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At least 469 records · Page 26Linked to original sources
PubMedDate not supplied

Cricoid pressure decreases ease of tracheal intubation using fibreoptic laryngoscopy (WuScope System.

PURPOSE: Cricoid pressure is commonly used during rapid sequence induction and intubation to minimize the risk of aspiration. The objective of the study was to evaluate the ease of fibreoptic (WuScope System(TM)) intubation in anesthetized adults receiving cricoid pressure. METHODS: The intubation difficulty scale (IDS) was used to measure tracheal intubation difficulties in 33 patients undergoing elective surgery with general anesthesia and complete neuromuscular blockade. Each patient had their trachea intubated under two conditions: with and without cricoid pressure. The order of conditions was determined randomly. Cricoid pressure was applied by an experienced anesthesia provider. MAIN RESULTS: An IDS value of 0 (ideal intubation, that is one performed by the first operator on the first attempt, using the first technique with full visualization of the glottis and no vocal cord compression) occurred in 30 of 33 patients (91%) without cricoid pressure and in 22 of 33 patients (67%) with cricoid pressure (P < 0.05). Cricoid pressure compressed the vocal cords in nine patients (27%) and impeded tracheal tube placement in five (15%). In three patients (9%), pressure had to be released in order to successfully intubate. CONCLUSION: Cricoid pressure may impede or even prevent fibreoptic laryngoscopic intubation with the WuScope System(TM).

Adult↗
PubMed2003

[Sonography of the larynx--an alternative to laryngoscopy?].

PROBLEM: The aim of this study was to determine whether the pictorial results obtained from B-mode ultrasonography duplicate those of laryngeal endoscopy and whether there are any additional advantages when using ultrasonography. PATIENTS AND METHODS: A total of 22 patients with various diseases of the larynx were examined ultrasonically with the ultrasound plusing a Sonoline Elegra as well as with a '7.5 L40' and a 'VF 13/5' linear array. In order to compare both methods directly, reference data were prepared and contrasted. RESULTS: All of the laryngeal lesions recognised in the endoscopic investigation were also demonstrable by the use of ultrasound, although minor changes were difficult to detect. In one case, ultrasonography suggested the presence of an infiltration of the thyroid cartilage, otherwise no additional information was available using this method. CONCLUSIONS: Using ultrasonography, the image quality of the larynx is worse than that of the soft tissue of the neck, which is determined by the air-mucous membrane boundary as well as the (ossified) cartilaginous skeleton. Thus, ultrasonography is useful in cases of larger laryngeal lesions, while there is no advantage in the detection of small processes.

Adult↗
PubMed2006

Seeing is believing: the importance of video laryngoscopy in teaching and in managing the difficult airway.

Of the several million patients who undergo surgery in North America annually, a large proportion undergo intubation of the trachea. In approximately 90% of these patients, the endotracheal tube is introduced using a traditional laryngoscope with a battery in the handle and a small bulb near the tip of the blade. This bulb provides a limited and often dim view of the glottic structures. In about 10% of cases, the patient is intubated using a flexible fiberoptic intubating scope. The authors have developed a video laryngoscope that preserves the standard blade configuration with a modified handle. A 3-mm image light guide is built into the blade, replacing the bulb. A small TV camera with an incorporated light bundle is inserted into the handle. A wide-angle panoramic view of the upper airway anatomy is displayed on a TV screen, which can be positioned at a convenient working distance. The use of a TV monitor is a well-accepted standard during minimally invasive surgical procedures.

Airway Obstruction↗
PubMed2006

The importance of preoperative laryngoscopy in patients undergoing thyroidectomy: voice, vocal cord function, and the preoperative detection of invasive thyroid malignancy.

BACKGROUND: Vocal cord paralysis is associated with extrathyroidal invasive malignancy. This study was performed to analyze the presentation of patients with invasive thyroid malignancy and to determine the preoperative symptomatic and radiographic correlates of vocal cord paralysis. METHODS: In a group of 365 consecutive patients undergoing thyroidectomy, the group of 21 patients with invasive thyroid malignancy was compared with the 344 patients who had benign thyroid disease or noninvasive cancers. RESULTS: Preoperative recurrent laryngeal nerve paralysis was a robust marker for invasive thyroid malignancy, being present in 70% of patients with invasive disease and only 0.3% of patients with noninvasive disease. Vocal cord paralysis was associated with voice change in only one third of patients. Preoperative computed tomography was read as positive for vocal cord paralysis in only 25% of patients. CONCLUSIONS: Laryngoscopic examination is essential for the detection of vocal cord paralysis preoperatively. Symptomatic voice assessment and radiographic evaluation are insufficient. Preoperative vocal cord paralysis tracts with invasive disease and facilitates preoperative recognition of disease extent, allowing for appropriate operative planning and central neck clearance at first operation. Because of the prevalence (approximately 6% in our study) of invasive thyroid disease, the importance of preoperative diagnosis of invasive disease in operative planning and patient counseling, and the importance of vocal cord functional analysis in recurrent laryngeal nerve management algorithms for nerves found infiltrated at operation, and laryngoscopic examination is recommended for all patients undergoing thyroid operation.

Aged↗
PubMed1999

Gender and intra-observer agreement about laryngoscopy of papilloma.

BACKGROUND: The gender of the observer may bias data. OBJECTIVE: Compare the intra-observer agreements of male and female pediatric otolaryngologists about videotaped images of laryngeal papilloma. DESIGN: Five male and six female pediatric otolaryngologists independently viewed videotapes of ten children undergoing treatment for laryngeal papilloma. Each of 12 anatomic sites was categorized as disease present, absent, or indeterminate. Each observer estimated the percent overall airway obstruction. 5-24 weeks later, each observer repeated his/her assessments. RESULTS: The mean intra-observer agreements for both male and female pediatric otolaryngologists were good, and identical (kappa 0.63; proportion of positive agreement 0.82; proportion of negative agreement 0.72). Females more frequently categorized a site as indeterminate. Males more frequently categorized a site oppositely on repeat assessment. The males' indeterminate/opposite ratio was less than that of the females' (P = 0.03). Intra-observer estimates of overall airway obstruction have wide variability: for male pediatric otolaryngologists, differences exceeding 30% are significant; for females, 40%. CONCLUSION: Male and female pediatric otolaryngologists had equally good and identical intra-observer kappa scores and proportions of positive and negative agreement. However, males used the indeterminate category less than did the females, and males more often gave an opposite categorization at the second viewing session. Estimates of overall airway obstruction have much intra-observer variability.

Child↗
PubMed1996

Association of esophageal reflux and globus symptom: comparison of laryngoscopy and 24-hour pH manometry.

Thirty-one patients with globus sensation were examined by dual probe pH manometry and videolaryngoscopy to investigate the role of gastroesophageal reflux disease in association with globus. Abnormal laryngeal findings, which included grossly abnormal and subtle changes, were seen in 17 patients. These findings included pharyngeal erythema (12 patients), interarytenoid pachydermia (11), laryngeal edema (11), arytenoid erythema (9), and thick mucus (3). Twenty-one of the 31 pH probe studies showed gastroesophageal reflux disease (14 grossly abnormal, 6 borderline abnormal) with Johnson and DeMeester composite scores for the distal probe. There was no correlation between the upright and supine position, nor was there correlation between positive laryngeal findings and a positive pH probe study. We conclude that globus sensation is often a nonspecific symptom of laryngopharyngeal irritation in which gastroesophageal reflux disease plays a significant role. Combining careful laryngoscopic examination with pH probe studies can help to differentiate between patients with organic pathology caused by gastroesophageal reflux disease and patients with other nonspecific laryngopharyngeal disorders.

Adult↗