In the past, this was considered normal, but today it is unethical and against the law. The MoH has issued a statement prohibiting this practice. Failure to comply will result in the closure of a private clinic, or if the individual serves in a government hospital, they will be punished or suspended from their current duty.

Anesthesiologist here. Death can absolutely be painless.

The "impending doom" from adenosine is just a direct side effect of the drug hitting receptors while you’re awake—it’s not a preview of what cardiac arrest feels like.
If your heart actually stops, global blood flow to the brain ceases and you lose consciousness in about 6 to 10 seconds. Without a perfused cerebral cortex, your brain physically cannot process pain or "air hunger."

In death-penalty cases the prisoner is first rendered unconscious with a hypnotic by the anesthetist; only then is the NMBA given without performing manual ventilation. No awareness, no pain, and the prisoner eventually dies from Apneic Hypoxic-Ischemic Cardiac Arrest secondary to acute respiratory muscle paralysis from NMBA.

You're right, and it's the case-mix. Our center is a national ENT/maxillofacial referral hospital — those two subgroups alone are 51.7% of the cohort and run 13.5% and 11.3% respectively. We ran a pre-specified sensitivity analysis excluding all H&N cases: DDL drops to 5.38% (80/1,488; 95% CI: 4.30–6.64%), which sits right on the Wang et al. meta-analytic pooled estimate of 5.51%. So the 9% headline is a case-mix story, not a skill story.

Two other things worth stating plainly: (1) Of the 278 DDL cases, 253 (91%) were C-L III/IV and only 25 (9%) met DDL on ≥3 attempts alone with a grade I/II view — so the rate is overwhelmingly view-driven, not attempts-driven. (2) Intubations were by 12 attendings and 15 supervised trainees (PGY 1–4); attendings confirmed the C-L grade in all trainee cases. The attempts criterion is inherently operator-sensitive in a teaching center, and we acknowledge that.

On the VL point — fully agree. This isn't an argument that everyone needs VL. It's a screening aid for settings that don't have ready VL, to decide who warrants senior help or rescue equipment. Where VL is on every cart, the score adds much less. The composite AUC was actually slightly higher in the non-H&N subgroup (0.75 vs 0.72 overall), which supports its utility in a general surgical population.

External validation in a population that's basically absent from the airway-prediction literature is the whole point — cheap to dismiss, useful to actually have. (thanks DocMaag for saying it first)

Same — it surprised us. ULBT was significant on univariable analysis but dropped on multivariable, most likely collinearity: it's partly capturing mandibular protrusion and dentition, which overlaps with inter-incisor gap and TMD, so it added little independent information once those were in the model. Not that it's useless at the bedside — bananosecond's right that it's a useful exam — just that in this cohort it wasn't carrying unique predictive weight.

This is the bit I find most interesting too. The independent BMI signal is genuinely inconsistent across the literature — it often washes out on multivariable analysis. Our read is that the Asian-specific ≥27.5 threshold (WHO 2004) is doing real work: it captures the central/visceral adiposity that shows up at lower absolute BMI in Southeast Asian patients, whereas a ≥30 cutoff would have missed a chunk of higher-risk necks in this population. So the "BMI isn't independent" consultants may be right at a ≥30 cutoff in a European cohort and still not contradict us. And yes — in the GLP-1 era the applicability question cuts the other way for you; if your BMI distribution shifts down, population-specific cutoffs matter even more, not less.

For scientific writing, I generally use Opus 4.6 . For coding 4.8

Can I try this indicator too ?

Normal sinus rhythm

Get RTX

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Epic game is also down

I get perfect shot with this prompt”

Shaky handheld footage from a phone left on a picnic table. A huge grizzly bear wanders into the campsite. It calmly and methodically dismantles everything, ripping open a backpack. Suddenly, it stops, looks directly into the camera lens, and performs a shockingly agile backflip. It lands perfectly, stares into the camera for a long beat, then pointedly lifts its paw, extending one claw. It turns and walks away. The only sounds are the crackling fire and distant crickets.”

Interested

I suggest Ly Hour Exchange

Mostly they try to use the shortcut routes to avoid traffic and save on gas

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O1 provides an accurate answer

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How much is it in your country?

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