Congenital vallecular cyst: a rare and potentially lethal condition

Congenital vallecular cyst is a rare laryngeal lesion, accounting for 10-20% of all laryngeal cysts, with a potential to cause severe upper airway obstruction, which can be fatal. It can cause stridor, apnea, cyanosis, respiratory distress, and feeding difficulties. Diagnosis requires a high level of clinical suspicion and helps in timely intervention. Direct laryngoscopy is gold standard for definitive diagnosis. Treatment options include aspiration, marsupialization, and surgical excision. Here, we report a case of 7-week-old infant with complain of recurrent episodes of cyanosis when agitated, since the age of 3 weeks, admitted with impression of apparent life-threatening events [ALTEs]

Extensive investigations were non-conclusive, which were done in local hospital. Direct laryngoscopy was performed in our hospital and showed presence of a vallecular cyst. Thus complete excision of cyst was done in the same setting with dramatic relief of symptoms

Comparative study between the use of Macintosh laryngoscope and Airtraq in patients with cervical spine immobilization

Airway management is a major responsibility for anesthetist. This study was carried out to evaluate and compare the efficacy of Airtraq [AL] and Macintosh Laryngoscopes [ML] in intubating patients with cervical spine immobilization using manual inline axial stabilization technique [MIAS]. This randomized controlled study was carried out in Alexandria Main University Hospital on 40 adult ASA I and II patients after written informed consent and approval of the ethical committee, randomly categorized into two equal groups. All patients were subjected to same anesthetic protocol. Group I patients were intubated using AL and group II patients were intubated using ML. Hemodynamic measurements and oxygen saturation were recorded. Intubation criteria for both groups including [duration of intubation procedure, number of attempts, number of optimization maneuvers, Cormack and Lehane grade at laryngoscopy, Intubation Difficulty Scale score [IDS], rate of successful placement of endotracheal tube, neck mobility during laryngoscopy and intubation complications were recorded. Data statistically analyzed using SPSS[R] software using [t and x[2] tests] and P < 0.05 considered significant. There was statistically significant increase in both heart rate and mean arterial blood pressure values following intubation in ML group than AL, oxygen saturation showed no significant difference between the two groups. Duration of intubation was statistically significant longer in ML group and needed more optimization maneuvers than the AL group, while for the number of intubation attempts; there was no statistically significant difference between the two groups. Both the Cormack and Lehane grading and IDS score values have shown statistically significant higher values in ML group. The Airtraq Laryngoscope offers a new approach for the management of difficult airway like patients with potential cervical spine injury, it is fast, easy to use, gets an easy view of the larynx without moving the cervical spines or causing hemodynamic stimulation

Is the airtraq laryngoscope superior to macintosh laryngoscope using armord endotracheal tube in head and neck surgery?

The control of the airway is a fundamental aim for the anaesthiologast during routine anaesthesia. The incidence of difficult tracheal intubation has been estimated at 3-18%. This incidence may be more in head and neck Surgery. Our study conducted on 30 patients divided randomly in two groups each of 15 patients. Fifteen patients intubated by Macintosh laryngoscope and 15 by Airtraq laryngoscope. We found that success rate in Airtraq laryngoscope was 100% in comparisons to Macintosh laryngoscope which was 81.8%. We found also the intubation time was reduced significantly with use the Airtraq laryngoscope. The intubation was done in the first attempts in all patients in Airtaq group without need to optimizing maneuvers in comparison to Macintosh laryngoscope which need optimizing maneuvers and also use intubating aids like Bougie. Nearly no complication in Airtraq group like oral mucosal laceration, oxygen alteration and heamodynamic changes. We found that the Airtraq laryngoscope provides superior intubating condition without need intubating aids and less or no complications

Comparative study of a standard Macintosh blade III and a modified Optic Viewmax blade II for endotracheal intubation

The availability of a laryngoscope blade that could improve visualization of glottic structures without requiring excess traction force during tracheal intubation would be helpful in reducing the perioperative complications related to laryngoscopy. The Viewmax laryngoscope blade II [Rusch] is a modified laryngoscope blade which incorporates an unmagnified optic side port to a standard Macintosh [MAC] blade III. This modification allows for an alternative view of the glottis from a position 1 cm behind the left tip of the blade while still allowing the standard direct view provided with MAC-3 blade during tracheal intubation. In this study, we compared the Viewmax to a standard MAC-3 blade using a randomized cross-over study design. Fifty six patients ASA physical status I and II requiring tracheal intubation were enrolled in this study. The preanesthesia airway evaluation included Mallimpoti score, thyromental distance, and maximal mouth opening. Anesthesia was induced with propofol 2 mg/kg and fentanyl 50-100 mg, followed by rocuronium 0.6 mg/kg IV for muscle relaxation. According to a randomization, either the standard MAC-3 blade [Mac Group] or Viewmax II blade [Viewmax Group] was first chosen for laryngoscopy. After viewing the laryngeal structures, the first blade was withdrawn and the second blade [MAC or Viewmax] was used to repeat the laryngoscopy. A strain gauge laryngoscope handle was used with both blades to measure the peak axial force applied at the handle by the anesthesiologist during the laryngoscopy. After viewing the laryngeal structures with the second blade, tracheal intubation was performed in all patients. The views of laryngeal structure during laryngoscopy were classified by the anesthesiologist as: Grade 1= most of the glottis is visible; Grade 2 = only the posterior portion of the glottis is visible; Grade 3 = only the epiglottis is visible; and grade 4 = only the soft palate is visible. Anesthesiologist's satisfaction with the Viewmax laryngoscope was evaluated using a verbal score from 0 to 100. Our results showed that there were no significant differences in the laryngoscopic views between the two blades. However, the use of Viewmax blade was associated with lower percentage of laryngoscopic views grade III and IV compared to MAC blade. The recorded force applied to the laryngoscope handle during laryngoscopy was significantly less in Viewmax group compared to MAC group. The view of the laryngeal structures with Viewmax 11 blade was comparable to the MAC-3 blade. However, the use of Viewmax blade required less axial force applied at-the handle during the laryngoscopy

Estenosis subglótica adquirida: experiencia en 80 casos: Hospital Niños "J. M. de los Ríos" / Adquire subglotic stenosis: experience in cases: Hospital of Niños \"J. M.\" of the Rios

La Estenosis Subglótica Adquirida es una entidad que afecta a tejidos blandos y estructuras cartilaginosas del espacio subglótico. Desde enero de 1987 hasta agosto de 1995, ingresaron al servicio de ORL del Hospital de Niños "J.M de Los Ríos" 80 pacientes con esta patología. El 87 por ciento (70) ameritaron traqueotomía y el 13 por ciento (10) no necesito tratamiento alguno. De los 70 pacientes traqueotomisados el 77 por ciento (60), se les realizó dilatación más infiltración de esteroides. al 10 por ciento (8), se les practicó laringotraqueoplastia, 2 pacientes fallecieron. El 75 por ciento (45) de los traqueotomisados fueron decanulados y dados de alta. El 25 por ciento (15) de los pacientes se mantienen en tratamiento. Fueron decanulados el 75 por ciento (6) de los 8 pacientes a los cuales se les realizó laringotraqueoplastia; y el 25 por ciento (2) no han podido ser decanulados por regresión de la estenosis.

Esmolol: efectos hemodinámicos a la laringoscopia e intubación / Esmolol: effect hemodynamic in the laringoscopy and intubation

El presente trabajo se realizó con la finalidad de observar los efectos hemodinámicos del esmolol a la laringoscopia e intubación. Se seleccionaron 48 pacientes ASA I-II entre 18/60 años, programados para cirugía electiva que requiera intubación orotraqueal. Se agruparon en dos grupos con su respectivo control. Al primer grupo se le administró TPS + esmolol y al segundo grupo propofol + esmolol. En todos los pacientes hubo un bloqueo de la respuesta presora a la intubación en comparación a su grupo control evidenciándose una diferencia estadísticamente significativa entre propofol esmolol y TPS-esmolol

Comparación de la respuesta hemodinámica durante la laringocopia e intubación traqueal con la administración de lidocaina topica vs. lidocaina intravenosa / Comparation of the hemodinamic response during laryngoscopy and traqueal intubation with the lignocaine asministrated intravenously

La lidocaína ha sido administrada por vía intravenosa y/o aerosol orofaringea y laringea superior con variado éxito, para atenuar la respuesta en el sistema cardiovascular a la laringoscopia e intubación endotraqueal. Nosotros tratamos de determinar la vía óptima de administración en 60 pacientes de ASA i, en edades comprendidas entre 15 y 45 años, sometidos a cirugía de urgencia o electiva, los cuales fueron anestesiados con Tiopental Sódico, Oxigeno/Oxido Nitroso, Halothano o Ethrane. Los pacientes fueron organizados al azar en tres grupos, el grupo A recibió Lidocaína intravenosa 1,5 mg/kgr de peso tres (3) minutos antes de la laringoscopia e intubación; el grupo B recibió Lidocaína en atomización orofaringea y laringea superior cinco (5) minutos antes de la laringoscopia y el grupo C recibió la combinación de las dos vías anteriores cinco (5) minutos antes. El análisis comparativo de los tres (3) grupos demostró que el incremento de los valores de los parámetros hemodinámicos, en porcentaje no fue significativo