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At least 343 records · Page 19Linked to original sources

PubMed1995

Difficult direct laryngoscopy in patients with cervical spine disease.

Two hundred and fifty three patients were examined before surgery for cervical spine disease. The grade of glottic visibility was determined at direct laryngoscopy, using the classification proposed by Cormack and Lehane. The overall prevalence of difficulty (grades 3 and 4) was 20%. Patients with disease that includes the occipito-atlanto-axial complex have a higher prevalence of difficulty than those with disease below the axis vertebra. Occipito-atlanto-axial disease is associated with poor mandibular protrusion. The best single predictor of difficulty was reduced separation of the posterior elements of the first and second cervical vertebrae on lateral radiographs. The Mallampati examination was the best single predictor on physical examination. The Mallampati may be an indicator of poor cranio-cervical extension. Difficulty was rare in patients with class A mandibular protrusion, and invariable in patients with class C protrusion.

Adolescent↗

PubMed1997

The effects of single-handed and bimanual cricoid pressure on the view at laryngoscopy.

The effects of two different methods of cricoid pressure on laryngoscopic view were studied in 94 healthy women presenting for routine gynaecological surgery. Laryngoscopy was performed with either single-handed or bimanual cricoid pressure; after grading of the view obtained, the other method was used and second grading performed. Laryngoscopic view was better with the bimanual than with the single-handed technique (p = 0.016). In 21 cases, a better laryngoscopic view was obtained with the bimanual technique; in eight cases it was better with the single-handed technique; and in 65 cases, the method of cricoid pressure made no difference. Age, weight, Mallampatti score and thyromental distance did not differ between patients in these three groups. Bimanual cricoid pressure should be the initial technique of choice during rapid sequence induction but, in a minority of cases, switching to a single-handed technique may improve the laryngoscopic view. The technique of cricoid pressure which produces the best laryngoscopic view in an individual patient cannot be predicted from the physical features studied.

Adult↗

PubMed2005

A comparison of 20 laryngoscope blades using an intubating manikin: visual analogue scores and forces exerted during laryngoscopy.

Fifty anaesthetists were recruited to use 20 different laryngoscope blades (one metal re-usable blade, five metal single-use blades and 14 plastic single-use blades, of which eight were bulb-type and 12 were fibreoptic-type) in a manikin to achieve a grade I Cormack and Lehane view. The anaesthetists were asked to provide visual analogue scores (VAS) for: ease of attachment of the blade to the handle; illumination; view of the larynx; and satisfaction for clinical use. The peak force applied and time to achieve the grade I Cormack and Lehane view were also measured. A cluster analysis method was used to group together blades with similar scores or measures. Ease of attachment, illumination, view, clinical use, force and duration were all significantly affected by the blade used (p < 0.0001 for all six). The mean peak force applied and mean duration for the 20 blades were 32-39 N and 4.4-9.5 s, respectively. All five metal single-use and four plastic single-use blades were always placed in the 'best' group in the cluster analysis. Two plastic blades provided a poor view and increased the duration of laryngoscopy.

Cluster Analysis↗

PubMed2006

Blood pressure and heart rate changes during intubation: a comparison of direct laryngoscopy and a fibreoptic method.

Blood pressure and heart rate changes during nasotracheal intubation under general anaesthesia were studied in 100 patients who were randomly allocated to fibreoptic bronchoscope or direct laryngoscopy intubation. Noninvasive blood pressure and heart rate were recorded before and immediately after anaesthesia induction, at anaesthesia intubation and every minute thereafter for 5 min. Nasotracheal intubation was accompanied by significant increases in blood pressure and heart rate compared to baseline values in both groups. Blood pressure and heart rate at intubation, and the maximum values of blood pressure during the observation were significantly higher in the fibreoptic bronchoscope group. However, the maximum values of heart rate were not significantly different between the two groups. Fibreoptic nasotracheal intubation may result in more severe pressor and tachycardiac responses than direct laryngoscopic nasotracheal intubation.

Adult↗

PubMed1992

Total intravenous anaesthesia for direct laryngoscopy: propofol infusion compared to thiopentone combined with midazolam and methohexitone infusion.

Total intravenous anaesthesia for direct laryngoscopy was investigated in 40 patients, randomized into four groups of 10 patients each. First, propofol infusion was compared to thiopentone combined with midazolam. Next, a comparison of propofol infusion with methohexitone infusion was undertaken. The propofol group showed significantly lower peroperative blood pressure compared to the thiopentone/midazolam group. The second propofol group required significantly less alfentanil to stabilize the blood pressure, compared to the methohexitone group. Completeness of recovery, assessed by means of a coin counting test, was faster in the propofol group compared to the thiopentone/midazolam group, while no difference could be demonstrated between the second propofol group and the methohexitone group. It is concluded that propofol seems to be superior to both thiopentone/midazolam and methohexitone with respect to the stability of peroperative blood pressure. Concerning recovery, propofol is superior to thiopentone/midazolam, but offers no advantage over methohexitone.

Adult↗

PubMedDate not supplied

Study of spastic dysphonia using videofiberoptic laryngoscopy.

Spastic dysphonia is a speech disorder, characterized by a "strangled voice quality," irregularly occuring phonatory arrests, and a jerky pattern of speech. This is often extremely disruptive to the patient's ability to communicate. Two cases are presented in which a new technique, videofiberoptic laryngoscopy, was employed in the study of these patients. The characteristic laryngeal behavior of this disorder is documented and recorded, particularly noting the increase in supraglottic activity and how different vocal maneuvers alter this activity.

Female↗

PubMedDate not supplied

Laryngoscopy in space travel.

The need for laryngoscopy aboard a spacecraft on a mission of one to three years is anticipated. Therefore, the inexperience of the potential endoscopists and the problems they face in the free-floating environment of space are considered. A simplified coaxial intubation technique employing a split-apart modification of a Jako-type laryngoscope is suggested.

Humans↗

PubMedDate not supplied

Video laryngoscopy using a rigid telescope and video home system color camera. A useful office procedure.

A simple but reliable method of videotaping the larynx using the Nagashima rigid laryngoscope (telescope) and a low-cost home video color camera is described. Video laryngoscopy using this technique is a useful office procedure. The video material obtained was of high quality and of great value for teaching, voice analysis, preoperative and postoperative evaluation and documentation of various laryngeal disorders.

Laryngoscopy↗

PubMedDate not supplied

Anesthesia for laryngoscopy.

The requirements of anesthesia for laryngoscopy and microlaryngeal surgery must be compatible with maximum safety and minimum patient discomfort. Some techniques require the use of an endotracheal tube while some do not. Others use a modified tube or a jetting system. In general, for pediatric endoscopy we prefer spontaneous respiration with inhalational anesthesia supplemented by topical lignocaine (lidocaine), and in adults, a relaxant technique with controlled jet ventilation supplemented by topical lignocaine. A new pediatric microlaryngoscope and a new tube for jet ventilation in older children and adults are described.

Age Factors↗

PubMed1989

Indirect videolaryngoscopy versus direct endoscopy for larynx and pharynx cancer staging. Toward elimination of preliminary direct laryngoscopy.

Thirty-nine patients with cancer of the larynx and pharynx (33 untreated and six previously treated patients) underwent tumor mapping by both direct laryngoscopy (DL) and indirect videolaryngoscopy (IVL). The examiner in each case was unaware of the findings of the other evaluation method. After definitive treatment had been carried out so that pathologic and operative information was also available, comparisons of the accuracies of the two methods of staging were made. In 32 cases, IVL provided information equal to or better than that provided by DL, and a tissue sample also could be obtained during IVL. On the basis of these findings, we conclude that aggressive, office-based IVL can guide initial treatment planning (partial or total laryngectomy versus irradiation) and patient counseling. A confirmatory DL can be performed without surprises at the time of definitive surgery, rather than as a separate procedure - a cost-effective modification of standard practice.

Biopsy↗

PubMed1998

Neonatal upper airway assessment by awake flexible laryngoscopy.

Awake flexible laryngoscopy (AFL) provides simple and quick assessment of both the structure and function of the upper airway. To determine its value in neonates, a prospective study was carried out over 2 years of 110 neonates (80 term, 30 premature) under 6 weeks of age (corrected for prematurity) presenting with symptoms suggestive of upper airway disease who underwent AFL performed by the author. A diagnosis was made in 79 cases, while no cause was found for the symptoms in 31. The commonest diagnoses were vocal cord paralysis (29; bilateral 16, unilateral 13), nasal stenosis (9), laryngomalacia (9), glossoptosis (7), subglottic stenosis (6), and choanal atresia (5; bilateral 2, unilateral 3). The AFL was repeated in 31 neonates and the condition was found to be stable in 16, improved in 8, resolved in 2, and progressed in 1, and an additional diagnosis was made in 4. Endoscopy under general anesthesia with or without corrective surgery was performed in 15 neonates (7 also having repeat AFL). The diagnosis was confirmed in 14 and an additional tracheal abnormality was found in 1. The AFL was complicated by cyanosis in 2 neonates and epistaxis in 1, but all complications resolved with minimal intervention. These data suggest that the neonatal upper airway can be relatively safely and reliably assessed by AFL performed by an experienced clinician.

Female↗

PubMed1977

Radiology and laryngoscopy for the diagnosis of laryngeal carcinoma.

A comparison is made of the radiologic and clinical findings in 51 patients with laryngeal carcinoma. The radiologic methods comprised conventional films, tomography and laryngography; the clinical examination technique included microlaryngoscopy and the use of a 90 degrees optical instrument. Laryngography was found to be superior to the other two radiologic methods, for the delineation of the tumors. Radiology should be performed before laryngoscopy and biopsy.

Adult↗

PubMed2001

Tracheal intubation using suspension laryngoscopy in an infant with Goldenhar's syndrome.

We present a case of a ten-month-old boy with Goldenhar's syndrome and significant retrognathia in whom a tracheostomy was performed to relieve upper airway obstruction. Tracheal intubation was facilitated by direct suspension laryngoscopy using a slotted rigid laryngoscope. We propose this technique as an alternative method for tracheal intubation in infants and young children with a difficult airway. The management of the difficult airway in children with Goldenhar's syndrome is discussed.

Goldenhar Syndrome↗

PubMedDate not supplied

Increased cerbrospinal fluid pressure during laryngoscopy and intubation for induction of anesthesia.

Intracranial pressure (ICP) was recorded in 12 patients undergoing craniotomy and 2 patients for carotid arteriogram. ICP did not change in response to the injection of contrast medium but rose significantly and dramatically in response to laryngoscopy and intubation. The increase appeared related to initial ICP and thus may represent exhaustion of compensatory mechanisms in these patients. Special attention must be given to this factor during manipulation of the larynx in neurosurgical patients with raised initial ICP or space-occupying intracranial lesions.

Anesthesia↗

PubMed2003

Nitrous oxide attenuates pressor but augments norepinephrine response to laryngoscopy and endotracheal intubation.

UNLABELLED: Nitrous oxide (N(2)O) exerts a sympathomimetic action. We investigated whether N(2)O modifies the cardiovascular responses to tracheal intubation during general anesthesia. One-hundred healthy patients were assigned randomly to receive one of four concentrations (0%, 25%, 50%, or 75%; n = 25 each) of N(2)O in oxygen throughout the study beginning 3 min before tracheal intubation. Anesthesia was induced with IV thiopental (5-7 mg/kg) whereas patients were ventilated with designated concentrations of N(2)O. Tracheal intubation was facilitated with IV vecuronium (0.12 mg/kg). After intubation, all received 2% sevoflurane in oxygen via a semiclosed anesthesia circuit. Systolic arterial blood pressure, heart rate and rhythm, and plasma catecholamine concentrations were measured. The intubation significantly increased arterial blood pressure and heart rate. The maximum pressure changes were 46 +/- 21 and 65 +/- 24 mm Hg in 75% N(2)O and control groups, respectively (P < 0.05), being attenuated by N(2)O without affecting the tachycardiac response. Norepinephrine concentrations were increased at 1 min after the intubation, the magnitude of which was augmented by N(2)O. N(2)O did not affect the incidence of arrhythmias. It was shown that N(2)O suppressed the pressor response to endotracheal intubation, despite the augmented increase of norepinephrine concentrations. IMPLICATIONS: We examined whether nitrous oxide modifies the cardiovascular response to endotracheal intubation because it activates the sympathetic nervous system. Nitrous oxide attenuated the pressor response, whereas it augmented the norepinephrine response to laryngoscopy and endotracheal intubation.

Adult↗

PubMed2001

Per oral awake flexible fibre-optic laryngoscopy in the investigation of children with stridor without respiratory distress.

Use of rigid direct larygnoscopy (RDL) in the investigation of stridor in children is well recognized. This study presents awake flexible fibre-optic laryngoscopy (FFL) as the first line in investigation of children, under six months of age, who present with stridor without any associated respiratory distress. Using the per oral approach the procedures were conducted either in the out-patient department or in the ward. No anaesthesia, local or general, nor sedation was used. Of the 20 cases included in the study, in 16 (80 per cent) cases a working diagnosis was reached on awake FFL. Eleven had laryngomalacia, two subglottic stenosis, one glottic web and two were normal. Only four (20 per cent) cases needed RDL to reach a definitive diagnosis. There were no problems with the maintenance of the airway during the procedure. It is particularly useful in the diagnosis of functional abnormalities of the larynx, such as laryngomalacia and vocal fold palsies. Awake FFL using the per oral approach is a safe and reliable technique for reaching a working diagnosis in approximately 80 per cent of cases.

Awareness↗

PubMed1976

Difficult direct laryngoscopy.

This article reviews some of the problems involved in direct laryngoscopy. It suggests adequate preparation and evaluation of the patient to avoid complications. An evaluation of laryngospasm is given. Solutions of the problems are suggested using gear power assistance and adequate drugs for relaxation. The importance of correct positioning of the patient is emphasized and illustrated. This summarizes clinical judgment and successful evaluation of the difficult mechanical problems in the exposure of the vocal cords.

Anesthesia, General↗

PubMed1976

CO2 laser laryngoscopy in a variety of lesions.

We have had the opportunity to employ the CO2 surgical laser with suspension laryngoscopy and microscopic adaptations to treat a variety of laryngeal conditions over two years. Each type of laryngeal condition is discussed, and the benefits of laser management is evaluated. This type of laryngeal management is compared with other forms of treatment such as the standard surgical approaches, electrocautery, and cryosurgery.

Aged↗