Removal of the connector on the laryngeal mask airway provides a useful alternative to the intubating laryngeal mask
摘要:
Purpose: We describe two cases in which fiberoptic intubation through the standard laryngeal mask airway (LMA) was successful with large-bore tracheal tubes (TTs) when an intubating LMA (ILMA) could not be used.Clinical features: Patient #, with obstructive sleep apnea, underwent elective surgical repair. His mouth opening was just under 25 mm, but difficult intubation was not anticipated. We induced general anesthesia, easily ventilated the patient by mask, and established neuromuscular blockade. Direct laryngoscopy and attempts to insert either a #5 or a #4 ILMA into the mouth failed. A standard #4 LMA, with the connector removed, was inserted, through which a 7.0 mm nasal RAE (TM) TT; fiberoptically guided, passed into the trachea at the first attempt. Patient #2, with a loosened implant after left hip arthroplasty, underwent revision prosthesis. Her neck movement was limited. We thus planned awake securing of the airway, but the patient refused. We induced anesthesia and established bag-mask-valve ventilation. The limited neck movement prevented direct laryngoscopy. Visualizing the laryngeal inlet with the fiberoptic bronchoscope (FOB) proved impossible as bloody secretions obscured the FOB's tip. Ventilation by mask was easy. As an ILMA was not available, we removed a #5 LMA's connector and passed an 8.0 mm nasal RAE (TM) TT through the LMA. fiberoptic-guided intubation was easy, In both cases, the remainder of the intraoperative course was uneventful.Conclusion: A standard LMA whose connector has been removed to allow passage of TTs of >6.0 mm internal diameter may be substituted for the ILMA when necessary.
Cu-Catalyzed Enantioselective Atropisomer Synthesis via Thiolative Ring Opening of Five-Membered Cyclic Diaryliodoniums
作者:Mengqing Hou、Ruixian Deng、Zhenhua Gu
DOI:10.1021/acs.orglett.8b02477
日期:2018.9.21
thiolative ringopening reaction of five-membered diaryliodonium salts and potassium thioates for the synthesis of atropisomeric 2′-iodo-[1,1′-biphenyl]-2-yl thioates was realized. The optimal catalytic system, Cu(CH3CN)4PF6/(Ph)-bis(oxazoline), showed the best performance with respect to both yields and stereocontrol. Finally, the utility of these products was briefly demonstrated by the synthesis of an
The synthesis of (aroylthiomethyl)-triphenylphosphonium bromides and the applications as an equivalent of (mercaptomethyl)-triphenylphosphonium bromide in the synthesis of aroyl vinyl sulfides (thioenolates) are described.
The synthesis and reduction of optically active 2-mercaptopropionic acid and some derivatives
作者:L. N. Owen、M. B. Rahman
DOI:10.1039/j39710002432
日期:——
toluene-α-thiolate, on methyl L-O-ptolysulphonyl-lactate, methyl L-2-chloropropionate, and sodium L-2-chloropropionate, have been used to prepare D-2-acylthio- and D-2-acylthio- and D-2-alkylthio-propionic acids and esters. Extensive racemisation occurs when an excess of thioacetate or thiobenzoate is used; this is attributed to further SN2 displacement, with acetylthio or benzoylthio as a leaving group. Concomitant
Synthesis of β-oxo carbonyl and thiocarbonyl compounds via basic sulfur abstraction
作者:Saúl Silva、Christopher D. Maycock
DOI:10.1016/j.tet.2019.130552
日期:2019.10
suitable thioesters represents a mild method for the formation of carbon-carbon bonds and the formation of 1,3-dicarbonyl compounds. A study of the scope and limitations of this reaction for the synthesis of these or mixed 1,3-carbonyl/thiocarbonyl compounds by a base promoted sulfur abstraction rearrangement is described. These reactions were typically very clean and the products were obtained in good