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Results for “LARYNGOSCOPY”

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At least 289 records · Page 16Linked to original sources

PubMed1976

The inflation-catheter technique of ventilation during laryngoscopy.

Over the past three years the inflation-catheter technique (ICT) of controlled ventilation during general anaesthesia has proved a safe and useful method for use with laryngoscopy and other trans-oral endoscopies (most notably flexible fiberoptic bronchoscopy). The ICT allows full control of the patient's airway for the anaesthetist and exceptionally good exposure for the surgeon. In this technique ventilation of the patient is accomplished by intermittent high flow (10 ml/kg/sec) inflation of the lungs through a small (2 to 6 mm diameter) plastic orotracheal catheter. The inflation-catheter is stiffened by fixation of an intralumenal wire. Exhalation is passive around the catheter through the open airway. The Inflation Catheter Technique is readily adaptable for patients ranging from large adults to small babies by variation of catheter sizes. It can be used safely with nitrous oxide-oxygen as the ventilating gas(i.e., Bird N2O/O2 Blender) since air entrainment is not a feature. It is also readily adaptable for use with mechanical ventilation (i.e., Wolf Injectomat).

Adult↗

PubMed1981

Difficult laryngoscopy and tracheal intubation due to calcified stylohyoid ligaments.

Two cases of difficult laryngoscopy and tracheal intubation caused by calcified stylohyoid ligaments are presented. Neither patient exhibited a skin crease over the hyoid bone. It is suggested that inability to lift up the epiglottis from the posterior pharyngeal wall be taken as a more useful sign of this condition than the presence of the skin crease.

Adult↗

PubMed2005

Modified Mallampati test, thyromental distance and inter-incisor gap are the best predictors of difficult laryngoscopy in West Africans.

PURPOSE: To determine the ability to predict difficult visualization of the larynx (DVL) from the following preoperative airway predictive indices, in isolation and combination: modified Mallampati test (MMT), thyromental distance (TMD), sternomental distance (SMD), horizontal length of the mandible (HLM) and inter-incisor gap (IIG). METHODS: Three hundred and eighty consecutive patients undergoing general anesthesia were evaluated using the MMT, TMD, SMD, HLM and IIG and the cut-off points for the airway predictors were Mallampati III and IV; < or = 6.5 cm, < or = 13.5 cm, < or = 9.0 cm and < or = 4.0 cm respectively. During direct laryngoscopy, the laryngeal view was graded using the Cormack and Lehane (CL) classification. CL grades III and IV were considered difficult visualization. Sensitivity, specificity and positive predictive value for each airway predictor in isolation and in combination were determined. Logistic regression analysis was used to determine independent predictors of DVL. RESULTS: Difficulty to visualize the larynx was found in 13 (3.4%) patients. The sensitivity, specificity and the positive predictive value for the five airway predictors were: MMT (61.5%; 98.4%; 57.1%), TMD (15.4%; 98.1%; 22.2%), SMD (0%; 100%; 0%), HLM (30.8%, 76.0%; 4.3%) and IIG (30.8%; 97.3%; 28.6%). The best combination of predictors was MMT/TMD/IIG with a sensitivity, specificity and positive predictive value of 84.6%; 94.6%; 35.5% respectively. Logistic regression analysis showed that weight, MMT, IIG and TMD were independent predictors of DVL. CONCLUSION: MMT, TMD and IIG appear to provide the optimal combination in prediction of DVL in a West African population.

Adult↗

PubMed2002

Systolic blood pressure, not BIS, is associated with movement during laryngoscopy and intubation.

OBJECTIVE: To compare bispectral index (BIS) values to hemodynamic variations, in order to evaluate adequacy of anesthesia during orotracheal intubation with muscle relaxants. METHODS: Forty-one patients ASA I-II, scheduled for elective peripheral surgery under general anesthesia with tracheal intubation were enrolled in the study. Fentanyl/thiopental followed by vecuronium were used for induction. Onset of relaxation was monitored at the orbicularis occuli (OO) muscle using train-of-four stimulation. Intubation was performed when no response at the OO was detected visually. Intubating conditions were noted. The "isolated forearm" technique was used to detect movement during laryngoscopy/intubation. BIS values, pulse rate (PR), and systolic pressure were recorded before induction, during laryngoscopy/intubation and 60 sec after intubation. RESULTS: Although intubating conditions were clinically adequate for all patients, ten out of 41 had movement of the isolated arm during laryngoscopy/intubation. BIS values were not significantly different for these patients: 67 (55-83) compared to those who had no movement: 60 (35-80), P = 0.6. During laryngoscopy, PR increased for all patients while systolic pressure increased significantly only in patients who moved: 125 (100-136) mmHg vs those who did not: 108 (67-140), P < 0.05. CONCLUSION: Systolic pressure elevations were associated with inadequate anesthesia as evaluated by the "isolated forearm" technique, during laryngoscopy/intubation. BIS values were not different between groups, suggesting that systolic blood pressure may be a better predictor of inadequate anesthesia under the circumstances described.

Adjuvants, Anesthesia↗

PubMed1996

Transverse forces exerted on the maxillary incisors during laryngoscopy.

PURPOSE: In this study the effect of level of experience of the intubator on the forces applied by the Macintosh laryngoscope on the maxillary incisors in both the axial and transverse direction were investigated. METHODS: Five groups of different levels of experience (15 per group), staff anaesthetists, residents, nurse anaesthetists, surgeons and students, performed one laryngoscopy and subsequent intubation on an intubation manikin equipped with sensors to measure these forces. RESULTS: Maximal transverse forces oriented toward the base of the skull (Fmtpmax) were between 0 and 10 N in 46 cases (61%), between 10 and 20 N in 21 (28%) and > or = 20 N (maximum 46.5 N) in eight cases (11%). The maximal values of the transverse forces oriented toward the intubator (Fmtnmax) were between 0 and 10 N in 69 cases (92%), between 10 and 20 N in 3 (4%) and > or = 20 N (maximum 36.4 N) in 3 (4%). Level of experience was related to Fmtpmax (Spearman: P = 0.04, r = 0.24). In addition, Fmtnmax was less in experienced intubators (anaesthetist and residents) than in inexperienced intubators (all other groups) (Student's t test: P = 0.04). CONCLUSION: In contrast to the effect on forces exerted in the axial direction, experience proved to have a beneficial effect on the forces in the transverse direction.

Humans↗

PubMed2004

[Influence of the head position in laryngoscopy].

INTRODUCTION: The aim of this study was to determine the optimal position of the head during larygoscopy. MATERIAL AND METHODS: During fiberoptic evaluation of the larynx, the head position of eight subjects (5 male, 3 female) was changed systematically. The influence of reclining and anteversion, tilting and rotation of the head on the quality of the endoscopic images was determined. RESULTS: The vocal tract became wider and the view onto the glottis could be improved by reclining the head and anteversion of the chin. On rotation of the head, the hypopharynx of the same side became narrower. This is well known and is used worldwide in the therapy of dysphagia. DISCUSSION: Positioning of the patient is important in laryngoscopy. Reclining the head and forward inclination of the trunk (horizontal axis of the mouth) seems to be the best position for obtaining an optimal view onto the glottis.

Adult↗

PubMed2004

Outpatient fibre-optic laryngoscopy for stridor in children and infants.

Many neonates are referred for a diagnosis with stridor. The gold standard investigation has traditionally been a rigid or direct microlaryngoscopy. This impacts on existing theatre schedules, demands a high level of skills from the paediatric anaesthetist along with the risk of exposing a neonate to a general anaesthetic. A bed in paediatric intensive care is often required and must be reserved. As laryngomalacia is the most common diagnosis and less serious than the investigations for infants with stridor themselves, clinicians have been looking to use the flexible fibre-optic laryngoscope to view the upper airway in awake neonatal patients. We present our experience in 66 neonatal patients initially managed by awake per-oral flexible fibre-optic laryngoscopy for stridor. We conclude that the technique is safe, straightforward and allows a diagnosis to be achieved in a significant number of cases. We recommend it as a first line investigation, reserving microlaryngoscopy for the group of patients in whom a diagnosis cannot be made in the outpatient clinic.

Ambulatory Care↗

PubMed1994

Bispectral analysis of the electroencephalogram during induction of anesthesia may predict hemodynamic responses to laryngoscopy and intubation.

The use of electroencephalography as a measure of adequacy of anesthesia has achieved limited success. Our purpose was to determine whether the non-linear properties of the electroencephalogram (EEG) as defined by the bispectral index was a better predictor of autonomic responses to endotracheal intubation during opioid-based anesthesia than the linear statistical properties of the EEG formulated by power spectral analysis. Thirty-nine adults scheduled for elective non-cranial surgery had a continuous EEG recorded during induction of anesthesia and endotracheal intubation. Anesthesia consisted of thiopental and nitrous oxide in oxygen, followed by 1 of 5 randomized opioid dose regimens. The EEG was continuously recorded and blood pressure was measured every minute. All electroencephalographic parameters were derived for the 3 min before and after intubation and were compared to the blood pressure and heart rate responses. Responders were defined by 2 analyses: patients who had a 20% or greater increase (1) in blood pressure or (2) in heart rate to laryngoscopy. Responders and non-responders were compared using Student's unpaired t test, and differences due to dose regimens were examined with logistic regression. Based on the criterion for blood pressure change, there were 27 responders and 12 non-responders. Heart rate changes did not differentiate between the two groups. There was a significant difference between response groups as measured by the bispectral index which distinguished responders from non-responders independently of the amount of drug given. None of the variables of power spectral analysis accurately distinguished responder from non-responder.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1981

The speech clinician's use of fiberoptics in indirect laryngoscopy.

This paper explores the use of fiberoptics in indirect laryngoscopy and encourages the speech pathologist to use this procedure in a diagnostic and therapeutic context. Routine use of this procedure by speech pathologists would broaden the role definition of the voice clinician as a skilled evaluator of vocal-fold pathologies.

Fiber Optic Technology↗

PubMed1987

Technique of laryngoscopy.

The role of the pediatric laryngologist has changed. He now manages a greater range of clinical problems in the upper airways. Direct laryngoscopy under general anesthesia is fundamental for correct diagnosis and management in infants and children. It is a precise procedure utilizing a range of modern miniaturized instruments. Major technological improvements include quartz iodine and xenon light sources, flexible light carrying leads, fiberoptic rod lighting, special purpose laryngoscopes, rigid telescopes, versatile techniques of anesthesia, microlaryngeal surgery, laser surgery and reliable photographic documentation.

Anesthesia, General↗

PubMed1990

Fiberoptic laryngoscopy under general anesthesia in neonates.

In the Sophia Children's Hospital we perform fiberoptic laryngoscopy in neonates under general anesthesia without the use of muscle relaxants in the diagnostics of functional laryngeal disorders. The necessary diagnostic and anesthetic equipment is described. Special attention is paid to the way in which the fiberscope is introduced into the breathing circuit and into the child's airway. Several advantages over other methods are discussed. The procedure has proved to be easy, safe and informative.

Anesthesia, General↗

PubMedDate not supplied

Comparison of the intubating laryngeal mask airway versus laryngoscopy in the Bell 206-L3 EMS helicopter.

INTRODUCTION: The purpose of this study is to compare intubation success rate and time to intubation for the intubating laryngeal mask airway (I-LMA) versus direct laryngoscopy (DL) using a manikin model during a simulated in-flight scenario. SETTING: The setting for the study was a University hospital-based air medical program. METHODS: This was a prospective, randomized, crossover trial. Eight nurses and 7 paramedics were randomly assigned to perform 3 intubations with either the I-LMA or DL first and then 3 intubations using the alternate technique. Descriptive statistics, 95% confidence intervals (CIs) of means, and Fisher's Exact test were conducted for comparisons. RESULTS: Fifteen set-ups and 45 intubations were performed with each technique. Previous experience was 74 mm (95% CI 64-84) with DL and 18 mm (95% CI 9-27) with the I-LMA. Set-up time was 33 seconds (95% CI 26-40) for DL and 40 seconds (95% CI 29-50) for I-LMA. Time to intubation was 12 seconds (95% CI 10-14) for DL and 39 seconds (95% CI 31-48) for I-LMA. Success rate was 100% for DL and I-LMA placement and 98% for intubation through the I-LMA. Crew rated difficulty of DL 13 mm (95% CI 6-20), placing the I-LMA 23 mm (95% CI 13-32), and intubating through the I-LMA 17 mm (95% CI 10-24). CONCLUSION: Intubation success was very high for both DL and the I-LMA, despite less flight crew experience with the I-LMA. Total time to intubation was longer with the I-LMA but still less than 1 minute. The flight crews considered both techniques easy to perform. The I-LMA appears to be a useful adjunct for airway management in the Bell 206-L3 helicopter.

Air Ambulances↗

PubMed2004

Evaluating the effectiveness and efficiency of voice therapy using transnasal flexible laryngoscopy: a randomized controlled trial.

Transnasal flexible laryngoscopy (TFL) is an examination of laryngeal anatomy and physiology using continuous light. TFL is being used increasingly by voice pathologists in treatment but with little scientific evidence to support it. The purpose of this study was to evaluate the effectiveness and efficiency of TFL as a therapeutic tool. The study used a prospective randomized controlled trial. Fifty dysphonic subjects were recruited and randomly assigned to either a traditional treatment group or a TFL-assisted treatment group. The effectiveness of voice therapy in both treatment groups was measured with a package of voice outcome measures. Subjects in both treatment groups demonstrated statistically significant improvements after voice therapy (perceptual auditory rating of voice quality measurement p < 0.01; instrumental electroglottographic measurement p < 0.01; patient questionnaire measurement p < 0.01). The time taken to complete treatment in both groups was recorded. The average (median) time taken to complete voice therapy in the TFL-assisted treatment group was 2 hours less than in the traditional treatment group (p < 0.01). Voice therapy with TFL as a therapy tool was effective and more efficient than traditional voice therapy.

Adult↗

PubMed2005

Effects of topical anesthetic and flexible fiberoptic laryngoscopy on professional sopranos.

This study examined the acoustic and perceptual effects of topical anesthetic and flexible fiberoptic laryngoscopy (FFL) against a control condition on the singing voices of ten professional sopranos. Recordings of a section of an aria, various scales, and a messa di voce exercise were obtained in the three experimental conditions. Acoustic analyses of the same aria section recorded during the three conditions were similar with respect to the distribution of energy across the spectrum (LTAS) and vibrato rate and extent. The ability of the participants to achieve their highest and lowest notes or to complete the messa di voce was also not affected by the anesthetic or FFL. Perceptual ratings of a variety of parameters by experienced singing teachers also revealed little difference across conditions with only "appropriate velopharyngeal closure" found to differ in one comparison. These results indicate that highly experienced operatic sopranos are either not affected by or appear to have the ability to compensate for the presence of anesthetic and the FFL. The most likely explanation is that this group of singers relied on a solid vocal technique. Results will need to be replicated on less accomplished singers before concluding that this medical procedure does not affect the operatic singing voice.

Administration, Topical↗

PubMed2000

The role of fibreoptic laryngoscopy in infants with stridor.

Stridor in infants may be potentially serious and would require further investigations in all cases. Laryngomalacia is the most common cause of congenital stridor. This is a self-limiting condition with a good prognosis but other causes of stridor should be excluded to enable the surgeon to plan further intervention if needed. Traditionally microlaryngoscopy and bronchoscopy under a general anaesthetic is performed to evaluate the airway. We have investigated the use of the flexible fibreoptic laryngoscope under local anaesthetics in infants with inspiratory stridor. The procedure was performed in the day surgery unit on a non-fasting, non-sedated child. A retrospective analysis of procedures performed between January 1998 and August 1999 was carried out. Of the 43 patients studied, laryngomalacia was diagnosed in 35, vocal cord palsies in six and two infants had a normal larynx. There were no complications during the procedure and only one child required further intervention. The results showed that the combination of fibreoptic laryngoscopy under local anaesthetic with follow-up is a safe, effective and cost effective method of assessing stridor in this group of patients.

Ambulatory Care↗

PubMed2003

Topical nasal anesthesia for transnasal fiberoptic laryngoscopy: a prospective, double-blind, cross-over study.

BACKGROUND: Transnasal fiberoptic laryngoscopy (TFL) is frequently performed by otolaryngologists, speech language pathologists, and various other health care providers. Historically, topical sprays have been administered to patients to decongest and anesthetize the nasal mucosa, thus minimizing the discomfort of the procedure. Recently, it was reported that patients undergoing TFL with topical anesthesia experienced no improvement in comfort compared with those who received oxymetazoline or saline. This observation is in direct opposition to our clinical experience that patients tolerate the procedure better with topical anesthesia. PURPOSE: We sought to compare patient comfort levels during TFL after the administration of cocaine, oxymetazoline, or saline. METHODS: Fifteen subjects undergoing TFL were prospectively evaluated. Each had TFL performed on 3 separate occasions. Before TFL, each patient received either 4% cocaine, 0.05% oxymetazoline, or saline topically administered via an atomizer to both nasal cavities (1 spray of 2-second duration). By the conclusion of the study, each patient had undergone TFL with each of the test agents. The subjects rated the discomfort they experienced on a scale ranging from 1 (minimal discomfort) to 5 (severe discomfort). Both patient and examiner were blinded to the test agent used. RESULTS: The mean nasal discomfort score for saline was 2.8 +/- 1.1. The scores for oxymetazoline and cocaine were 3.4 +/- 0.9 and 2.0 +/- 0.9, respectively. Compared with saline and oxymetazoline independently, TFL with topical cocaine appeared to provide more comfort (P < 0.05 and P < 0.005). CONCLUSION: The continued routine use of topical anesthetics such as cocaine before the performance of TFL is justified because it significantly decreases the patient's discomfort.

Administration, Topical↗

PubMed2001

Rhinoscopy, pharyngoscopy, and laryngoscopy.

Rhinoscopy, pharyngoscopy, and laryngoscopy are important procedures to include in the workup of patients with upper airway disorders. They are simple to perform, yield important information, spare the patient from undergoing invasive rhinotomy, and improve client relations when a diagnosis is reached.

Animals↗

PubMed1998

Tracheal intubation via the laryngeal mask airway: a viable alternative to direct laryngoscopy for nursing staff during cardiopulmonary resuscitation.

Eight nurses with no previous experience of advanced airway management were randomly assigned to be taught tracheal intubation either by direct laryngoscopy or via a laryngeal mask. Once competent in the technique using a manikin, they attempted a maximum of ten intubations on anaesthetised patients. They were then taught the alternative technique and the assessment repeated. Median times for practice were the same for both techniques. Intubation in under 30 s was successful via the laryngeal mask in 60% of patients (42/70) compared to 39% (27/70) when using a laryngoscope (P = 0.11). It appears that non-medical personnel can be successfully taught to intubate the trachea using the laryngeal mask as a conduit, for those circumstances where a cuffed tracheal tube is considered essential during resuscitation.

Adult↗