(1) Introdução: Alguns estudos indicam que a doença arterial aterosclerótica intracraniana (ICAD) pode ser um fator de risco para demência vascular. No entanto, os mecanismos fisiopatológicos envolvidos neste processo são ainda pouco compreendidos. Foi posto em hipótese que o sistema nervoso autónomo poderá ter algum papel neste processo, uma vez que este sistema se encontra disfuncional em muitas doenças neurológicas. (2) Métodos: O sistema nervoso autónomo foi avaliado através de parâmetros relacionados com o barorreflexo, a variabilidade da frequência cardíaca e da tensão arterial em doentes com ICAD, controlos Saudáveis e controlos Hipertensos. Os resultados foram posteriormente comparados entre os 3 grupos. Os parâmetros autonómicos foram também correlacionados com o desempenho dos doentes com ICAD em testes cognitivos. (3) Resultados: o grupo ICAD mostrou uma menor atividade simpática em alguns testes autonómicos em comparação com os dois grupos controlo e uma menor atividade simpática correlacionou-se com um pior desempenho nos testes cognitivos. (4) Conclusão: Os achados deste estudo indicam que ICAD tende a estar associada a disfunção autonómica, particularmente a nível do ramo simpático, e que estas alterações podem possivelmente ser responsáveis pelas alterações cognitivas vasculares documentadas neste grupo de doentes. / (1) Background: Intracranial arterial atherosclerotic disease (ICAD) has been pointed by some studies as a contributor to vascular cognitive impairment. However, the pathophysiological mechanisms that play a part in the development of cognitive decline are not clearly understood. It was hypothesized that the autonomic nervous system could have a role in this matter, since it is frequently dysfunctional in neurological diseases. (2) Methods: Autonomic Nervous System was evaluated through parameters related to baroreflex, heart rate and blood pressure variability in ICAD patients, Healthy and Hypertensive Controls. The results were then compared between the 3 groups. The autonomic parameters were also correlated with performance in cognitive tests in ICAD patients. (3) Results: the ICAD group showed lower sympathetic activity in some autonomic tests when compared to both control groups and lower sympathetic activity correlated to a generally worse cognitive performance. (4) Conclusions: The findings of this study indicate that ICAD tends to be associated with autonomic dysfunction, especially at sympathetic level, and that these alterations might possibly be responsible for the vascular cognitive impairment reported in this group of patients.

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Direct laryngoscopy (DL) is the gold standard technique for advanced airway management. However, currently, the most evolved devices for are Video Laryngoscopes (VL), which allow an Indirect Laryngoscopy and are already used in different clinical contexts. Some questions remain unclear concerning VL advantages over DL. This article aims to discuss if VL can be a good substitution for DL in the future. To write this review, relevant articles were identified via MEDLINE search, followed by a secondary search of references cited by retrieved articles. Search engines, indexing services and repositories were also utilized to trace documents as far back as 2000. In difficult airway, VL was associated with an easier intubation and a shorter intubation time. It can also be useful in trauma victims with cervical spine immobilization, emergency situations and morbidly obese patients. VL showed superiority as a learning tool and when the patient is not in supine position. However, VL has also some limitations such as loss of depth perception, soft tissues injury, a false sense of security and some economical issues. Data regarding hemodynamic response is conflicting. Thus, more studies with big samples are needed to figure out if VL is safer than DL, namely in patients with cardiovascular disease. Likewise, studies are needed to understand if VL is benefic in a normal airway. Cost-benefit studies would be useful to understand if VL is a viable substitution to DL.

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