A lexicon for endoscopic adverse events: report of an ASGE workshop.

National High Blood Pressure Education Program.

This is a retrospective study of patients whose tracheas were impossible to intubate on a previous occasion. There is a correlation between the degree of difficulty and the anatomy of the oropharynx in the same patient. The study was initially on obstetric patients but was extended to nonobstetric surgical patients in order to increase the number of cases investigated. The incidence of failed intubations in the obstetric group over a 3-year period was seven out of 1980 cases, whereas in the surgical group the results were six out of 13,380 patients. Any screening test which adds to our ability to predict difficulty in intubation must be welcomed, as failure to intubate can potentially lead to fatality.

https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/pdf/10.1111/j.1365-2044.1987.tb04039.x

Difficult tracheal intubation: a retrospective study

The objective of this study was to systematically determine the diagnostic accuracy of bedside tests for predicting difficult intubation in patients with no airway pathology. Thirty-five studies (50,760 patients) were selected from electronic databases. The overall incidence of difficult intubation was 5.8% (95% confidence interval, 4.5‐7.5%). Screening tests included the Mallampati oropharyngeal classification, thyromental distance, sternomental distance, mouth opening, and Wilson risk score. Each test yielded poor to moderate sensitivity (20‐62%) and moderate to fair specificity (82‐97%). The most useful bedside test for prediction was found to be a combination of the Mallampati classification and thyromental distance (positive likelihood ratio, 9.9; 95% confidence interval, 3.1‐31.9). Currently available screening tests for difficult intubation have only poor to moderate discriminative power when used alone. Combinations of tests add some incremental diagnostic value in comparison to the value of each test alone. The clinical value of bedside screening tests for predicting difficult intubation remains limited.

/pdf/predicting-difficult-intubation-in-apparently-normal-1kor8ihpxe.pdf

Predicting difficult intubation in apparently normal patients: a meta-analysis of bedside screening test performance.

The Social Transformation of American Medicine is one of the most comprehensive studies on the rise of the medical profession and the development of the health care industry published to date, Starr is able to span the fields of medicine so that he discusses intelligently the economic, political, and historical developments in medical care. His wri ting is clear and succinct, his arguments are copiously footnoted, and the inferences he draws are sound. In Book I, he covers \"the rise of medical authority and the shaping of the medical system\"; in Book II, \"doctors, the State, and the coming of the corporation.\" Reviews by Daniel Bell of Harvard and George Silver of Yale call Starr's work brilliant-I would agree. I would recommend this book to anyone who wants to understand the current health care system. Starr describes the movement of the medical profession from one that was initially viewed skeptically to one that was later embraced; and now, coming full circle, to one that is viewed critically. Starr maintains that the current status of American medicine is the result of our history of accommodating professional interests while failing to exercise control over health programs, and then needing to adopt piecemeal regulations and cut-backs on programs that become too inflationary, One of the primary messages I take from this book is the importance of a com bination of forces: a profession's authority, the political climate, and the current philosophy about health care. Starr illustrates how these forces coalesce to defeat or achieve medical improvements. As occupational therapists, we are dependent on the development of the health care industry. It is wise for us to understand the forces that have an impact on medical care and what they could mean for our profession, Kay Barbara Schwartz, M.S., OTR

The social transformation of american medicine.

It has been suggested that the size of the base of the tongue is an important factor determining the degree of difficulty of direct laryngoscopy. A relatively simple grading system which involves preoperative ability to visualize the faucial pillars, soft palate and base of uvula was designed as a means of predicting the degree of difficulty in laryngeal exposure. The system was evaluated in 210 patients. The degree of difficulty in visualizing these three structures was an accurate predictor of difficulty with direct laryngoscopy (p less than 0.001).

/pdf/a-clinical-sign-to-predict-difficult-tracheal-intubation-a-3shggw1jw9.pdf

A clinical sign to predict difficult tracheal intubation: a prospective study

A Clinical Sign to Predict Difficult Tracheal Intubation: A Prospective Study

A Clinical Sign to Predict Difficult Tracheal Intubation: A Prospective Study S. Mallampati;S. Gatt;L. Gugino;S. Desai;B. Waraksa;D. Freiberger;P. Liu; Obstetric Anesthesia Digest

A Clinical Sign to Predict Difficult Tracheal Intubation

https://rapm.bmj.com/content/rapm/29/5/434.full.pdf

Neurologic and histopathologic evaluation after high-volume intrathecal amitriptyline

Evidence of human use of opium dates back as far as the sixth millennium BCE. Ancient societies through the Renaissance period created a variety of opium products, proliferating its common use and subsequent addiction. Because the active moiety was not known at this time, the potency of these opium concoctions could neither be predicted nor controlled. The first step in identifying opium's active ingredient, morphine, was its chemical isolation in the early 1800s by Wilhelm Serturner. The subsequent elucidation of morphine's chemical formula and Sir Robert Robinson's derivation of morphine's structural formula, which won him the 1947 Nobel Prize in Chemistry, round out 150 years of the incremental advances in our chemical understanding of morphine. Nevertheless, our attempts to synthesize morphine, despite our advanced knowledge in synthetic chemistry, are still no match for the plant-based extraction of morphine from the poppy plant. The status quo remains problematic socially, economically, and politically; the relationships between the countries laboriously growing poppy plants to extract morphine and those countries importing these painkillers are unstable at best. In this study, we contrast the cumulative scientific discoveries that have led to our current chemical knowledge of morphine with the centuries-old natural method of morphine production that still dominates the opioid market today.

Sukumar P. Desai

Papers

A clinical sign to predict difficult tracheal intubation: a prospective study

A Clinical Sign to Predict Difficult Tracheal Intubation: A Prospective Study

A Clinical Sign to Predict Difficult Tracheal Intubation

Neurologic and histopathologic evaluation after high-volume intrathecal amitriptyline

The Chemical History of Morphine: An 8000-year Journey, from Resin to de-novo Synthesis.