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At least 163 records · Page 9Linked to original sources

PubMed1992

Catecholamine response to laryngoscopy and intubation. The influence of three different drug combinations commonly used for induction of anaesthesia.

The haemodynamic response and changes in plasma catecholamine concentrations associated with laryngoscopy and tracheal intubation were compared during anaesthesia employing three strictly standardised techniques with commonly used drug combinations. Thirty-six patients were investigated consecutively resulting in 12 patients in each of three study groups. Anaesthesia was induced with thiopentone 5 mg.kg-1 (group 1), fentanyl 6 micrograms.kg-1 with thiopentone 5 mg.kg-1 (group 2), or midazolam 0.2 mg.kg-1 with fentanyl 6 micrograms.kg-1 (group 3). Undesirable changes in haemodynamic effects and an elevation of plasma catecholamine concentrations during laryngoscopy and intubation occurred in group 1. Heart rate and mean arterial pressure increased significantly (34% and 23% respectively). Noradrenaline concentration increased by a maximum of 147%. The addition of fentanyl (groups 2 and 3) attenuated the adverse haemodynamic response and elevation of plasma catecholamine concentrations; heart rate and mean arterial pressure did not differ from pre-intubation values and plasma catecholamine concentrations decreased steadily. Substitution of thiopentone by midazolam in combination with fentanyl abolished the adverse haemodynamic response and modified the increase in plasma catecholamine concentrations. 'High-dose' opioid anaesthesia is not necessary to produce optimal conditions during laryngoscopy and intubation.

Adolescent↗

PubMed1994

Excursions of the cervical spine during tracheal intubation: blind oral intubation compared with direct laryngoscopy.

The most appropriate technique for performing tracheal intubation in patients with cervical spine injury is debatable. Recently, a new device enabling blind oral intubation (Augustine Guide) with the patient's head and neck in the neutral position has been introduced. The aim of this study was to compare the extent of upper cervical spine movement during intubation with this device compared to direct laryngoscopy. Twelve patients (Mallampati I and II), without a cervical spine injury, were intubated using the Augustine Guide and afterwards by direct laryngoscopy. Both procedures were viewed radiographically. Extension in the upper cervical spine was determined at the point of the maximum excursion. By evaluating the joints occiput-C3 together as a functional unit, blind oral intubation caused 17 degrees (median) less extension compared to direct laryngoscopy (p < 0.01). The median differences observed for the individual joints were: 7 degrees in occiput-C1 (p < 0.05), 5 degrees in C1-2 (p < 0.01) and 6 degrees in C2-3 (p < 0.01) respectively. Since we assume that intubation-induced excursions of the injured spine are even higher, blind oral intubation might be a safe alternative for airway management in this special group of trauma victims.

Adult↗

PubMed2005

A comparison of direct laryngoscopy and jaw thrust to aid fibreoptic intubation.

We compared two manoeuvres, jaw thrust and laryngoscopy, to open the airway during fibreoptic intubation in 50 patients after induction of anaesthesia in a crossover study. Patients were randomly allocated to receive either jaw thrust or conventional Macintosh laryngoscopy first. Airway clearance was assessed at both the soft palate and the epiglottis. Direct laryngoscopy provided significantly better airway clearance at the level of the soft palate than jaw thrust (44 (88%) vs 31 (62%), respectively; p = 0.002). At the level of the larynx, airway clearance was equally good in both groups (45 (90%) vs 46 (92%), respectively; p = 0.56). The times to view the larynx (median (interquartile range [range]) 4 (3-5 [2-35]) s vs 3 (3-4 [2-8]) s, respectively) and intubation time (20 (17-23 [11-83]) s vs 18 (15-20 [11-28]) s, respectively) were also similar.

Adult↗

PubMed1982

Attenuation of circulatory response to laryngoscopy and tracheal intubation: a comparison of two methods of topical anaesthesia.

Circulatory responses to laryngoscopy and endotracheal intubation were compared between three groups of patients, two of which were subjected to a procedure of topical anaesthesia before induction of general anaesthesia. Topical anaesthesia, achieved with either a lidocaine dose aerosol or by gargling with viscous lidocaine, attenuated the magnitude of the pressor response to laryngoscopy and intubation but had no effect on the heart rate response. Lidocaine aerosol had some advantages over viscous lidocaine; these were the significantly smaller haemodynamic response to the local anaesthetic procedure itself and probably shorter duration of the circulatory changes produced by intubation. It is concluded that both of these simple methods are relatively ineffective in preventing haemodynamic changes associated with laryngoscopy and intubation and should probably be combined with another preventive method.

Adult↗

PubMed1998

The palm print as a sensitive predictor of difficult laryngoscopy in diabetics.

BACKGROUND: Grading of the ink impression made by the palm of the hand has been proposed as a means of screening diabetic patients in whom tracheal intubation may be difficult because of glycosylation of both metacarpal and cervical joints. The current study was designed to test the predictability of the palm print and other airway evaluation indices in a diabetic population. METHOD: 83 adult, diabetic patients scheduled for surgery under general anesthesia were evaluated preoperatively using 4 physical examination indices predictive of difficult laryngoscopy and intubation: Mallampati classification, thyromental distance, head extension, and palm print. Following induction of anesthesia and neuromuscular relaxation, laryngoscopy was performed and the laryngoscopic view scored. The sensitivity, specificity and positive predictive value of each airway evaluation index was calculated. RESULTS: The palm print had the highest sensitivity of all indices (100%). The other 3 indices failed to detect 9 to 13 difficult laryngoscopies. CONCLUSION: We believe that in the diabetic population, the palm print index may be a sensitive marker of difficult intubation. It is possible that other airway evaluation indices would prove more sensitive, and have greater utility, in distinct populations as compared to when they are applied to all patients.

Adult↗

PubMedDate not supplied

Effects of various anesthetic agents on laryngeal motion during laryngoscopy in normal dogs.

OBJECTIVE: To evaluate the effects of various drugs and drug combinations conventionally used for anesthesia on arytenoid cartilage motion during laryngoscopy in normal dogs. STUDY DESIGN: Experimental study. ANIMALS: Six large breed healthy dogs with no previous history of respiratory dysfunction. METHODS: Each dog was randomly assigned to a different injectable anesthetic protocol once weekly for 6 weeks, then in the 7th week all dogs were anesthetized with isoflurane. Videolaryngoscopy was performed and recorded starting immediately after induction until dogs could no longer be safely restrained for endoscopy. Video was digitized and 3 still images of maximal inspiration and expiration from the first 15 seconds (induction) and the last 15 seconds (recovery) were captured and imported into an image analysis software program. The height and area of the laryngeal ostium were measured in pixels. Normalization of the glottal gap area was performed using the formula (normalized glottal gap area (NGGA)=area in pixels/height(2)). ANOVA was performed on the NGGA of images collected at inspiration and expiration during induction and recovery. Fischer's exact test was performed when significance (P<.05) was found. RESULTS: Within each protocol, laryngeal motion (defined as change in NGGA) at induction was not significantly different from laryngeal motion measured at recovery. Additionally, no significant differences were found in arytenoid motion immediately after induction when anesthetic protocols were compared. Arytenoid motion before recovery was significantly greater with thiopental when compared with propofol (P=.046), ketamine+diazepam (P=.0098), acepromazine+thiopental (P=.0021), and acepromazine+propofol (P=.0065). No significant difference in arytenoid motion was seen immediately after induction or before recovery when acepromazine+butorphanol+ isoflurane and thiopental were compared. CONCLUSION: We concluded that intravenous thiopental given to effect is the best choice for assessing laryngeal function in dogs. Dogs premedicated with acepromazine with or without opioids that require further anesthetic restraint for laryngoscopy should be anesthetized with isoflurane administered by mask. CLINICAL RELEVANCE: Misdiagnosis of laryngeal paralysis during laryngoscopy can be avoided by selecting the anesthetic regimens with the least effect on arytenoid motion.

Acepromazine↗

PubMed2001

Role of laryngoscopy, dual pH probe monitoring, and laryngeal mucosal biopsy in the diagnosis of pharyngoesophageal reflux.

There is no standard for determining significant pharyngoesophageal reflux. This prospective blind comparison study compared dual pH probe studies, direct laryngoscopy, and mucosal biopsy in children without symptoms of gastroesophageal reflux who underwent airway evaluation. Significant reflux to the lower esophageal probe did not correlate with statistical significance with reflux to the upper probe. In this group of asymptomatic patients, a positive lower pH probe finding did not correlate with upper or lower esophageal mucosal inflammation. Eosinophilia in the esophageal mucosa is diagnostic of gastroesophageal reflux disease, and was seen in 5 of the laryngeal biopsies. A weak correlation was seen between positive findings at laryngoscopy and positive posterior cricoid biopsy in this group. There may be no consistent way to predict significant pharyngoesophageal reflux in asymptomatic patients. Single-probe pH testing will not predict significant pharyngoesophageal reflux with mucosal changes. Laryngoscopy and upper pH probe findings only weakly correlate with significant histologic findings. Laryngeal and posterior cricoid biopsy may be the only sensitive test for mucosal injury. Clinical trials of empiric antireflux therapy should be used to determine whether the laryngeal changes seen in these patients are reversible.

Biopsy↗

PubMedDate not supplied

Flexible laryngoscopy in neonates, infants, and young children.

Flexible laryngoscopy was performed 453 times on 264 patients 4 years of age or younger. Sixty-five percent were under 6 months of age. Stridor was the indication for laryngoscopy in 60% of the patients. Problems secondary to intubation and poor voice each were indications in 12%. The most common finding was laryngomalacia, followed by laryngeal edema, normal larynges, and vocal cord paralysis or paresis. Subglottic stenosis was diagnosed in 17 patients. Flexible laryngoscopy is a relatively noninvasive, safe, and effective technique for examining the larynx of infants and young children.

Child, Preschool↗

PubMed1997

Role of flexible laryngoscopy in evaluating aspiration.

Flexible fiberoptic laryngoscopy is used to evaluate dysphagia, but its clinical utility has not been compared to that of the videofluorographic swallowing study (VFSS). This study correlates parameters of both procedures and identifies laryngoscopic predictors of aspiration in 105 patients. Presence of aspiration, pharyngeal residue, laryngeal sensation, vocal cord mobility, and glottic closure during flexible laryngoscopy (FL), and gag reflex were correlated with aspiration during the VFSS. An algorithm for laryngoscopically detecting aspiration was synthesized. Aspiration (p = .004) and pharyngeal residue (p < .00001) were highly correlated between the two studies. Aspiration during the VFSS was correlated with pharyngeal residue (p < .00001) and laryngeal sensation (p = .027) during FL, but not glottic closure (p = .169) nor vocal cord mobility (p = .056). Patients with a normal gag reflex and without aspiration or pharyngeal residue during FL had a 2.94% risk of aspiration during the VFSS. Flexible laryngoscopy can be used as a relatively safe, portable screening test for aspiration, but cannot always replace the VFSS to identify the presence or cause of aspiration.

Adult↗

PubMed1989

Teaching indirect mirror laryngoscopy.

Indirect mirror laryngoscopy is difficult to learn. An anatomic model of the oropharynx and larynx is described here. This model is used to familiarize medical students with the component skills of mirror laryngoscopy. The students progress to competency at mirror laryngoscopy on patients more quickly after initial use of this model.

Laryngoscopy↗

PubMed1994

Admission planning and complications of direct laryngoscopy.

Increasingly, third party payers are challenging the necessity of a hospital admission for endoscopic procedures. Direct laryngoscopy (DL), with or without open, rigid esophagoscopy or flexible, fiberoptic bronchoscopy, was evaluated for the incidence of perioperative complications and associated risk factors. A retrospective review of 200 in-patient admissions between 1987 and 1990 for direct laryngoscopy or panendoscopy is presented. Complications were classified as major for untoward events that required hospitalization for proper management. Complications were otherwise considered minor. The incidence of major complications was at least 19.5%, with minor complications occurring in 21% of patients. The total population was partitioned into subsets according to the occurrence of major complications, minor complications, and no complications. For the total population and each subset, distributions were developed by age, sex, habitus, physical status level, diagnosis of malignancy, presence of a malignant lesion in the aerodigestive tract, or medical history of head and neck surgery or radiation therapy. Statistical analysis indicates that these parameters do not offer reliable predictors of which patients are at risk for minor or major complications. It is concluded that all patients who undergo direct laryngoscopy are most safely managed in an in-hospital setting for a period on the order of 24 hours.

Adult↗

PubMed1997

Bacteraemia during direct laryngoscopy and endotracheal intubation: a study using a multiple culture, large volume technique.

Bacteraemia secondary to orotracheal intubation has been reported to occur in 0-5.3% of patients. Bacteraemia detection is dependent upon several factors including the volume of blood per culture and the number of cultures. Prior studies used small volumes of blood and one or two cultures, and may therefore have underestimated the incidence of bacteraemia. Sixty-two adult patients who underwent direct laryngoscopy and endotracheal intubation were studied. Baseline blood cultures were sterile in all patients. After intubation, four blood cultures were obtained in ten minutes, with 10 ml being evenly divided between aerobic and anaerobic media. Two patients (3.2%) became bacteraemic. This is a lower incidence than occurs in association with other procedures for which The American Heart Association does not recommend administration of prophylactic antibiotics. Therefore, prophylactic antibiotics are not recommended prior to direct laryngoscopy. However, when a prophylactic antibiotic is administered prior to surgery, it would be best to administer the antibiotic prior to direct laryngoscopy and intubation.

Adult↗

PubMedDate not supplied

Circulatory changes during anesthetic induction: impact of d-tubocurarine pretreatment, thiamylal, succinylcholine, laryngoscopy, and tracheal lidocaine.

Circulatory changes after IV d-tubocurarine (3 mg), thiamylal (4 mg/kg) plus succinylcholine (2 mg/kg) and followed by direct laryngoscopy with or without intratracheal lidocaine spray (2 mg/kg) just before endotracheal intubation (EI), were measured in 40 adult patients. Pretreatment with d-tubocurarine did not alter mean arterial pressure (MAP), heart rate (HR), or central venous pressure (CVP). One minute after thiamylal-succinylcholine and just before laryngoscopy, MAP was 15 torr less than the awake value (p less than 0.05) and HR was 13 beats/min greater than the awake value (p less than 0.05). Laryngoscopy and EI elevated MAP above awake levels and further increased HR in all patients. The magnitude of these responses immediately following EI was not altered by tracheal lidocaine. However, the pressor and HR changes following EI were more transient when tracheal lidocaine was used (20 patients) and these patients were more likely to tolerate the tracheal tube without immediate additional anesthesia. The incidence of ventricular dysrhythmias was not altered by tracheal lidocaine. Compared with awake values, the cardiac index did not change significantly following intubation but stroke volume was decreased (p less than 0.05), with or without tracheal lidocaine.

Adult↗

PubMed1994

Determination of the distance between the laryngoscope blade and the upper incisors during direct laryngoscopy: comparisons of a curved, an angulated straight, and two straight blades.

We compared visibility and dental complications from a variety of blades during tracheal intubation. Ninety-eight patients who received tracheal intubation were enrolled. They were divided into two groups: Study 1 (n = 50) and Study 2 (n = 48). Four laryngoscopic evaluations were planned for each patient using Miller and Wisconsin straight blades with different heel heights, a Macintosh curved blade, and a Belscope angulated straight blade (Study 1: Miller No. 3, Wisconsin No. 3, Macintosh No. 4, and Belscope medium; and Study 2: Miller No. 2, Wisconsin No. 2, Macintosh No. 3, and Belscope medium, respectively). All laryngoscopies were performed by the same anesthesiologist. The distance between the blade and the upper central incisors was measured when the optimum visibility of the glottis was obtained. The visibility was determined according to the Cormack and Lehane grading. Analysis of the distance between the blade and upper incisors was performed using the results of the 44 patients (166 distances) in Study 1 and the 48 patients (181 distances) in Study 2 who had a visibility of two or better. The Belscope blade provided a significantly greater visual field than the other types of blade. Two patients sustained a fracture of the central incisor and subluxation of the central incisor, respectively, during laryngoscopy in which a Wisconsin blade was used. The average incidence of dental injury was 1/191. The Belscope blade may contribute to a reduced likelihood of upper dental injuries during laryngoscopy.

Adult↗

PubMed2004

Laryngoscopy and morbid obesity: a comparison of the "sniff" and "ramped" positions.

BACKGROUND: The effect of patient position on the view obtained during laryngoscopy was investigated. METHODS: 60 morbidly obese patients undergoing elective bariatric were studied. Patients were randomly assigned into one of two groups. In Group 1, a conventional "sniff" position was obtained by placing a firm 7-cm cushion underneath the patient's head, thus raising the occiput a standard distance from the operating-table while the patient remained supine. In Group 2, a "ramped" position was achieved by arranging blankets underneath the patient's upper body and head until horizontal alignment was achieved between the external auditory meatus and the sternal notch. Following induction of general anesthesia, tracheal intubation was performed using a Video MacIntosh laryngoscope. The laryngoscopy and intubation sequences were recorded onto videotape. Three independent investigators, unaware as to which position the patient had been in at the time of tracheal intubation, then viewed the videotape and assigned a numerical grade to the best laryngeal view obtained. RESULTS: The "ramped" position improved the laryngeal view when compared to a standard "sniff" position, and this difference was statistically significant (P=0.037). CONCLUSION: The "ramped" position is superior to the standard "sniff" position for direct laryngoscopy in morbidly obese patients.

Adult↗

PubMed1976

[Our experience with pulsed oxygen and general anesthesia in direct suspension laryngoscopy].

The authors describe a group of 77 direct suspension laryngoscopies in which general anaesthesia and oxygen therapy were used. The technique is described in considerable detail. The catheter used is independent of the laryngoscope and is passed into the nasal cavity. Analysis of the gases in the blood of 15 patients showed that after three minutes of apnea, ventilation was still satsifactory. No pneumothorax occured during this type of anaesthesia. For the O.-R.-L. practitioner using the method, the advantages are as follows: induction anaesthesia is quicker than after neuroleptanalgesia, exposure of the larynx is excellent due to curarization and three endoscopies can be carried out in the same operation: laryngoscopy, oesophagoscopy and bronchoscopy. The disadvantage of general anaesthesia is that it makes it impossible to judge the mobility of the larynx. In 7,8 p. 100 of the cases, direct suspension laryngoscopy proved difficult or impossible to carry out fir anatomical reasons.

Alfaxalone Alfadolone Mixture↗

PubMed2001

[Virtual laryngoscopy of neoplastic pharyngeal and laryngeal pathology].

PURPOSE: This study investigated the feasibility and clinical value of high-resolution virtual laryngoscopy (VL) based on helical CT data sets. MATERIAL AND METHODS: Fifteen patients with neoplastic laryngeal pathology underwent helical CT examination performed with controlled breath. The CT data were downloaded to a workstation equipped with software for three-dimensional rendering (Silicon Graphics O2, Vitrea Visualization 1.2.8). Two radiologists using Fly Through software generated both antegrade and retrograde endoluminal virtual endoscopy navigations of the larynx. The results of the radiological study were compared with conventional endoscopy findings. RESULTS AND CONCLUSIONS: Virtual laryngoscopy provided the correct diagnosis in 13 of 15 cases. VL is capable of simulating the visual findings of endoscopy in cases of laryngeal tumors and subglottic stenosis. Small and plane tumors of the vocal chords are not adequately visualized. This technique appears to be useful both as biopsy guide during conventional laryngoscopy and as a correct pre-surgery staging, particularly in stenotic tumors.

Humans↗

PubMed2003

Evaluation of i.v. verapamil effects on cardiovascular responses in normotensive patients during laryngoscopy.

Laryngoscopy and intubation are known to increase systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR). In this study, we demonstrated that the injection of intravenous verapamil (0.1 mg/kg) prior to laryngoscopy can blunt the cardiovascular responses to laryngoscopy and intubation and result in stable hemodynamic profile in normotensive patients.

Anti-Arrhythmia Agents↗