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PubMed2004

Direct and indirect autofluorescence laryngoscopy in the diagnosis of laryngeal cancer and its precursor lesions.

Autofluorescence endoscopy has proven to facilitate the detection and delineation of precancerous lesions, carcinoma in situ and microinvasive cancer during bronchoscopy. The aim of the present study is to evaluate the diagnostic potential and limitations of this imaging technique applied during direct and indirect laryngoscopy. In a prospective study, 109 patients with suspected precancerous or cancerous lesions were investigated preoperatively by indirect autofluorescence laryngoscopy as well as during microlaryngoscopy. Autofluorescence was induced by filtered blue light (375-440 nm) of a xenon short arc lamp and processed by a CCD camera system (D-light-AF System, Storz, Tuttlingen, Germany). Autofluorescence images were immediately assessed for diagnosis, compared to the direct autofluorescence picture obtained during microlaryngoscopy and compared with pathohistological findings. Comparable to direct autofluorescence images, normal laryngeal mucosa showed a typical green fluorescence signal. Moderate and high epithelial dysplasia, carcinoma in situ, and microinvasive cancer displayed a diminished green fluorescence. False negative results were related to extreme hyperkeratosis. False positive cases showed mild dysplasia with inflammatory reactions or scarring. In 98 cases (90%) we found concordant results. According to our results, the presented technique seems to be a promising diagnostic tool for the early detection of laryngeal cancer and its precursor lesions during direct and indirect laryngoscopy. Scarring, marked hyperkeratosis, and inflammation can limit the predictive value of the method.

Carcinoma, Squamous Cell↗

PubMed2005

[Autofluorescence laryngoscopy in the diagnosis of laryngeal cancer--early results].

BACKGROUND: During oncogenesis significant changes in tissue properties occur that result in alteration of fluorescence characteristics of the tissue. The aim of our study was to determine the usefulness of autofluorescence technique in diagnostic of laryngeal epithelium lesions. MATERIAL AND METHODS: 40 patients admitted to the Department of Otolaryngology Wroclaw Medical University due to different laryngeal lesions were included into the study. They underwent white light laryngoscopy followed by autofluorescence videoendoscopy. AF was induced by blue light of xenon short arc lamp and processed by a D-light AF System (Storz). Autofluorescence and white light images were immediately assessed and later compared with to histopathological findings. RESULTS: Normal laryngeal mucosa showed a typical green fluorescence signal. Squamous cell carcinoma displayed a diminished green fluorescence and in some cases presented reddish-yellow color. CONCLUSIONS: We revealed that autofluorescence laryngoscopy is very helpful, supplementary tool in diagnosis of laryngeal pathology. Autofluorescence laryngoscopy is noninvasive technique designed especially for diagnostic of early and premalignant lesions.

Carcinoma, Squamous Cell↗

PubMed2005

[Sinus arrest during laryngoscopy for induction of general anesthesia with intravenous fentanyl and propofol].

A 43-year-old woman with Plummer's disease underwent left thyroid lobectomy without premedication using ambulatory electrocardiogram monitoring under general anesthesia. Anesthesia was induced with an intravenous bolus of fentanyl 100 microg, lidocaine 40 mg, propofol 80 mg and vecuronium 7 mg. As she moved 5 min after induction of anesthesia, fentanyl 100 microg and propofol 30 mg were administered additionally. After positive pressure ventilation by mask for 8 min, heart rate decreased from 71 beats x min(-1) to 48 beats x min(-1), and laryngoscopy was performed. When the tip of the laryngoscope was pressed on the base of the tongue and on lifting the epiglottis, the electrocardiogram showed RR interval prolongation and gradually going to sinus arrest. The laryngoscope was removed immediately and mask ventilation was performed. The heart beat resumed at 5.5 sec after sinus arrest. Atropine 0.5 mg was given intravenously and heart rate increased to 50 beats x min(-1). Additionally atropine 0.25 mg increased heart rate to 70 beats x min(-1). The second laryngoscopy was performed uneventfully. We consider this phenomenon as a result of vagovagal reflex. Fentanyl and propofol, by reducing sympathetic tone to a greater extent than parasympathetic tone, decrease blood pressure and heart rate, and predispose to a parasympathetic response for noxious stimulation. This case indicates that intravenous injection of atropine must be immediately used for bradycardia during laryngoscopy for induction of general anesthesia with fentanyl and propofol.

Adult↗

PubMed2006

Computed tomography virtual laryngoscopy: comparison between radiological and otolaryngological evaluations for laryngeal carcinoma.

OBJECTIVES: We evaluated the utility of computed tomography virtual laryngoscopy (CTVL) in identifying endolaryngeal lesions in laryngeal tumors. PATIENTS AND METHODS: Virtual laryngoscopic images were obtained from axial CT scans of 21 patients with known laryngeal carcinoma. Findings from rigid telescopic videolaryngoscopy (RTV) and CTVL images were evaluated and compared with reference to operative records. RESULTS: Lesions localized in the base of the tongue, pyriform sinus, aryepiglottic folds, and arytenoids were well visualized by both RTV and CTVL. The two techniques were not found effective in identifying lesions of the ventricular bands, ventricular cavities, and the anterior commissure. Virtual laryngoscopy was superior to RTV in the visualization of the subglottic area and vocal cords. CONCLUSION: Virtual laryngoscopy is a noninvasive and reliable technique that provides visualization of endolaryngeal surfaces and tumor extension. It may be beneficial in staging larynx carcinoma and planning the most appropriate surgical procedure.

Adult↗

PubMed1988

Effects of aerosolized and/or intravenous lidocaine on hemodynamic responses to laryngoscopy and intubation in outpatients.

A randomized, double-blind study was carried out on 40 unpremedicated, ASA I-II adult surgical outpatients to assess the effects of aerosolized lidocaine, intravenous lidocaine, both, or neither, on circulatory responses to laryngoscopy and intubation. Lidocaine (4 mg/kg) or saline was given by nebulizer in the holding area beginning at -15 minutes. The patient underwent a standardized induction of anesthesia that included IV curare (3 mg) and O2 by facemask at minute 2, followed by IV thiopental (5 mg/kg) and succinylcholine (1.5 mg/kg) at minute 5. Lidocaine (2 mg/kg) or saline was given by IV push at minute 4. Laryngoscopy was begun at 5 minutes and continued for 45 seconds before intubation. Heart rate and systolic, diastolic, and mean blood pressures were automatically recorded at 1-minute intervals from 0 to 11 minutes. The four treatment groups included: group 1, aerosolized and IV saline; group 2, aerosolized saline, IV lidocaine; group 3, aerosolized lidocaine, IV saline; and group 4, aerosolized and IV lidocaine. There were no differences among the four treatment groups (n = ten per group) in any of the four hemodynamic variables before laryngoscopy and intubation. Within each group, after intubation all four hemodynamic variables increased significantly over the corresponding baseline values for that group. However, the maximum values attained after intubation did not differ significantly among the four treatment groups for any of the four hemodynamic variables, whether those maxima were expressed as absolute values or as a percentage of baseline.(ABSTRACT TRUNCATED AT 250 WORDS)

Aerosols↗

PubMed1977

Circulatory responses to laryngoscopy and endotracheal intubation in patients with and without cardiovascular disease. Effect of prophylactic practolol.

The effect of small intravenous doses of practolol (0.2 mg/kg body weight) on the circulatory response to laryngoscopy and endotracheal intubation, when administered with atropine (0.01 mg/kg b.w.) prior to anaesthesia was studied in 39 patients with and without cardiovascular disease. Practolol diminished significantly the rise of mean arterial pressure and pulse rate affected by laryngoscopy and endotracheal intubation when performed under thiopentone-succinylcholine anaesthesia. Arrhythmias were also less frequent through the statistical significance could not be ascertained in this small series. The small practolol dose used had no adverse circulatory effects. It is suggested that the administration of a small prophylactic dose of practolol is useful in preventing the excessive cardiovascular response due to laryngoscopy and endotracheal intubation.

Adult↗

PubMedDate not supplied

Direct laryngoscopy: a retrospective analysis.

A retrospective analysis of direct laryngoscopies performed at our institution in 1978 was undertaken utilizing computer technology. The population which consisted of 54% males and 46% females had an average age of 50.4 years. The most common symptom was hoarseness (83.6%). The most frequent benign and malignant diagnoses were vocal cord polyp and squamous cell carcinoma, respectively. Males predominated in all disease entities except vocal cord polyps. Benign disease entities presented most frequently with one or two symptoms, while malignant pathology presented with a varied array and number of symptoms. The indications: "tumor" seen on indirect laryngoscopy, sore throat, dysphagia, otalgia, upper respiratory tract obstruction, hemoptysis, cough and leukoplakia were most frequently associated with malignancy. Voice abuse occupations were most commonly associated with vocal cord polyps and tobacco and alcohol use was most frequently associated with laryngeal cancer. Eighty-five percent of direct laryngoscopies were done under general anesthesia with two-thirds utilizing direct suspension microlaryngoscopy.

Adolescent↗

PubMed1994

The effect of single bolus dose of esmolol for controlling the tachycardia and hypertension during laryngoscopy and tracheal intubation.

Tachycardia and hypertension usually accompany laryngoscopy and tracheal intubation. This response is undesirable, especially in patients with cardiovascular or intracranial diseases. Esmolol is a cardioselective, ultrashort-acting beta adrenergic blocking agent with a very short half-life. The efficacy of bolus dose of esmolol in blunting hemodynamic responses during laryngoscopy and tracheal intubation was evaluated. 45 patients (15 in each group) of ASA physical status I and II scheduled for elective non-cardiac surgery were included in this randomized, placebo-controlled study. At time zero, the study preparation (placebo, 100 or 200 mg of esmolol) was administered intravenously, followed by thiopentone 5 mg/kg and succinylcholine 1.5 mg/kg for induction. Tracheal intubation was performed 2 minutes after time zero. Anesthesia was maintained with 50% nitrous oxide and 1.0 MAC halothane in oxygen, and vecuronium 0.08 mg/kg. Heart rate (HR) and systolic blood pressure (SBP) were recorded every minute for 10 minutes. To compare with the placebo group, there was a significant decrease in either HR or SBP in 200 mg group in the 8 minutes course after intubation (p < 0.05). There was a significant decrease in HR in the 100 mg group at the 3rd, 4th, and 5th minutes when compared with the placebo group (p < 0.05). The differences in SBP between the 100 mg group and placebo group were significant at the 3rd and 4th minutes (p < 0.05). Both bolus dosages of esmolol could effectively attenuate the tachycardia and hypertension produced by laryngoscopy and tracheal intubation. Furthermore, esmolol 200 mg presented a better hemodynamic stability than esmolol 100 mg during induction of anesthesia.

Adrenergic beta-Antagonists↗

PubMed1993

The cardiovascular and intracranial effects of laryngoscopy and endotracheal intubation in hypercarbic neonatal piglets.

Laryngoscopy and endotracheal intubation is a potent sympathetic stimulus in adults. Neonates are frequently intubated, but few data exist on the cerebral effects of this intervention. The cardiovascular and intracranial effects of laryngoscopy and endotracheal intubation were studied in 17 hypercarbic neonatal piglets. The mean arterial pressure in the study group (11 piglets) increased significantly within 2 minutes of the stimulus, and remained elevated for almost 14 minutes. The intubated animals showed significantly more haemorrhage in the basal area of the brain than the 6 control animals. The distribution suggests bleeding in the choroid plexus of the 4th ventricle. The significance of such bleeds is not immediately apparent, since none of the animals was grossly neurologically affected by the intervention. However, subtle long-term neurological deficits cannot be excluded and this aspect requires further study. Laryngoscopy and endotracheal intubation may cause non-lethal haemorrhage in the choroid plexus and central canal of the hindbrain in hypercarbic, neonatal piglets.

Animals↗

PubMed1992

Measurement of forces during laryngoscopy.

The forces transmitted by the laryngoscope blade onto the base of the tongue are assumed to be a major cardiovascular stimulus. This study investigates the various forces applied onto a Macintosh laryngoscope during laryngoscopy. The forces acting along the axis of the handle are described, as well as the forces exerted by the anaesthetist to prevent the laryngoscope from turning. Based on a relatively simple technique, a modified laryngoscope has been designed to measure these forces. Four different laryngoscopic parameters are determined: (1) the duration of laryngoscopy, (2) the maximally applied force, (3) the mean force and (4) the integral of the force over the time (area under the curve). The force measurements of 49 anatomically normal patients undergoing uncomplicated intubation are included in the study. The duration of laryngoscopy was 16.3s (SD 11.8), the applied peak force was 35N (SD 12) and mean force necessary was 20N (SD 6) while the force-time integral was 324N (SD 194).

Adult↗

PubMedDate not supplied

[Direct video-laryngoscopy].

The combination of modern bivalved operative laryngoscopes, laryngeal telescopes and videotaping techniques has given us a new tool in the objective evaluation of organic laryngeal lesions. The purpose of the present study has been to describe a new method for direct video-laryngoscopy, an alternative to the classical Kleinsasser microlaryngoscopy technique, in diagnosis, clinical documentation and endolaryngeal microsurgery under video control without using an operating microscope. The direct video-laryngoscopy system consists of: a Weerda distending operating laryngoscope, Hopkins rod lens and Lumina telescopes (0 degrees, 25 degrees, 70 degrees or Mueller subglottoscope), an original telescope holder for a distending laryngoscope, a lightweight medical videocamera, a VHS videorecorder, laryngoscope holder and chest support. From November 1987 to May 1989, 370 patients with laryngeal lesions were examined and recorded. Only in 3 cases was the microlaryngoscopy technique used as it proved difficult to introduce the telescope into its holder because of patient anatomy: one short-necked, obese patient, and two with a prominent tongue base and limited ability to open the mouth. In 367 cases direct video-laryngoscopy made careful diagnosis possible leaving a permanent record of the size and extent of the lesion. Such information could be used in accurate staging and follow-up. 320 patients were also treated by endolaryngeal microsurgery under video control without an operating microscope. Thanks to the width of the bivalved scope, the space for microsurgical instruments would be appreciably extended laterally, making it possible to better control the instruments on the monitor. The telescope lies on the superior spatula of the laryngoscope without interfering with the surgical procedures. The video material obtained was of high quality and of great value for diagnosis, pre- and post-operative evaluation, follow-up and documentation of various laryngeal disorders.

Laryngeal Diseases↗

PubMed2001

Correlation of findings at direct laryngoscopy and bronchoscopy with gastroesophageal reflux disease in children: a prospective study.

OBJECTIVE: To correlate direct laryngoscopic and bronchoscopic findings with the presence of positive test results for gastroesophageal reflux disease (GERD) in children. DESIGN: Prospective collection of structured data. SETTING: An academic pediatric otolaryngology department. PATIENTS: Seventy-seven consecutive patients who underwent direct laryngoscopy and bronchoscopy between June and October 1999. INTERVENTIONS: During direct laryngoscopy and bronchoscopy, descriptions of 7 laryngeal and 6 cricotracheal findings were recorded on a 3-point scale (i.e., absent, mild, or severe). Medical records were later reviewed to obtain results of the following tests, if they were part of the record: gastric scintiscan, 24-hour pH probe monitoring, upper gastrointestinal tract series, and esophageal biopsy. MAIN OUTCOME MEASURES: Correlation of mucosal abnormalities with the presence or absence of a positive test result for GERD. RESULTS: Fifty (65%) of 77 patients had GERD diagnosed with at least 1 positive test result, 21 (27%) had no clinical symptoms and no positive GERD test results, and 5 (7%) had clinical symptoms but no positive test results. There were significant differences for total laryngeal and cricotracheal scores (P<.001) between the groups with positive and negative results. Significant differences were as follows: in the larynx-large lingual tonsil (P<.001), postglottic edema (P<.001), arytenoid edema (P<.001), ventricle obliteration (P =.03), and true vocal fold edema (P = .001), and in the cricotracheal region-general edema and erythema (P =.003) and blunting of the carina (P<.001). Severe arytenoid edema, postglottic edema, or enlargement of lingual tonsil were pathognomonic of GERD. CONCLUSION: Many direct laryngoscopic and bronchoscopic findings correlate well with the diagnosis of GERD as determined by using other tests.

Adolescent↗

PubMed2004

A comparison of ocular protective measures during carbon dioxide laser laryngoscopy.

OBJECTIVE: To determine the efficacy of various eye protection measures during carbon dioxide laser laryngoscopy. DESIGN: A standard medical mannequin was equipped with indicator paper over the eyes and subjected to multiple passes of direct carbon dioxide laser beam contact at 400-mm focal length with powers ranging from 2.5 to 4.0 W during simulated laser microlaryngoscopy. Several different eye protection materials, including silk tape, paper tape, cloth tape, occlusive dressing, and eye pads, were used to cover the eyes and tested for their degree of protection against the laser beam. Thermal injuries were quantified and compared among these protective materials. SETTING: Academic medical center. MAIN OUTCOME MEASURE: Degree of eye protection against the laser beam injury on a scale of 0 to 4. RESULTS: The carbon dioxide laser beam at both 2.5 and 4.0 W produced considerable thermal damage to the indicator paper in the absence of any protective barrier. Among the adhesive protective barriers, moistened cloth tape was the most effective adhesive material against laser beam-induced thermal damage (P<.001). Silk tape and paper tape offered poor protection. Moist eye pads, although not adhesive and therefore unable to maintain eye closure, were very effective barriers against the laser beam. Dry paper tape and dry eye pads were imminently flammable. CONCLUSION: A combination of moistened cloth tape to maintain eye closure coupled with placement of well- moistened cotton-based eye pads over the tape provides excellent eye protection during carbon dioxide laser laryngoscopy.

Eye Protective Devices↗

PubMed1993

Effects of laryngoscopy and tracheal intubation on cerebral and systemic haemodynamics in children under different protocols of anaesthesia.

The effects of laryngoscopy and tracheal intubation on cerebral and systemic haemodynamics were studied in 30 children. The objective was to identify conditions in which the alterations of cerebral and systemic haemodynamics were minimal. The children were intubated after muscular relaxation and following 10 min of mechanical ventilation with end-tidal halothane concentrations of 1.5%, 2.0% and 2.5%, respectively. With 1.5%, 2.0% and 2.5% end-tidal halothane, the mean flow velocity increased by 26%, 19% and 5%, the mean blood pressure by 14%, 10% and 1%, and the heart rate by 26%, 8% and 5% respectively after intubation. Adverse effects of laryngoscopy and tracheal intubation on cerebral haemodynamics in children can be avoided by adequate anaesthetic protocols.

Anesthesia, Inhalation↗

PubMed1977

Cardiovascular reactions to laryngoscopy and tracheal intubation following small and large intravenous doses of lidocaine.

The efficacy of intravenously administered lidocaine 0.75 mg/kg and 1.5 mg/kg to protect against cardiovascular reactions associated with laryngoscopy and tracheal intubation was studied in two comparable groups of ten patients and compared with a similar control group of ten patients given only saline. Following laryngoscopy and tracheal intubation, the 1.5 mg/kg dose afforded complete protection against cardiac arrhythmias of all types. The smaller dose was ineffectual in this respect. While the larger dose caused borderline protection against hypertension and tachycardia, the smaller dose prevented only the rise in systolic blood pressure. Possible mechanisms to account for these observations are discussed. These include a direct myocardial depressant effect, a central stimulant effect, a peripheral vasodilating effect and finally an effect on synaptic transmission.

Adult↗

PubMed1987

Precipitous bradycardia induced by laryngoscopy in cardiac surgical patients.

We present three patients with severe ischaemic heart disease who developed profound bradycardia (heart rates of 15 beats.min-1, 10 beats.min-1 and asystole) at the time of laryngoscopy and spraying of the trachea with topical lidocaine. All patients had received fentanyl 20-30 micrograms.kg-1 and pancuronium 0.1-0.13 mg.kg-1 and in each case laryngoscopy was performed three minutes after the administration of these agents. We believe that in these cases the dosage of fentanyl was inadequate and since increasing the dosage of fentanyl to at least 50 micrograms.kg-1 and eliminating the manoeuvre of laryngeal spraying with topical anaesthesia, we have not encountered this problem.

Aged↗

PubMed1998

[High-resolution virtual laryngoscopy based on spiral CT data].

This pilot study investigated the feasibility and clinical value of high-resolution virtual real-time laryngoscopy based on helical CT data sets. Nine patients with laryngeal pathology (three with tumors of the vocal cords, two laryngeal carcinomas, one with invasion of the larynx by thyroid carcinoma and six subglottic stenoses) underwent examination by helical CT at a collimation of 1 mm. Following acquisition, the images were processed at a workstation with standard visualization software, such that virtual endoscopy (VE) in real time was possible. The images were then compared with the findings of conventional endoscopy. Because of swallowing artifacts, reconstruction failed in 2 of 12 patients. None of the carcinomas of the vocal cords was recognized at VE or in the cross-sectional CT images. VE provided the correct diagnosis in 8 of 12 cases (laryngeal tumors, subglottic stenoses). Virtual laryngoscopy is capable of simulating the visual findings of endoscopy in cases of laryngeal tumors and subglottic stenoses. Small tumors of the vocal cords are not adequately visualized. The major problem affecting results is motion artifacts resulting from involuntary swallowing.

Aged↗

PubMed1982

Continuous monitoring of left ventricular performance with the computerized nuclear probe during laryngoscopy and intubation before coronary artery bypass surgery.

Left ventricular performance was monitored serially in 25 patients during laryngoscopy and intubation in the anesthetic induction period before elective coronary artery bypass surgery using the labeled equilibrium blood pool and the computerized nuclear probe. Left ventricular ejection fraction was obtained preoperatively, after induction of anesthesia but before endotracheal intubation, immediately after intubation, and at 1 minute intervals thereafter for 10 minutes. In all patients, there was an immediate decrease (mean 16%) in left ventricular ejection fraction accompanying the reflex hypertension and tachycardia occurring during laryngoscopy and endotracheal intubation; it was significantly depressed for 3 minutes with the concomitant hemodynamic changes. Seven patients did not demonstrate a recovery of left ventricular ejection fraction to the preintubation value. In 10 healthy noncardiac patients undergoing orthopedic surgery, after an identical anesthetic induction sequence and intubation, there was a similar decrease in ejection fraction, but of shorter duration. In these patients the recovery of left ventricular performance preceded the recovery of blood pressure and heart rate. This study demonstrates that profound decreases in left ventricular performance accompany the reflex hypertension and tachycardia occurring during endotracheal intubation and that there is persisting depression of left ventricular function in some patients with coronary artery disease. These findings indicate the potential utility of the computerized nuclear probe for monitoring ventricular performance during this critical period.

Adult↗