Laparoscopic surgery in obese patients and robotic procedures in steep Trendelenburg position impairs ventilation and increases postoperative pulmonary complications. Flow-controlled ventilation (FCV) is a ventilation mode that may improve lung mechanics and gas exchange. We report ventilatory and gas exchange effects of FCV in four patients: two with class III obesity having bariatric surgery and two undergoing robotic urological procedures. FCV enabled compliance-guided lung recruitment with increased tidal volumes and PaO2/FiO2 ratios. No patient developed respiratory complications. This case series suggests FCV may be particularly beneficial in patients with markedly altered respiratory mechanics during laparoscopic or robotic surgery.

BACKGROUND:MicroRNAs (miRs) regulate gene expression post-transcriptionally and are transported by high-density lipoproteins (HDL). Hypercholesterolemic HDL particles are enriched with miR-126-3p/5p, which can be delivered to endothelial cells, leading to the downregulation of hypoxia-inducible-factor-1α (HIF-1α), a key transcription factor involved in metabolic responses to hypoxia and cell survival during myocardial ischemia/reperfusion (I/R). OBJECTIVE:To investigate the effects of miR-126 mimic and inhibitor transfection on the HIF-1α/apoptosis axis in cardiac cell constituents under experimental I/R. METHODS:Firstly, specific durations of I/R were established for cardiac cells (cardiomyocytes, fibroblasts, endothelial cells, and macrophages) based on their susceptibility to metabolic changes and cell death. Then, we assessed the impact of transfecting these cells with mimic-miR-126-5p and anti-miR-126-5p to the selected timings of I/R on the HIF-1α/apoptosis axis. RESULTS:Endothelial cells were resistant to I/R and fibroblasts were sensitive to ischemia whereas cardiomyocytes displayed high metabolic flexibility. Endogenous miR-126 expression was exclusively found in endothelial cells. Transfection with anti-miR-126 increased HIF-1α transcription in endothelial cells and cardiomyocytes, while reducing HIF-1α levels in fibroblasts, resulted in decreased transcript levels of apoptotic markers. HIF-1α transcript levels remained unchanged in macrophages and transfection with mimic-miR-126 exerted no changes in the HIF-1α/apoptosis axis in all tested cells. CONCLUSIONS:miR-126 differentially regulates HIF-1α/apoptosis expression in cardiac cells exposed to experimental I/R and may serve as a potential therapeutic target for enhancing myocardial resilience in the setting of myocardial infarction.

The most frequent causes of airway obstruction during the use of laryngeal mask airway (LMA) devices are related to a superficial plane of anesthesia or misposition. However, uncommon causes must also be considered. This case report presents a patient scheduled for elective surgery, encountering unexpected difficulties during airway management due to a previously undiagnosed giant vocal cord polyp. The steps for managing a difficult airway were followed correctly finally leading to awakening the patient to prevent a potentially dangerous “can’t intubate, can’t ventilate” scenario.This case emphasizes the importance of thorough preoperative airway assessment, early recognition of airway difficulties and the strategic use of awake intubation techniques in complex airway management situations.

Idiopathic intracranial hypertension (IIH) is a condition characterized by elevated intracranial pressure (ICP) of unknown etiology, more prevalent in obese women of childbearing age. The management of IIH during pregnancy represents a multidisciplinary challenge, as medical treatment is contentious due to the foetal teratogenic risk, and the technically challenging placement of a ventriculoperitoneal shunt is hindered by the presence of the pregnant uterus. The goal of anaesthetic management during childbirth is to maintain hemodynamic stability, cerebral perfusion pressure, and cerebral tissue oxygenation, while avoiding abrupt fluctuations in intracranial pressure. The choice of anaesthetic technique is complex and depends on the assessment of risks and benefits associated with each technique, involving a decision between neuraxial anaesthesia and general anaesthesia. We present the case of a pregnant woman with rapidly progressing IIH, approached in a multidisciplinary manner, whose anaesthetic management was technically challenging, resulting in a favourable outcome without subsequent complications.

Skeletal dysplasias and short stature are a heterogeneous group of pathologies in which achondroplasia is the most common presentation. The presence of bone deformities leads to thoracic and airway changes that can complicate ventilation and airway management. Most individuals with skeletal dysplasia present spinal abnormalities that increase the difficulty of administering neuraxial anaesthesia. In pregnant patients, physiological and anatomical changes further complicate obstetric and anaesthesia management.We report the case of a patient with skeletal dysplasia and short stature who was admitted to our hospital in week 34.3 of her pregnancy due to labour and respiratory difficulties. It was decided to perform an emergency caesarean section due to the disproportionate size of the foetal head with respect to the pelvis. We also review the different anaesthesia techniques described in the literature, and discuss their potential advantages and difficulties.

INTRODUCTION:Emergency thoracostomy is applied in life-threatening situations. Simulation plays a pivotal role in training in invasive techniques used mainly in stressful situations. Currently available commercial simulation models for thoracostomy have various drawbacks.METHODS:We designed a thoracostomy phantom from discarded hospital materials and pigskin with underlying flesh. The phantom can be used alone for developing technical skills or mounted on an actor in simulation scenarios. Medical students, intensive care unit (ICU) and emergency department teams, and thoracostomy experts evaluated its technical fidelity and usefulness for achieving learning objectives in workshops.RESULTS:The materials used to construct the phantom cost €47. A total of 12 experts in chest-tube placement and 73 workshop participants (12 ICU physicians and nurses, 20 emergency physicians and nurses, and 41 fourth-year medical students) evaluated the model. All groups rated the model's usefulness and the sensation of perforating the pleura highly. Experts rated the air release after pleura perforation lower than other groups. Lung reexpansion was the lowest rated item in all groups. Ratings of the appearance and feel of the model correlated strongly among all groups and experts. The ICU professionals rated the resistance encountered in introducing the chest drain lower than the other groups.CONCLUSIONS:This low-cost, reusable, transportable, and highly realistic model is an attractive alternative to commercial models for training in chest-tube insertion skills.

Editorial FocusTranslational PhysiologyNarrowing the gap toward successful translational research in cardiovascular diseaseGemma Vilahur, Sebastia Alcover, and Marta MagaldiGemma Vilahur* Corresponding Author; email: [email protected]Sant Pau Institute for Biomedical Research, Barcelona, Barcelona, Spain*, Sebastia AlcoverSant Pau Institute for Biomedical Research, Spain, andMarta MagaldiHospital Clínic de Barcelona, SpainPublished Online:02 Feb 2024https://doi.org/10.1152/ajpheart.00038.2024MoreSectionsPDF (380 KB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations ShareShare onFacebookTwitterLinkedInWeChat Back to Top Next Download PDF FiguresReferencesRelatedInformation More from this issue > Articles in PressPublished 2/2/24 7:20 AM Crossmark Copyright & PermissionsCopyright © 2024, American Journal of Physiology-Heart and Circulatory Physiologyhttps://doi.org/10.1152/ajpheart.00038.2024PubMed38305750History Received 22 January 2024 Accepted 29 January 2024 Published online 2 February 2024 Keywordstranslational researchcardiovascular diseaseatherosclerosisvascular functionendothelium Metrics