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At least 307 records · Page 17Linked to original sources
PubMed1987

[Propofol versus propanidid for the conduction of suspension laryngoscopy].

Forty patients who where to undergo suspension laryngoscopy were randomly assigned to two groups, the first receiving 1 microgram . kg-1 fentanyl and a bolus of 2.5 mg . kg-1 propofol followed by 5 to 10 mg . kg-1 . h-1 propofol infusion, and the second 1 microgram . kg-1 fentanyl and 0.2 mg . kg-1 flunitrazepam with 8 mg . kg-1 propanidid in a bolus followed by 40 to 50 mg . kg-1 propanidid infusion. The following parameters were studied: length of apnoea, quality of anaesthesia, the time between stopping giving the anaesthetic and the moment when the patient opens the eyes, gives his name and date of birth, the heart rate, the systolic, diastolic and mean blood pressures, blood gases, before induction, during suspension and at stopping the infusion. Anaesthetic quality was the same for both protocols, and the variations of the haemodynamic parameters were very similar for both groups. Apnoea lasted twice as long with propofol as with the flunitrazepam-propanidid association (p less than 0.001), whereas recovery was twice as quick (p less than 0.001). This seemed to confirm that propofol is better indicated for this type of surgery than the previously used flunitrazepam-propanidid association.

Adult↗
PubMed1988

[Multiple laryngotracheal block for the biopsy of the base of the tongue and of the piriform sinuses during laryngoscopy].

Most laryngoscopies with diagnostic biopsies are usually carried out under general anaesthesia. Multiple laryngotracheal blocks were used in the patient reported; this 55 year old man presented with cachexia and a history of severe angina, myocardial infarction, arterial hypertension and chronic bronchitis. The different nerve blocks were carried out with a total of 2 mg.kg-1 lignocaine: the superior laryngeal nerve trunk, the internal laryngeal nerve, the trachea (by an intratracheal injection) and the tongue (using a lignocaine gel). The whole procedure was well tolerated by the patient. The advantages and disadvantages of this technique are discussed.

Biopsy↗
PubMed1998

Chevalier Jackson's contributions to direct laryngoscopy.

Chevalier Jackson championed rigid endoscopy of the upper aerodigestive tract and facilitated its development and popularity at the beginning of the 20th century. He realized that endoscopy and open surgery are inextricably linked for effective management of diseases of the upper air and food passages. Toward this end, Jackson contributed a number of important innovations to direct laryngoscopy, while developing a unique mastery of the technique. Ultimately, he combined this endoscopic proficiency with open surgical techniques.

History, 19th Century↗
PubMed2000

Awareness during laryngoscopy and intubation: quantitating incidence following induction of balanced anesthesia with etomidate and cisatracurium as detected with the isolated forearm technique.

STUDY OBJECTIVE: To measure the incidence of awareness during induction of anesthesia with etomidate and fentanyl, and to model its frequency as a function of dose of etomidate. DESIGN: Prospective cohort study. SETTING: Anesthesia department of a university hospital. PATIENTS: 30 ASA physical status I, II, and III patients undergoing elective general surgery. INTERVENTIONS: Patients were assigned to one of three groups of etomidate (0.2 mg/kg, 0.3 mg/kg, 0.4 mg/kg) and received fentanyl (2 microg/kg) and 2 x ED(95) of cisatracurium (0.1 mg/kg). Neuromuscular block was monitored with a peripheral nerve stimulator. Intubation was performed after maximum T(1)-depression. To identify awareness, the isolated forearm technique (IFT) was used. The IFT was performed by prompting the patient every 20 seconds. Only a verified response was considered a positive IFT response. Anesthesia was maintained with isoflurane in oxygen/air and fentanyl. MEASUREMENTS AND MAIN RESULTS: Maximum neuromuscular block occurred after 352 +/- 96 seconds and intubation was performed 424 +/- 86 seconds after loss of consciousness (LOC). Awareness was dose dependent: 80% of patients receiving 0.2 mg/kg etomidate, 70% of patients receiving 0.3 mg/kg etomidate, and 20% of patients receiving 0.4 mg/kg etomidate had a positive IFT response. Awareness occurred in one patient 3 minutes after LOC, in 65% during laryngoscopy, and in 30% within the following 120 seconds. One patient had explicit recall without finding awareness unpleasant. Hemodynamic parameters did not differ between patients with a positive or a negative IFT response. CONCLUSIONS: The incidence of awareness during bolus induction can be modeled as dose dependent. However, when combining a short-acting induction drug and a delayed-onset neuromuscular blocker, the continuous infusion of the hypnotic drug may prevent awareness during induction.

Adult↗
PubMed2006

Comparative analysis of perceptual evaluation, acoustic analysis and indirect laryngoscopy for vocal assessment of a population with vocal complaint.

UNLABELLED: As a result of technology evolution and development, methods of voice evaluation have changed both in medical and speech and language pathology practice. AIM: To relate the results of perceptual evaluation, acoustic analysis and medical evaluation in the diagnosis of vocal and/or laryngeal affections of the population with vocal complaint. STUDY DESIGN: Clinical prospective. MATERIAL AND METHOD: 29 people that attended vocal health protection campaign were evaluated. They were submitted to perceptual evaluation (AFPA), acoustic analysis (AA), indirect laryngoscopy (LI) and telelaryngoscopy (TL). RESULTS: Correlations between medical and speech language pathology evaluation methods were established, verifying possible statistical signification with the application of Fischer Exact Test. There were statistically significant results in the correlation between AFPA and LI, AFPA and TL, LI and TL. CONCLUSION: This research study conducted in a vocal health protection campaign presented correlations between speech language pathology evaluation and perceptual evaluation and clinical evaluation, as well as between vocal affection and/or laryngeal medical exams.

Adolescent↗
PubMed1975

Fibreoptic laryngoscopy in the assessment of laryngeal disorders.

The fibreoptic laryngoscope is described, and its method of use detailed. Seventy patients were submitted to this examination. Its advantages and disadvantages in the assessment of the various groups of laryngeal disorders in these patients are discussed and compared with indirect and direct laryngoscopy. Its teaching and research possibilities are also mentioned. The technique shows considerable promise and will, we believe, achieve an accepted place as an addition to our diagnostic armamentarium in the investigation of laryngeal disorders.

Adult↗
PubMed1997

Neonatal and paediatric fibre-optic laryngoscopy and bronchoscopy using the laryngeal mask airway.

Endoscopy of the upper airways in neonates and infants was traditionally been accomplished using rigid laryngoscopes and bronchoscopes. The laryngeal mask may be used both to control the airway for anaesthetic ventilation and to guide a fibre-optic endoscope to the laryngeal inlet and beyond. We report our experience with five neonatal and paediatric cases where fibre-optic laryngoscopy and bronchoscopy were performed through the laryngeal mask airway. All were cases in which standard rigid endoscopy had proved difficult with only a poor and restricted view of the laryngeal inlet being obtained due to the age of the infants, or abnormal anatomy of the upper airways. No problems have been encountered with maintenance of the airway or with endoscopic view obtained. In fact in neonatal patients, this technique has been found to be preferable with regard to safety and ease of use when compared to the ventilating bronchoscope. With the size 1 laryngeal mask airway it is not possible to simultaneously ventilate and endoscope the patient. Cases included, a vascular ring, Goldenhar's syndrome, laryngomalacia, supraglottis and vocal fold paresis. This technique provides a secure method of maintaining anaesthetic ventilation during airway endoscopy, and also a means of easily locating the glottis.

Bronchoscopy↗
PubMed2006

Gabapentin reduces cardiovascular responses to laryngoscopy and tracheal intubation.

BACKGROUND AND OBJECTIVE: We have compared the effects of gabapentin on arterial pressure and heart rate at induction of anaesthesia and tracheal intubation in a randomized double-blind study. METHODS: Ninety normotensive patients (ASA I) undergoing elective surgery were divided into three groups of 30 patients each. Patients received oral placebo (Group I), 400 mg of gabapentin (Group II) or 800 mg of gabapentin (Group III) 1 h prior to surgery in the operating theatre. After induction of anaesthesia heart rate and mean arterial pressure were recorded at baseline 1, 3, 5, 10 and 15 min after intubation. RESULTS: Patients receiving placebo and 400 mg gabapentin showed a significant increase in blood pressure and heart rate associated with tracheal intubation compared to baseline levels and Group III. There was significant decrease in heart rate and arterial pressure in Group III after intubation 1, 3, 5 and 10 min (P < 0.001, P < 0.001, P < 0.05 and P < 0.05, respectively) compared to Groups I and II. CONCLUSION: Given 1 h before operation gabapentin 800 mg blunted the arterial pressure and heart rate increase in first 10 min due to endotracheal intubation. Oral administration of gabapentin 800 mg before induction of anaesthesia is a simple and practical method for attenuating pressor response to laryngoscopy and tracheal intubation after standard elective induction.

Administration, Oral↗
PubMed2001

Assessment of the efficacy of esmolol on the haemodynamic changes induced by laryngoscopy and tracheal intubation: a meta-analysis.

BACKGROUND: Adrenergic stress response induced by laryngoscopy and tracheal intubation (LTI) appears to be attenuated by esmolol, but its potential clinical benefits have not been fully weighed against possible adverse effects. METHODS: A systematic search up to May 2000 was performed using MEDLINE, EMBASE, LILACS, Cochrane library, manual searching and bibliographies in all languages. All randomised comparisons of esmolol with placebo on the haemodynamic changes elicited by LTI were obtained. Trials were included in the present meta-analysis if they recorded heart rate (HR), systolic pressure (SBP), mean arterial pressure (MAP) or diastolic pressure (DBP) at three different stages: pre-induction, immediately prior to intubation, and in the post-intubation period. Weighted mean differences (WMD) and 95% confidence intervals (CI) of the changes in the haemodynamic variables between treatment and placebo groups were calculated. RESULTS: Of 72 publications identified, 38 randomised controlled trials containing a total of 2009 patients were finally included. Eleven different regimens and doses of esmolol demonstrated effectiveness in the attenuation of HR and BP after LTI in a dose-dependent manner. The most effective regimen was a loading dose of 500 microg x kg(-1) x min(-1) over 4 min followed by continuous infusion dose of 200-300 microg x kg(-1) x min(-1) [WMD: 20.2 bpm (95% CI: 15.6 to 24.7)]. High bolus dose (200 mg) of esmolol produced a considerable decrease in DBP [WMD 10.1 mmHg (95% CI: 7.3 to 12.8)]. CONCLUSION: Esmolol is effective, in a dose-dependent manner, in the attenuation of the adrenergic response to LTI. To minimise its adverse effects it should be administered, when considered clinically appropriate, as a continuous infusion regimen.

Adrenergic beta-Antagonists↗
PubMed1998

The best view at laryngoscopy using the McCoy laryngoscope with and without cricoid pressure.

The best view obtained by levering the tip of the McCoy laryngoscope blade with or without modified cricoid pressure was studied in 100 patients presenting for general surgery. The airway was assessed pre-operatively (Mallampati score, thyromental distance, mouth opening, protrusion of the jaw and weight) in an attempt to identify the patients who might benefit from the use of the McCoy laryngoscope. The vocal cords were visible at laryngoscopy with the blade in the neutral position in 32 cases. In the 68 remaining patients the vocal cords were partly visible in 48. The epiglottis only was seen in 18 patients and in two not even the epiglottis could be visualised. Elevation of the blade or modified cricoid pressure improved the view in 38/68 cases and 57/68 cases, respectively (p < 0.001, Wilcoxon signed rank). Using our method of pre-operative assessment we were unable to identify those patients who might benefit from either manipulation.

Adult↗
PubMed1998

Evaluation of an improved scoring system for the grading of direct laryngoscopy.

A modified version of the Cormack and Lehane scoring system was prospectively evaluated in 663 patients requiring tracheal intubation. In the modified system, grade 2 (only part of the glottis visible) was divided into 2a (part of the cords visible) and 2b (only the arytenoids or the very posterior origin of the cords visible). One hundred and sixty-two intubations (24.4%) were scored as grade 2a and 43 (6.5%) as grade 2b, of which seven (4.3%) and 29 (67.4%), respectively, were difficult, defined as requiring more than one laryngoscopy or the use of specialist equipment. Grade 2b denotes a laryngoscopic view that is relatively common and is often associated with difficulty passing a tracheal tube. The modified scoring system thus provides more information than the original Cormack and Lehane system and its use should be considered when recording the ease of tracheal intubation in the anaesthetic record or in studies of tracheal intubation.

Adolescent↗
PubMed2002

An unexpected difficult laryngoscopy.

A case of unexpected difficult laryngoscopy in a patient with gross hydrocephalus and generalized hypertonus is described. The 30-month-old girl had no antecedent history of such difficulty, having had two recent uneventful anaesthetics. We suggest that the reason for our inability to open the patient's mouth was a result of contracture of the temporalis muscle. The patient was managed using a laryngeal mask airway with controlled ventilation.

Anesthesia↗
PubMed2002

[Diagnosis and therapy of diseases of the larynx in the history of medicine. Part III. After the invention of laryngoscopy].

BACKGROUND: Laryngology a discipline of its own: When in 1855 Garcia had invented the indirect laryngoscopy and Türck and Czermak had introduced the method in clinical medicine numerous laryngological centres were founded in Austria, Germany, England, and France. FIRST INTERVENTIONS AND SOLUTION OF TECHNICAL PROBLEMS: In 1859 Czermak had already examined 20 patients with laryngeal diseases and demonstrated that it was possible to apply local treatment such as cautery under laryngoscopic view. The surgeon von Bruns in Tübingen (Germany) reported in 1862 on the successful removal of a polyp in the larynx. One common problem was the epiglottis preventing the view on the anterior part of the glottis. Czermak had suggested to make the epiglottis rise by intoning "hee". Methods of holding the epiglottis with a suture or with a forceps were not successful. In 1879 Reichert in Rostock (Germany) presented his epiglottis retractor which is still in common use. The irritability of the laryngeal mucosa remained the major problem for the next 20 years. CONSERVATIVE ENDOLARYNGEAL TREATMENT: The dominant means were local applications with brushes, powder blowers or injections of caustic fluids. Starting at about 1860 there were also steam inhalations. SURGICAL ENDOLARYNGEAL INTERVENTIONS: In a very early stage numerous instruments were devised such as sickle knives, various forceps, polyp snares and instruments for applications of electric currents. These were used in a monopolar and a bipolar way to induce electrolysis, coagulation and stimulation. INTRODUCTION OF SURFACE ANAESTHESIA: In 1884 in Vienna the surface anaesthesia with cocaine was introduced by Koller in the ophthalmology and by Jelinek in the laryngology. THE SPECIAL CASE HISTORY: The case history of the German emperor Frederick III, who died of laryngeal cancer in 1888, is briefly reported, because here all knowledge and technical facilities available at that time were brought into play. The treatment was guided by the German surgeons von Bergmann and Bramann, the laryngologists Gerhardt, Tobold and Schrötter (Vienna), the pathologists Virchow and Waldeyer, and the English laryngologist Mackenzie. The dominant problem was to have a safe diagnosis preoperatively. There was a passionate discussion about who was to blame for the fatal outcome of the emperor's disease. CONCLUDING: Another case history is reported when the surgeon von Bergmann believed he could demonstrate a successful operation on a patient with an apparently secure diagnosis of a laryngeal carcinoma the way it should have been done on the emperor. He was wrong: it turned out to be a tuberculosis and the patient died three hours after the operation.

Europe↗
PubMed1992

[Lidocaine plus fentanyl for controlling cardiovascular reactions to laryngoscopy and intubation].

Administration of fentanyl or lidocaine alone often insufficiently suppresses the haemodynamic reaction to laryngoscopy and intubation. We therefore evaluated the combination of both substances in patients with good ventricular performance (EF > 60%) undergoing coronary bypass surgery. 20 patients were randomly assigned to Group 1 (G1) or Group 2 (G2). As induction agents flunitrazepam (0.025 mg/kg), fentanyl (6-7 micrograms/kg) and pancuronium (0.1 mg/kg) were used. 3 minutes prior to intubation G1-patients received saline (0.1 cc/kg) while in G2 patients lidocaine (1 mg/kg) was administered. 10 minutes after termination of the preparations for induction (M1), prior to (M2), during (M3) and 10 minutes after the end of intubation (M4) heart rate (HR), blood pressure (MAP), pulmonary artery pressure (PAP) pulmonary capillary wedge pressure (PCWP) and cardiac output (CO) were measured. From these values we calculated rate-pressure product (RPP), total peripheral resistance (TPR), pulmonary vascular resistance (PVR), cardiac index (CI), stroke volume (SV) and stroke index (SI). Whitney-Mann test (U-test) served for statistical evaluation. If compared to baseline (M1), induction of anaesthesia caused in both groups a significant decrease of MAP (G1: 109 to 81 mmHg; G2: 97 to 77 mmHg), CO (G1: 6.2 to 5.2 l/min; G2: 6.6 to 5.2 l/min), CI (G1: 3.3 to 2.8 l/min m2; G2: 3.5 to 2.7 l/min m2) and RPP (G1: 12701 to 10201 mmHg min-1; G2: 11309 to 8070 mmHg min-1).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1995

[Alfred Kirstein (1863-1922)--pioneer in direct laryngoscopy].

On April 23rd 1895, in Berlin, Alfred Kirstein performed the first direct examination of the interior of the larynx. 23 days after his first view of larynx, he gave a comprehensive demonstration of autoscopy to the Berlin Medical Association. Until then laryngologists had been content with the technique of indirect laryngoscopy using mirrors, a method popularised by Garcia, Türck and Czermak. Kirstein named the combination of the electroscope and the oesophagoscope "The autoscope" and direct examination of the larynx he termed "autoscopy". Despite the infancy of autoscopy and the autoscope, Kirstein already recognised the potential of his new discovery. He reported that the removal of foreign bodies from the trachea must be easier through an autoscope then by means of a tracheostomy; furthermore, catheterisation of the bronchi should now present no great difficulties. The similarity between the blades he used and those described in the 1940s by Macintosh and Miller is remarkable.

Germany↗
PubMed1975

A technique of ventilation during laryngoscopy and bronchoscopy.

A technique for ventilating patients thorugh a catheter with nitrous oxide and oxygen utilizing the venturi principle is described for patients undergoing laryngoscopy or bronchoscopy. Arterial blood-gas measurements in 34 patients reveal that ventilation was adequate.

Atropine↗