was impossible to insert the device correctly. Tracheal intubation through the device was successful in 28 of 30 patients (93%). These results suggest that the intubating laryngeal mask airway has a potential role for tracheal intubation in adult patients with difficult airways.

Rabbit antiserum to Klebsiella pneumoniae showed a powerful protective effect against intramuscular infection in normal mice. No protective effect was observed in mice whose monocytes and polymorphonuclear cells were depleted by X-irradiation. The antiserum had approximately the same protective effect in mice whose macrophages were blocked selectively by carrageenan as in normal mice. It is concluded that antiserum exerted its effect by opsonic function and that opsonized K. pneumoniae were eliminated mainly by polymorphonuclear cells rather than macrophages, at least in an early phase of the infection. these findings were supported by histological examination and observation of intracellular killing in vitro.

Seventy consecutive patients were randomly allocated for intubation through the intubating laryngeal mask airway using a straight reinforced silicone tracheal tube with either a conventional or a modified bevel. The conventional bevel was firm, wedge-shaped and with a leading edge at the side. The modified bevel was soft, hemispherical and with a leading edge in the midline. The intubating laryngeal mask position was adjusted until optimal ventilation was obtained and intubation was attempted using the randomised device. If tactile resistance was felt, a predetermined sequence of adjusting manoeuvres were utilised before a subsequent attempt. The first-attempt successful intubation rate with the conventional bevel was 23/37 (62%) and with the modified bevel was 28/33 (85%). The second-attempt successful intubation rate for the conventional bevel was 12/37 (32%) and for the modified bevel was 4/33 (12%). Intubation failed after three attempts for one patient in each group. Fewer overall intubation attempts were required with the modified bevel (p = 0.033). We conclude that intubation success rates through the intubating laryngeal mask with a straight silicone-reinforced tube are higher with a soft, hemispherical bevel with a leading edge in the midline compared with the firm, wedge-shaped bevel with a leading edge at the side.

Key Clinical MessageThe acuinjections at acupuncture points (GB41, BL60, ST36, and SP6) provide immediate relief of sensory symptoms and motor signs of restless legs symptom (RLS). An acuinjection can be promising and safe alternative treatment for pharmacotherapy in patients of RLS.

SummaryPositioning of the epiglottis when the Brain laryngeal mask airway is in place was studied in 20 adult patients, using a new technique of insertion. The laryngeal mask was inserted when the anterior displacement of the mandible extended the epiglottis, thereby the providing an excellent airway in all patients. In 10 out of these 20 patients, the conventional technique of insertion revealed an incomplete extension of the epiglottis, and inadequate opening of the laryngeal inlet. It was concluded that the anterior displacement of the mandible during insertion of the laryngeal mask enhances the opening of the larynx, the result being an excellent airway.