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PubMedDate not supplied

Prediction of difficult laryngoscopy in a population of Nigerian obstetric patients.

Difficulty in the maintenance of the airway during obstetric anaesthesia is a major contributory factor in anaesthetic related morbidity and mortality. There is an eightfold increase in the incidence of failed intubation in obstetrics. This is attributable to the physiological changes in pregnancy. Eighty consecutive obstetric patients, over a one year period who required general anaesthesia for caesarian section were evaluated using five bedside tests viz: Mallampati test, Thyrometal distance, Sterno-mental distance, Horizontal length of the Mandible and Inter-incisor gap. Eight patients had difficult laryngoscopy (10%). Mallampati test had a sensitivity, specificity and positive predictive value of 87.1%, 99.6% and 70% respectively. The values obtained for the Thyro-mental distance were 62.5%, 93.1% and 50% respectively. The other tests were not able to predict intubation difficulty significantly. When all tests were combined, sensitivity, specificity and positive predictive were values 100%, 36.1% and 14.8%. The combination of Mallampati and Thyro-mental distance had values of 100%, 93.1% and 61.5%--sensitivity, specificity and positive predictive value. Mallampati can be used as the sole predictor of difficult intubation in Nigerian obstetric patients.

Adult↗

PubMed2000

[The achievement of Warsowian physicians in otolaryngology after introduction of laryngoscopy].

The professional and scientific activities of Konstanty Karwowski (1834-1918), one of the pioneers of the laryngoscopy in Warsaw are described. The widespread contacts of Ignacy Baranowski (1833-1919) with the Viennese scientific medical world are stressed. The beginning of otological lectures by Wiktor Szokalski (1811-1897) in 1864, the famous Polish ophtalmologist is mentioned. The achievements of eminent Polish surgeons: Aleksander A. Le Brun (1803-1868), Hipolit Korzeniowski (1827-1897), Polikarp Girsztowt (1827-1877) and Julian Kosiński (1833-1914) from surgical clinics in Warsaw are presented. The first total laryngectomy in Poland, performed by Kosiński in 1877 is presented in detail.

Achievement↗

PubMed2001

Facilitation of fiberoptic nasotracheal intubation by simultaneous direct laryngoscopy in anesthetized patients.

Two cases of unexpected difficult intubation during induction of general anesthesia were reported. The first case, a 68-year-old male was scheduled for coronary artery bypass surgery. The second case, a 94-year-old male with senile dementia was arranged for exploratory laparotomy. Anesthesia was induced with diazepam 10 mg, fentanyl 30 micrograms/kg, and pancuronium 8 mg in the first case while in the second case fentanyl 100 micrograms, lidocaine 80 mg, thiopental 200 mg and succinylcholine 80 mg were used. In these two cases oral tracheal intubation with laryngoscope was unsuccessful. Assisted ventilation could be maintained via a face mask. With the help of direct laryngoscopy, fiberoptic bronchoscope-aided nasotracheal intubation was successfully achieved.

Aged↗

PubMed2002

Posture used by anaesthetists during laryngoscopy.

BACKGROUND: There is little advice on the posture to be used when intubating the trachea. Does the stance used depend on experience? METHODS: Twenty-six subjects with varying experience of intubation were photographed during laryngoscopy of an intubation training mannequin. Posture was measured from the photographs and the data were analysed with the Mann-Whitney U-test. RESULTS: The less experienced group had shallower lines of sight, levered more, and stood with their face closer to the mannequin (P=0.037, 0.018 and 0.06 respectively). CONCLUSIONS: Novice anaesthetists should be given explicit instructions on correct trolley height and should be taught to intubate with a straight back.

Anesthesiology↗

PubMedDate not supplied

[Laser surgery and phototherapy of the larynx and laryngopharynx under indirect laryngoscopy].

The authors elaborated the equipment and technique of endolaryngeal laser surgery under indirect laryngoscopy in conditions of local anesthesia as well as phototherapy of the larynx with coherent and noncoherent monochromatic light in the postoperative period. Therapy was conducted and assessment of its efficacy was made in 93 patients with benign tumours, cysts of the larynx and laryngopharynx, cicatricial membranes of the middle regions of the larynx. The efficacy of the given method was assessed on the basis of long-term laryngoscopic studies, stroboscopy and acoustic measurements of the voice. Indications and contraindications to the mentioned therapy have been specified.

Fibroma↗

PubMed1976

[Side-effects and complications following suspension laryngoscopy].

The following report deals with the frequency of side-effects following suspension laryngoscopy and ways to avoid them, based on the evaluation of 800 cases. As there was only a low rate of complications established (4,5 per cent) which is mainly caused by tooth damages and intubation-lesions, the preoperative information may be limited to those two points.

Cicatrix↗

PubMedDate not supplied

[Application of high frequency jet ventilation during microsurgery of the larynx under suspending laryngoscopy].

OBJECTIVES: This study describes the results obtained with high frequency jet ventilation (HFJV) in 19 patients who underwent laryngeal microsurgery under suspending laryngoscopy. MATERIAL AND METHODS: After premedication and anesthetic induction with propofol (Diprivan R, ICI-Farma), we performed an endotracheal intubation (28F tube) under succinyl-choline facilitation. Conventional ventilation was started at a rate of 14-16 cpm with a minute volume of 8-10 l, and a FiO2 of 0.4 (air-oxygen). The endotracheal tube was replaced by an insufflation catheter of 2 mm internal diameter and HFJV was initiated at a rate of 100 cpm, inspiratory time equal to the 33% of the total cycle, generator pressure of 2.5-3.6 kg/cm2, and similar FiO2. We used an Ergojet CVT (Temel SA) respirator that allowed continuous monitoring of the injector released volume during each cycle (Vjet) as well as the air way pressure. Anesthesia was maintained with continuous propofol perfusion. RESULTS: During HFJV there were no significant hemodynamic alterations and surgeons considered that the condition of the surgical field was excellent. Air way pressure was maintained at low levels in all cases, although brief hypertensive episodes occurred during laryngeal manipulation. Oxygenation was satisfactory in all except one patient with chronic obstructive pulmonary disease. Conventional ventilation and HFJV did not induce significant differences in alveolar ventilation nor in PaCO2. However, during HFJV oxygenation and ventilatory levels suffered a high degree of interindividual variability. This phenomenon could be due to the existence of variable degrees of gas reflux during insufflation. CONCLUSIONS: We conclude that HFJV is a very useful technique for anesthesia in laryngeal microsurgery. However, an appropriate monitoring of ventilatory dynamics and a detailed knowledge of the influences of patient's characteristics on HFJV are required.

Adult↗

PubMed2004

Reducing cardiovascular responses to laryngoscopy and tracheal intubation: a comparison of equipotent doses of tramadol, nalbuphine and pethidine, with placebo.

The stress response to tracheal intubation may be obtunded by opioids given with induction of anesthesia. Tramadol is an opioid acting on mu-receptors and the monoaminergic pain modulating systems. This study examined vasomotor responses to tracheal intubation after equipotent doses of tramadol, nalbuphine and pethidine (3.0, 0.3 mg/kg(-1), and 1.5 mg/kg(-1), respectively), and placebo, given prior to induction of anesthesia in 118 healthy patients. Premedication and induction of anesthesia were standardized. Recordings of HR and SAP were made prior and subsequent to induction of anesthesia, and at 1, 3, 5 and 7 minutes after tracheal intubation. Prior to laryngoscopy and intubation, HR increased in all groups (p < or = 01, all comparisons), but least so after nalbuphine, whilst SAP remained unchanged after placebo, tramadol and pethidine, but fell after nalbuphine (p < 0.025). Maximum increases in HR (p < or = 0.005, all comparisons) and SAP (p < or = 0.02, all comparisons) occurred one minute after intubation. Maximum HR after placebo (108 SD 15 bpm), tramadol (107 SD 20 bpm), pethidine (113 SD 16 bpm) and nalbuphine (110 SD 26 bpm) was similar; with placebo HR remained faster than baseline until the seventh minute but had returned to baseline by the fifth minute with the opioids. Maximum SAP with tramadol (151 SD 26 mmHg) was similar to that with placebo (157 SD 20 mmHg), but was greater than after pethidine (136 SD 27 mmHg; p < 0.05) and nalbuphine (135 SD 19 mmHg; p < 0.02). With each test drug SAP returned to baseline by the third minute. It is concluded that, in these doses, 1) tramadol does not attenuate the chronotropic nor the inotropic response to tracheal intubation, and 2) pethidine and nalbuphine reduce only the inotropic response to airway instrumentation.

Adult↗

PubMed2006

Cocaine toxicity after laryngoscopy in an infant.

Iatrogenic cocaine toxicity was observed in a 5.5-month-old male who received intranasal cocaine as a topical anesthetic for laryngoscopy. He became agitated, diaphoretic, tachycardic, and hypertensive shortly following the procedure. To control his signs and symptoms, he required 3 doses of IV lorazepam. Systemic absorption and toxicity can vary amongst individuals, making it difficult to determine appropriate dosing. The maximum dose of 1 mg/kg in children has not been validated and toxicity may appear at a much lower dose in certain individuals. Pediatric patients receiving topical cocaine as an anesthetic must be given the lowest possible dose, and then carefully monitored for signs of systemic absorption.

Administration, Topical↗

PubMed1991

[The effect of the sedative and analgesic detomidine for laryngoscopy of adult horses and foals].

Detomidine was used in this field trial effectively as a sedative and analgesic for laryngoscopic examinations in a total of 193 foals and 806 mature horses (Hanoverians). Detomidine was given either i.v. in foals 3 to 11 months old (20 micrograms/kg) and in mature horses (15 micrograms/kg), or i.m. in foals below 6 months of age (35 micrograms/kg). After i.v. administration, laryngoscopy was tolerated in more than 90% of all animals without additional use of a twitch, while in foals treated i.m. more than 70% required a twitch in order to enable this procedure. The effectiveness of detomidine was influenced by dose, route of administration, the time interval between treatment and examination and the degree of excitement before treatment, but not by sex. Profound bradycardia was evident in all treated animals, but arrhythmias were seen only in animals older than 4 months and were more pronounced in horses with a lower resting heart rate. These cardiovascular responses never endangered any of the treated animals. A transient dyspnea was seen in 13 foals (6.7%) and 10 horses (1.2%). Other side effects were rare. The foaling rate of 297 mares treated at any time during the first 8 months of pregnancy was 66.7%. A comparison with 5499 untreated, contemporary controls revealed a foaling rate of 61.0%. Hence treatments had no adverse effects on pregnancies.

Analgesics↗

PubMed1991

[Effect of continuous infusion of diltiazem on cardiovascular responses to laryngoscopy and intubation].

We studied the cardiovascular responses to laryngoscopy and intubation in 30 patients who received continuous infusion of either diltiazem 10 micrograms.kg-1.min-1, 40 micrograms.kg-1.min-1 or saline as control group during 20 min before induction. Heart rate, arterial pressure, rate pressure product (RPP), pressure rate quotient (PRQ) were measured starting 20 min before induction to 3 min after tracheal intubation. The increases in arterial pressure and RPP following tracheal intubation were reduced significantly in patients receiving diltiazem 40 micrograms.kg-1.min-1, but they were not reduced in patients receiving diltiazem 10 micrograms.kg-1.min-1 compared with control. We conclude that continuous infusion of diltiazem during 20 min before induction is effective for preventing the increases in arterial pressure and RPP following tracheal intubation, and the optimal infusion rate is from 10 to 40 micrograms.kg-1.min-1.

Aged↗

PubMed1991

Etomidate vs. propofol to carry out suspension laryngoscopies.

Patients about to undergo a suspension laryngoscopy were randomly assigned to one of two groups (n = 10). They were given either etomidate 1 mg kg-1 followed by 1 mg kg-1 h-1, or propofol 2.5 mg kg-1 followed by 9 mg kg-1 h-1. Alfentanil 10 micrograms kg-1 was given to provide analgesia with a further half dose if necessary. Duration of apnoea, quality of anaesthesia, times between stopping hypnotic administration and the moment when the patients opened their eyes, gave their name, date of birth and the day's date were noted. Heart rate, blood pressures, respiratory frequency and blood gases were noted before induction, before suspension and when hypnotic infusion was stopped. Clinical tolerance was good, the duration of surgery, apnoea and quality of anaesthesia were the same for both groups. Blood pressure was less depressed by etomidate, but ventilatory frequency was higher. Recovery was significantly faster after propofol. Propofol is recommended for patients who require good post-operative cooperation (chronic obstructive pulmonary disease) and etomidate for those who are haemodynamically compromised.

Alfentanil↗

PubMed1991

Endotracheal intubation through the Laryngeal Mask--helpful when laryngoscopy is difficult or dangerous.

The correctly placed Laryngeal Mask will act as a guide to endotracheal intubation in over 90% of adult patients. Although the size of tube is limited to a 6-mm-internal-diameter cuffed oral or nasal pattern tube the technique is easy to learn and can provide a rapid solution when endotracheal intubation is necessary but conventional laryngoscopy is unexpectedly difficult or dental restorations are at risk. Application of cricoid pressure reduces the success rate of the technique; therefore, if this manoeuvre is indicated to reduce the risks of regurgitation, anaesthetists are advised to arrange for its momentary relaxation during the final stages of placement of the Laryngeal Mask and of the endotracheal tube.

Anesthesiology↗

PubMed1991

Flexible fiberoptic laryngoscopy used to assess swallowing function.

Flexible fiberoptic laryngoscopy can be used to evaluate swallowing dysfunction by observing the patient's pharynx with a fiberoptic laryngoscope while the patient's swallowing function is challenged with various food materials. This technique provides much of the same information obtained from the formal videofluoroscopic swallowing examination and has the advantages of being a bedside technique requiring only a fiberoptic laryngoscope that can be performed in 15 minutes by a single otolaryngologist.

Deglutition↗

PubMedDate not supplied

[Circulatory and respiratory repercussions to direct suspension laryngoscopy in the adult: value of a propofol-alfentanil combination].

The clinical effects of a propofol-alfentanil association were studied in fifteen patients ASA II (mean age 50.1 +/- 14.1) anaesthetized for E.N.T. endoscopy after informed consent. All the patients received an intramuscular premedication with 0.10 to 0.15 mg.kg-1 midazolam. Propofol 2.5 mg.kg-1 was injected in a peripheral venous line with alfentanil 10 micrograms.kg-1, followed by continuous automatic injection of propofol at a dose of 5 to 10 mg.kg.h-1 and alfentanil 5 micrograms.kg-1 given just before suspension. After induction and during maintenance of anaesthesia, the patients were allowed to breathe oxygen spontaneously O2 assisted when apneic. The following variables were studied before induction (to), after induction (t1), during suspension (t2) and when stopping the infusion (t3): haemodynamic parameters using an invasive method and blood gases. Statistical analysis was performed using the Student's test for paired samples. Surgical conditions and anaesthetic quality were good with early recovery of consciousness and return of all reflexes. After an initial period of cardio vascular depression, the haemodynamic parameters did not vary much during the anaesthesia and propofol-alfentanil appeared to limit considerably the hypertension due to laryngoscopy. However, there was a moderate degree of hypercapnia (p less than 0.001) in most patients, giving evidence of some respiratory depression and possibly a greater depth of anaesthesia than desirable. Indeed, the doses of alfentanil required seemed to be more important with propofol because of a probably interference between the two drugs; the doses of these drugs should therefore be modified according to the length of surgery.

Adult↗

PubMed1989

The effect of advancing age on the sympathetic response to laryngoscopy and tracheal intubation.

The effect of aging on the hemodynamic and sympathetic response to tracheal intubation was evaluated in 27 patients aged 18 to 80 years, ASA Class I and II, given atropine 0.4 mg and diazepam 10 mg as premedication and thiopental, 4.0 mg/kg, and succinylcholine 100 mg for anesthesia induction. Laryngoscopy and tracheal intubation was performed 60 seconds after induction. The elderly had significantly less chronotropic response to intubation 2, 3, 4, and 5 minutes after induction so that the maximum increase in heart rate above awake values was negatively correlated with age (R = -0.66, P less than 0.001). Baseline systolic blood pressure (SBP) and mean BP increased significantly with age (R = 0.81, P less than 0.001 and R = 0.76, P less than 0.001, respectively) but age was not significantly related to increases in SBP and mean BP following intubation. Baseline plasma norepinephrine (NE) levels increased with age ( R = 0.51, P less than 0.01). Following intubation, mean plasma NE concentrations were significantly higher in elderly patients than young patients, despite the diminished heart rate response. Heart rate (HR) per pg/ml of NE, a measure of cardiac sensitivity to beta stimulation, was therefore significantly less 2, 3, and 4 mins after induction in elderly patients than in younger patients. To determine if this alteration in cardiac sensitivity to endogenous catecholamines was reflected by changes in beta receptor function on lymphocytes, beta receptor density and the proportion of receptor binding agonist with high affinity (%RH) were measured. No significant correlation between beta-receptor affinity for agonist, %RH, or receptor density was found with age, HR, or HR per pg/ml NE.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1989

[Indirect laryngoscopy].

The inside of the larynx during an indirect laryngoscopy canbe better inspected by inspiratory phonation. The author has used a simple maneouvre in patients where the inspection of the larynx is difficult.

Humans↗

PubMed1988

Attenuation of pulse rate and blood pressure response to laryngoscopy and tracheal intubation by clonidine.

Forty healthy patients (ASA class 1) of both sexes, aged between 20 and 45 years, undergoing routine surgical procedures were included in this double-blind randomized study. They were divided into two groups of 20 each. Patients in group A received no pretreatment, while patients in group B received oral clonidine 5 micrograms kg-1 90 min before induction of anesthesia. All patients received thiopentone (5 mgs kg-1) followed by suxamethonium (1.5 mgs kg-1) to facilitate endotracheal intubation. Control patients showed a significant increase in heart rate and blood pressure; they were significantly lower in the clonidine treated group immediately after intubation (p less than 0.001). The data suggest that the rise in heart rate and blood pressure associated with laryngoscopy and intubation during a routine induction sequence can be attenuated by the use of oral clonidine.

Adult↗