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At least 271 records · Page 15Linked to original sources

PubMed1981

[Jet ventilation in laryngoscopy and microlaryngeal surgery under general anaesthesia (author's transl)].

This is a report on a technique which provides an unimpeded access to the operating field during laryngoscopy and laser microsurgery of the larynx. Under barbiturate-induced neuroleptanaesthesia and relaxation with alcuronium 18 patients were jet-ventilated with nitrous oxide and oxygen. The gas mixture was delivered via an automatic injection ventilator (Injection-Timer, Storz) connected to a short endotracheal tube (Injectoflex, Rüsch - a modified Carden tube). Arterial blood sampling was carried out during the whole procedure. In all patients the recommended technique provided adequate alveolar ventilation with minimal metabolic disturbances; the partial pressures of oxygen exceeded the standard values in all cases. Moderate circulatory alterations were observed. Clinical experience with the anaesthetic technique is presented and the advantages of the modified tube compared with the original Carden tube and former devices for jet ventilation during laryngoscopy are described.

Adolescent↗

PubMed1981

[Laryngoscopy of laryngeal damage in long-term intubated intensive care patients].

67 long intubated, critically ill patients were examined by direct laryngoscopy between the 3rd and 14th day of intubation. It was found that even after 5 days most of the patients investigated had severe laryngeal damage. Damage occurs preferentially on the vocal cord (laryngeal granuloma), on the arytenoid vocal process and on the cricoidal plates (ulcerations). It is concluded that laryngoscopy should be performed after 5 days of intubation at the latest to determine the extent of laryngeal damage. If necessary, secondary tracheotomy should be considered.

Adolescent↗

PubMed1995

Direct laryngoscopy in children: rigid and flexible fiberoptic.

Examination of the child's larynx is mandatory in the management of pediatric airway problems. The techniques used to perform this examination have evolved over time and now present the airway specialist with choices that can be tailored to each specific situation. Traditionally, rigid direct laryngoscopy (RDL) has been used to evaluate the pediatric larynx. More recently, flexible fiberoptic laryngoscopy (FFL) has been used to visualize the child's airway. RDL and FFL each play a role in the evaluation of the pediatric larynx. Expertise with both techniques is mandatory for the otolaryngologist managing respiratory disorders in children. FFL has become our technique of choice to evaluate the pediatric larynx especially when airway dynamics are of concern. RDL remains the preferred technique when laryngeal/tracheal surgery is planned or establishment and protection of the airway with intubation or bronchoscopy is required.

Anesthesia↗

PubMed1993

[Predicting the difficulty of laryngoscopy using the distance between the lower border of the mandible and the thyroid notch].

We examined the relationship between the degree of difficulty in visualization of the larynx and the distance from the lower border of the mandible to the thyroid notch (M-T distance). Patients were examined and the M-T distance was measured with their neck fully extended during preoperative period. Difficulty of laryngoscopy was graded as reported previously. Five hundred sixty one patients were assessed, and those with obvious neck and head pathology were excluded. There were 440 cases (78.4%) in grade 1, 116 cases (20.7%) in grade 2 and only 5 cases (0.9%) in grade 3. There were no grade 4 cases. The M-T distance was 5.4 +/- 0.6 cm in grade 1, 4.6 +/- 0.7 cm in grade 2 and 3.6 +/- 0.7 cm in grade 3. These were significantly different with each other (P < 0.05). If the M-T distance is 4.5 cm or less, the difficulty in visualization of laryngoscope increases. Therefore, in the case in which the M-T distance is 4.5 cm or less, we recommend further examination and preparation for difficult laryngoscopy.

Forecasting↗

PubMedDate not supplied

[Cardio-circulatory response to laryngoscopy. Comparative study between Macintosh and McCoy laryngoscopes].

To assess the cardiocirculatory repercussions of laryngoscopy performed with the Macintosh or McCoy laryngoscopes, we studied 20 patients randomly divided into 2 groups of 10 to undergo laryngoscopy with one or the other of the aforementioned instruments. All patients were in good health overall (ASA I or II) and presented no criteria for difficult intubation (Mallampati I or II, distance between the thyroid and the menton greater than 7 cm and maximum distance between the incisors greater than 3.5 cm). The McCoy laryngoscope was associated with significantly lower systolic arterial pressure and heart rate.

Adolescent↗

PubMed1996

A comparison of lidocaine, fentanyl, and esmolol for attenuation of cardiovascular response to laryngoscopy and tracheal intubation.

BACKGROUND: Laryngoscopy and tracheal intubation are known to increase sympathetic activity that may be detrimental to patients with pre-existing ischemic or hypertensive heart diseases. In order to alter the hyperdynamic consequences resulting from intubation during induction of general anesthesia, we chose esmolol, an ultra-short acting cardioselective beta-adrenergic blocker, to attenuate the cardiovascular responses during tracheal intubation in patients undergoing elective surgery. The efficacy of esmolol in this regard was carefully evaluated. METHODS: Eighty ASA physical status class I or II patients undergoing elective, non-cardiac procedures were included in a randomized, single-blinded study consisting of 4 groups with each group receiving a designated drug: group A received normal saline as control, while group B, group C and group D received lidocaine 2 mg/kg, fentanyl 3 micrograms/kg and esmolol 2 mg/kg, respectively. Monitoring included EKG, pulse oximetry, capnometry and arterial pressure. All patients were premedicated with diazepam 0.1 mg/kg 30 min before induction of general anesthesia. Each designated drug was given upon induction of anesthesia (time zero). Anesthesia was induced with thiopental 5 mg/kg and succinylcholine 1.5 mg/kg, and maintained with N2O, 1% isoflurane in 50% O2 and vecuronium. Intubation was carried out 3 min after the designated drug was given. Heart rate (HR) and systolic arterial blood pressure (SBP) were obtained every min for 10 min after induction. Either chi-square test or analysis of variances (ANOVA) was used for statistical comparison. A p value less than 0.05 was considered statistically significant. RESULTS: There was no difference in the demographic data among the four groups. After intubation, the incidence of tachycardia (HR > 100/min) was found in 3 of 20 (15%) patients in esmolol group, significantly lower than 17 of 20 (85%) patients in the control group, 15 of 20 (75%) patients in lidocaine group, and 11 of 20 (55%) patients in fentanyl group, respectively (p < 0.05). The incidence of hypertension (SBP > 180 mmHg) was found in 4 of 20 (20%) patients in esmolol group, significantly lower than 16 of 20 (80%) patients in control group and 14 of 20 (70%) patients in lidocaine group, respectively (p < 0.05), but not in 8 of 20 (40%) patients in fentanyl group. Besides, the incidence of hypertension in fentanyl group (40%) was significantly lower than control group (80%; p < 0.05), but not in lidocaine group (70%). CONCLUSIONS: Results of this study showed that only esmolol could reliably offer protection against the increase in both HR and SBP, low dose of fentanyl (3 micrograms/kg) prevented hypertension but not tachycardia, and 2 mg/kg lidocaine had no effect to blunt adverse hemodynamic responses during laryngoscopy and tracheal intubation.

Adrenergic beta-Antagonists↗

PubMed1995

[A historical outline of laryngoscopy].

The attempts of examination of the larynx since the 18th century made by many European doctors have been presented; namely, the mirror laryngoscopy by M. Garcia, L. Türck, and J. Czermak's diserts to development and propagation of laryngoscopy. The authoscopy by Kirstein, Pieniazek's lower tracheobronchoscopy and Killian's tracheobronchoscopy have been discussed.

History, 19th Century↗

PubMed1999

[The potential uses and limitations of the flexible laryngoscopy under local anesthesia in clinical practice].

Microsurgery of the larynx is commonly performed as direct laryngoscopy (DL) under general anesthesia. An alternative in selected cases is flexible laryngoscopy (FSL) under local anesthesia. We used a flexible laryngoscope that contained an additional working tunnel (Olympus ENF Type T3). Local anaesthesia of the larynx was achieved with 1% oxybuprocaine-HCl. Tissue samples were taken under endoscopic view and control. Twenty-five patients were studied and had benign lesions of the larynx or were being followed after treatment for cancer. The examination was tolerated well by all patients. The handling of the endoscope allowed precise targeting and sample taking. Due to the 2.2 mm diameter of the forceps the sizes of the biopsies were also limited. However, nearly all of the biopsies taken allowed sufficient histological examination. The advantage of the FSL was its simplicity and the minor inconvenience for patients. Although true histological results of suspect findings are possible, limitations in examining the hypopharynx prevent true staging of cancer patients. In general, FCL is a worth-while complement to DL.

Anesthesia, Local↗

PubMed2002

Haemodynamic responses to laryngoscopy and intubation in patients with pregnancy-induced hypertension: effect of intravenous esmolol with or without lidocaine.

The pressor response is known to be exaggerated in patients with pregnancy-induced hypertension, which can result in increased morbidity and mortality in both mother and newborn. Various pharmacological agents have been used before induction in an attempt to attenuate the adrenergic response but with varying degree of success. Esmolol, an ultra short-acting cardioselective beta-blocker with rapid onset and short elimination half-life, is an attractive choice for attenuating the adrenergic response in pregnant patients. In a prospective, randomised double blind study we evaluated the efficacy of two bolus doses of esmolol with or without lidocaine, in patients with pregnancy-induced hypertension. Eighty such patients undergoing lower segmental caesarean section were randomly divided into four groups and received the following study drugs before intubation: group I, esmolol 1 mg.kg(-1); group II, esmolol 2 mg.kg(-1); group III, esmolol 1 mg.kg(-1) and lidocaine 1.5 mg.kg(-1); and group IV, esmolol 2 mg.kg(-1) and lidocaine 1.5 mg.kg(-1). In groups II, III and IV, the changes in maternal heart rate, systolic blood pressure and mean arterial pressure in response to laryngoscopy and intubation were attenuated to a comparable degree (P > 0.05). No adverse effects were noticed in mother or baby. We conclude that esmolol 1 mg.kg(-1) with lidocaine 1.5 mg.kg(-1) is effective in attenuating the adrenergic responses to laryngoscopy and intubation in patients with pregnancy-induced hypertension.

Clinical Trial↗

PubMed2001

The effects of clonidine premedication and scalp infiltration of lidocaine on hemodynamic responses to laryngoscopy and skull pin head-holder insertion during skull base procedures.

This study was designed to determine if oral clonidine or lidocaine, injected into the scalp before head-holder (H-H) insertion, would attenuate the hemodynamic effects associated with intubation and H-H placement. Thirty-four patients undergoing skull base procedures were randomized to four groups. Group 1 received clonidine 5 mcg/kg po before surgery with 10 to 15 ml of 1% lidocaine infiltrated at pin insertion sites; Group 2 received clonidine with saline infiltration; Group 3 received a placebo preoperatively and had lidocaine infiltrated at pin sites; and Group 4 received a placebo with saline infiltrated. All patients had a standard anesthetic titrated to a 10 to 14 Hz EEG endpoint during laryngoscopy and H-H placement. Mean arterial pressure (MAP) was similar between groups during intubation, but heart rate (HR) increased in patients who did not receive clonidine. H-H application increased HR and MAP in Group 4. HR also increased after H-H placement in patients who received oral clonidine, while patients receiving scalp lidocaine or both clonidine and scalp lidocaine had little change in either value. Clonidine attenuated HR increases after laryngoscopy but not after H-H placement. Lidocaine injected at the pin sites reduced HR, and MAP increased after H-H insertion. The combination of oral clonidine and scalp lidocaine blunted hemodynamic responses to both intubation and H-H placement.

Journal Article↗

PubMed1982

Flexible fiberoptic bronchoscopy and laryngoscopy in children under 2 years of age: diagnostic and therapeutic applications of a new pediatric flexible fiberoptic bronchoscope.

The new flexible fiberoptic bronchoscope (Olympus BF Type 3C4, Tokyo, Japan) was employed for diagnostic and therapeutic purposes in 96 children below 2 yr of age. Sixty-two laryngoscopies and 34 bronchoscopies were performed without any mortality or significant morbidity. The bronchoscope was helpful in establishing diagnosis and also served as a tool for aspirating secretions and resolving atelectasis. It is concluded that flexible fiberoptic bronchoscopy and laryngoscopy in children 2 yr or younger is a safe procedure and may aid in the diagnosis and therapy of disorders of the respiratory tract in this age group.

Bronchoscopes↗

PubMed2007

Minimum and optimum light output of Macintosh size 3 laryngoscopy blades: a manikin study.

Illumination provided by laryngoscope blades varies widely. It is not known what the optimum level of illumination should be during laryngoscopy. So far, no published standards exist for light intensity provided by laryngoscopes. Fifty anaesthetists were recruited to perform laryngoscopy on a manikin with three different laryngoscopes attached to a variable voltage supply. Anaesthetists were asked to find the minimum and optimum level of light they would wish to have for intubation. This study demonstrated that anaesthetists can see the larynx at very low light levels. The optimum level was significantly greater than the minimum level. The vacuum bulb laryngoscopes provides a significant lower light output than halogen and xenon laryngoscopes. There is a large variation in illumination requirements amongst anaesthetists which may make setting standards difficult. A brighter laryngoscope, as suggested by some manufacturers, may not necessarily be a better one.

Adult↗

PubMed1983

Flexible fiberoptic bronchoscopy and laryngoscopy in infants and children.

A pediatric flexible fiberoptic bronchoscope was employed in the examination and/or therapy of 164 infants and children ranging in age from 1 day to 16 years. Ninety-two bronchoscopies and 72 laryngoscopies were performed without any mortality or significant morbidity; 78% of laryngoscopies and 35% of bronchoscopies were performed in children under 2 years of age. The instrument was helpful in terms of diagnosis, as a tool for aspirating secretions and resolving atelectasis, and as a guide for surgical intervention. It is concluded that flexible fiberoptic bronchoscopy is a safe procedure in small infants and children and serves as an important aid in the diagnosis and therapy of disorders of the respiratory tract in this age group. However, caution should be expressed in its use in children with compromised ventilation, bradycardia or bleeding diathesis. Moreover, in suspected foreign body aspiration, the rigid-open tube bronchoscopy should be employed.

Adolescent↗

PubMedDate not supplied

Laryngoscope modification to avoid perioral trauma due to laryngoscopy.

Trauma to hard and soft tissues of the oral and perioral regions occurs due to laryngoscopy. This paper identifies patients predisposed to dental complication preoperatively, explains the course to be taken intra- and post-operatively should such a complication occur and presents a modification of the MacIntosh laryngoscopy blade suitable for most patients.

Equipment Design↗

PubMed1986

Cardiac complications of suspension laryngoscopy. Fact or fiction?

A nonselective, prospective study of 100 consecutive patients undergoing suspension laryngoscopy was undertaken to observe the cardiac ischemic changes related to pharyngeal and laryngeal manipulation. Blood pressure, heart rate, rhythm, and cardiac response were monitored before, during, and after surgery. No significant changes were observed in normal, hypertensive, or high-risk patients. These findings differ from those previously reported.

Adult↗

PubMed1975

A method for prevention of cardiovascular reactions to laryngoscopy and intubation.

A technique of nebulizing lidocaine in the upper airways was developed and its effectiveness in preventing cardiovascular responses to laryngoscopy and intubation was documented. In ten pre-treated patients the average percentage-rise in systolic blood pressure was 10.3 per cent and there were no arrhythmias. The pulse rate increased by 16.8 per cent. In ten control patients, the systolic blood pressure increased by 56 per cent and the incidence of arrhythmias was 40 per cent. The pulse rate increased by 38.8 per cent. The significance and application of these results is discussed and compared to other available methods. The opinion is expressed that the effect of the aerosol, especially as it relates to the suppression of arrhythmias, is partly due to systemic absorption of lidocaine.

Aerosols↗

PubMed1989

Haemodynamic responses to laryngoscopy and tracheal intubation in geriatric patients: effects of fentanyl, lidocaine and thiopentone.

The haemodynamic responses to laryngoscopy and intubation after induction of anaesthesia with thiopentone alone or in combination with 1.5 mg.kg-1 lidocaine and/or 1.5 or 3.0 microgram.kg-1 fentanyl were measured in 150 patients over 64 years of age to determine whether lidocaine, fentanyl or both lidocaine and fentanyl attenuated the pressor response. Fentanyl reduced the rises in systolic, diastolic and mean arterial pressures, heart rate, and rate pressure product and lidocaine decreased the rises in arterial blood pressure and rate pressure product (P less than 0.05). Fentanyl decreased the incidence of marked fluctuations in haemodynamic variables, often seen in geriatric patients (P less than 0.05). The haemodynamic effects of lidocaine and fentanyl were independent of each other. Complications occurred in all groups. Lidocaine-treated patients had fewer cardiac dysrhythmias (P less than 0.05) and 34 per cent of them had tinnitus. Fentanyl-treated patients had a higher incidence of hypotension (P less than 0.05). Respiratory depression developed in only one per cent of the fentanyl-treated patients. Both lidocaine and fentanyl are recommended adjuncts to induction of anaesthesia with thiopentone in geriatric patients.

Aged↗

PubMed1990

Intravenous lidocaine does not attenuate the haemodynamic response of children to laryngoscopy and tracheal intubation.

The haemodynamic responses to laryngoscopy and intubation after induction of anaesthesia with thiopentone alone or in combination with 1.5 mg.kg-1 IV lidocaine were measured in 125 children age 2 to 12 yr to determine whether lidocaine administered one, two, three or four minutes before tracheal intubation attenuated the pressor response. Lidocaine did not attenuate the increases in heart rate and arterial blood pressure. The pressor response was significantly affected by baseline haemodynamic values, P less than 0.05. The increases in systolic and mean blood pressure were significantly affected by the age of the patient, P less than 0.05. Lidocaine is not a beneficial adjunct to induction of anaesthesia with thiopentone in healthy children for the purpose of attenuating the pressor response to intubation.

Age Factors↗