Consistent Technique Limits Suspension Laryngoscopy Complications

Abstract Introduction Suspension laryngoscopy (SL) is a commonly performed procedure among otolaryngologists. Several studies have shown that adverse effects occur regularly with SL. Objective To evaluate the postoperative complications of SL, and to determine if protecting the dentition and the oral mucosa and limiting suspension times decrease the overall incidence of oral cavity and pharyngeal complications of SL. Methods All of the cases of SL performed by 1 surgeon from November 2008 through September 2014 were retrospectively reviewed. A consistent technique for dental and mucosal protection was utilized, and suspension times were strictly limited to 30 consecutiveminutes. The incidence of postoperative complications was calculated and analyzed with respect to gender, smoking status, dentition, laryngoscope type, and suspension system. Results A total of 213 consecutive SL cases were reviewed, including 174 patients (94 male, 80 female). The overall postoperative complication rate was of 3.8%. Four patients experienced tongue-related complications, two experienced oral mucosal alterations, one had a dental injury, and one experienced a minor facial burn. The complication incidence was greater with the Zeitels system(12.5%) compared with the Lewy suspension system (3.3%), although it was not significant (p = 0.4). Likewise, the association of complications with other patient factors was not statistically significant. Conclusion Only 8 out of 213 cases in the present series experienced complications, which is significantly less than the complication rates observed in other reports. Consistent and conscientious protection of the dentition and of the oral mucosa and limiting suspension times to 30 minutes are factors unique to our series that appear to reduce complications in endolaryngeal surgery.

Effects of lidocaine and magnesium sulfate in attenuating hemodynamic response to tracheal intubation: single-center, prospective, double-blind, randomized study / Os efeitos da lidocaína e do sulfato de magnésio na atenuação da resposta hemodinâmica à intubação orotraqueal: estudo unicêntrico, prospectivo, duplamente encoberto e aleatorizado

Abstract Background and objectives: Hemodynamic response to airway stimuli is a common phenomenon and its management is important to reduce the systemic repercussions. The objective of this study is to compare the efficacy of intravenous magnesium sulfate versus lidocaine on this reflex hemodynamics after laryngoscopy and tracheal intubation. Methods: This single-center, prospective, double-blind, randomized study evaluated 56 patients ASA 1 or 2, aged 18-65 years, scheduled for elective surgeries under general anesthesia with intubation. The patients were allocated into two groups: Group F received 30 mg·kg-1 of magnesium sulphate and Group L, 2 mg·kg-1 of lidocaine, continuous infusion, immediately before the anesthetic induction. Blood pressure (BP), heart rate (HR), and bispectral index (BIS) were measured in both groups at six different times related to administration of the study drugs. Results: In both groups there was an increase in HR and BP after laryngoscopy and intubation, compared to baseline. Group M showed statistically significant increase in the values of systolic and diastolic blood pressure after intubation, which was clinically unimportant. There was no difference in the BIS values between groups. Among patients receiving magnesium sulfate, three (12%) had high blood pressure versus only one among those receiving lidocaine (4%), with no statistical difference. Conclusion: Magnesium sulfate and lidocaine have good efficacy and safety for hemodynamic management in laryngoscopy and intubation.

Resumo Justificativa e objetivos: A resposta hemodinâmica aos estímulos das vias aéreas é um fenômeno comum e seu controle é importante para diminuir as repercussões sistêmicas. O objetivo deste trabalho é comparar os efeitos da administração endovenosa de sulfato de magnésio versus lidocaína na hemodinâmica desse reflexo após a laringoscopia e intubação orotraqueal. Métodos: Este estudo duplamente encoberto, aleatorizado, unicêntrico e prospectivo avaliou 56 pacientes, ASA 1 ou 2, entre 18 e 65 anos, escalados para cirurgias eletivas sob anestesia geral com intubação orotraqueal. Foram alocados em dois grupos, o M recebeu 30 mg·kg-1 de sulfato de magnésio e o L, 2 mg·kg-1 de lidocaína, em infusão contínua, imediatamente antes da indução anestésica. Os valores de pressão arterial (PA), frequência cardíaca (FC) e índice biespectral (BIS) foram aferidos nos dois grupos em seis momentos relacionados com a administração dos fármacos do estudo. Resultados: Em ambos os grupos houve aumento na FC e PA após a laringoscopia e intubação, em relação aos valores basais. No Grupo M observou-se elevação estatisticamente significativa, mas clinicamente pouco importante, nos valores das pressões arteriais sistólica e diastólica após a intubação. Não houve diferença nos valores de BIS entre os grupos. Dos pacientes que receberam o sulfato de magnésio, 3 (12%) apresentaram episódio de hipertensão, ao passo que apenas um dos que receberam lidocaína (4%) apresentou esse sinal, sem diferença estatística. Conclusão: Sulfato de magnésio e a lidocaína apresentam boa eficácia e segurança no controle hemodinâmico à laringoscopia e intubação.

A randomised comparative study of the effect of Airtraq optical laryngoscope vs. Macintosh laryngoscope on intraocular pressure in non-ophthalmic surgery / Estudo comparativo randomizado do efeito do laringoscópio óptico Airtraq vs. laringoscópio Macintosh sobre a pressão intraocular em cirurgia não oftálmica

BACKGROUND: We compared intraocular pressure changes following laryngoscopy and intubation with conventional Macintosh blade and Airtraq optical laryngoscope. METHODS: Ninety adult patients were randomly assigned to study group or control group. Study group (n = 45) - Airtraq laryngoscope was used for laryngoscopy. Control group (n = 45) - conventional Macintosh laryngoscope was used for laryngoscopy. Preoperative baseline intraocular pressure was measured with Schiotz tonometer. Laryngoscopy was done as per group protocol. Intraocular pressure and haemodynamic parameters were recorded just before insertion of the device and subsequently three times at an interval of one minute after insertion of the device. RESULTS: Patient characteristics, baseline haemodynamic parameters and baseline intraocular pressure were comparable in the two groups. Following insertion of the endotracheal tube with Macintosh laryngoscope, there was statistically significant rise in heart rate and intraocular pressure compared to Airtraq group. There was no significant change in MAP. Eight patients in Macintosh group had tongue-lip-dental trauma during intubation, while only 2 patients received upper airway trauma in Airtraq group. CONCLUSION: We conclude that Airtraq laryngoscope in comparison to Macintosh laryngoscope results in significantly fewer rises in intraocular pressure and clinically less marked increase in haemodynamic response to laryngoscopy and intubation.

JUSTIFICATIVA: Comparar as alterações de pressão intraocular após laringoscopia e intubação com lâmina Macintosh convencional e laringoscópio óptico Airtraq. MÉTODOS: Noventa pacientes adultos foram randomicamente designados para os grupos estudo ou controle. No grupo estudo (n = 45) o laringoscópio Airtraq foi usado para laringoscopia e no grupo controle (n = 45) o laringoscópio Macintosh convencional foi usado para laringoscopia. A pressão intraocular foi mensurada no pré-operatório com tonômetro Schiotz. A laringoscopia foi feita de acordo com o protocolo de cada grupo. Pressão intraocular e parâmetros hemodinâmicos foram registrados logo antes da inserção do dispositivo e três vezes após a inserção do dispositivo, com intervalo de um minuto. RESULTADOS: As características dos pacientes, os parâmetros hemodinâmicos basais e a PIO basal foram comparáveis nos dois grupos. Após a inserção do tubo endotraqueal com o laringoscópio Macintosh, houve um aumento estatisticamente significativo da frequência cardíaca e da pressão intraocular em comparação com o grupo Airtraq. Não houve alteração significativa da PAM. Oito pacientes do grupo Macintosh sofreram trauma de língua-lábio-dental durante a intubação, enquanto apenas dois pacientes sofreram trauma das vias aéreas superiores no grupo Airtraq. CONCLUSÃO: Concluímos que o laringoscópio Airtraq, em comparação com o laringoscópio Macintosh, resultou em elevações significativamente menores da PIO e em aumentos clinicamente menos acentuados da resposta hemodinâmica à laringoscopia e intubação.

Efficacy of nalbuphine in preventing hemodynamic response to laryngoscopy and intubation

To determine the efficacy of nalbuphine in preventing increase in heart rate and mean arterial pressure in response to laryngoscopy and tracheal intubation. This double blind randomized controlled trial was conducted on 100 ASA [American Society of Anesthesiologists] grade I-II patients scheduled for general anesthesia. Patients were randomly allocated to receive either saline [group I, control group, n=50] or nalbuphine 0.2 mg kg-1 [group II, study group, n=50] as a bolus dose 5 minutes before laryngoscopy. Anaesthesia was then induced with propofol [2mg kg-1] and atracurium [0.6mg kg-1] and or tracheal intubation was then performed within 30 seconds. Heart rate [HR] and mean arterial pressures[MAP] were recorded before the administration of the study drug, baseline value [T-0], 3 minutes after study drug administration [T-1], immediately after tracheal intubation [T-2] and then after every 1 minute up to 5 minutes [T3-7] and then after 10 minutes of intubation [T-8]. The Nalbuphine group showed significantly lesser rise in HR compared to control group after laryngoscopy and or tracheal intubation that continued till 10 minutes after intubation [p-value from ?0.0001-0.0297]. The Nalbuphine group also showed significantly lesser rise in MAP compared to control group after laryngoscopy and or tracheal intubation that continued till 5 minutes after intubation [p-value from ?0.0001-0.0152]. At 10 minutes post intubation though the rise in MAP was still lesser in Nalbuphine group than control group but it was not significant [p-value=0.0540]. Nalbuphine 0.2 mg kg-1 prevents a marked rise in heart rate and mean arterial pressure associated with laryngoscopy and or tracheal intubation

Obstrução das vias aéreas com risco para a vida, causada por edema de via aérea superior e inchaço cervical significativo depois do trabalho de parto/parto / Life-threatening airway obstruction due to upper airway edema and marked neck swelling after labor and delivery / Obstrucción de las vías aéreas con riesgo para la vida, causada por edema de vía aérea superior e hinchazón cervical significativa después del trabajo de parto

EXPERIÊNCIA E OBJETIVOS: Em geral, alterações nas vias aéreas ocorrem em grávidas normais; no entanto, essas alterações podem gerar situações críticas em populações específicas. OBJETIVOS: Esse artigo apresenta o caso de uma paciente que entrou em choque por causa de sangramento atônico em seguida a parto vaginal de natimorto. RELATO DE CASO: Mulher com 32 anos com sangramento atônico em seguida a parto vaginal de natimorto foi transferida para nosso hospital. A paciente manifestou choque e seu estado respiratório estava em progressiva deterioração. Ficou evidenciada obstrução das vias aéreas causada por inchaço cervical e edema faringolaríngeo. Tentamos intubação traqueal utilizando laringoscopia direta e indireta. No entanto, não foi possível inserir qualquer dos dispositivos de laringoscopia tentados. Depois de várias tentativas com TrachlightTM, finalmente obtivemos sucesso com a intubação. Depois da histerectomia, a paciente foi internada na unidade de terapia intensiva (UTI), onde ficou em tratamento durante cinco dias. Ao receber alta da UTI, tinha escore de Mallampati I-II. Durante sua estadia na UTI, seu peso diminuiu de 60 kg para 51 kg. CONCLUSÕES: É provável que episódios simultâneos de trabalho de parto/parto e de ressuscitação com fluidos pioraram suficientemente o edema de via aérea e o inchaço cervical a ponto de causar obstrução aguda das vias aéreas e dificuldade na laringoscopia.

BACKGROUND AND OBJECTIVES: Airway changes generally occur in normal gravidas; however, these changes could cause critical situations in specific populations. OBJECTIVES: This article presents the case of a difficult airway patient that went into shock because of atonic bleeding after vaginal delivery for stillbirth. CASE REPORT: A 32-yr-old woman with atonic bleeding after vaginal delivery for stillbirth was transferred to our hospital. She manifested shock, and her respiratory condition was progressively deteriorating. Airway obstruction caused by neck swelling and pharyngolaryngeal edema was apparent. We tried tracheal intubation using direct and indirect laryngoscopes. However, it turned out that insertion of the laryngoscopic devices to the oral cavity was impossible. After several attempts using the TrachlightTM, successful intubation was finally made. After hysterectomy, she was admitted to the intensive care unit (ICU) and treated for five days. At discharge from the ICU, her Mallampati score was I-II. Her body weight decreased 60 kg to 51 kg during ICU stay. CONCLUSIONS: We believe that concomitant attacks of labor and delivery and fluid resuscitation probably worsened upper airway and neck edema enough to cause acute airway obstruction and difficult laryngoscopy.

EXPERIENCIA Y OBJETIVOS: De manera general, las alteraciones en las vías aéreas se dan en las embrazadas normales; sin embargo, esas alteraciones pueden generan situaciones críticas en poblaciones específicas. OBJETIVOS: Este artículo presenta el caso de una paciente que entró en chock a causa del sangramiento atónico inmediatamente después del parto vaginal de mortinato. RELATO DE CASO: Mujer de 32 años, con sangramiento atónico inmediatamente después del parto vaginal de mortinato que fue derivada a nuestro hospital. La paciente manifestó chock y su estado respiratorio estaba deteriorándose mucho. Se descubrió una obstrucción de las vías aéreas causada por hinchazón cervical y edema faringolaríngeo. Intentamos la intubación traqueal utilizando laringoscopia directa e indirecta. Sin embargo, no se pudo insertar ninguno de los dispositivos de laringoscopia mencionados. Después de varios intentos con TrachlightTM, finalmente logramos el éxito con la intubación. Después de la histerectomía, la paciente fue ingresada en la unidad de cuidados intensivos (UCI), donde permaneció bajo tratamiento durante cinco días. Al recibir el alta de la UCI, tenía una puntuación de Mallampati I-II. Durante su permanencia en la UCI, su peso cayó de 60 kg para 51 kg. CONCLUSIONES: Es posible que episodios simultáneos de trabajo de parto y de resucitación con fluidos, hayan empeorado suficientemente el edema de vía aérea y la hinchazón cervical, hasta el punto de causar la obstrucción aguda de las vías aéreas y la dificultad en la laringoscopia.

Hemodynamic responses and upper airway morbidity following tracheal intubation in patients with hypertension: conventional laryngoscopy versus an intubating laryngeal mask airway

OBJECTIVES: We compared hemodynamic responses and upper airway morbidity following tracheal intubation via conventional laryngoscopy or intubating laryngeal mask airway in hypertensive patients. METHODS: Forty-two hypertensive patients received a conventional laryngoscopy or were intubated with a intubating laryngeal mask airway. Anesthesia was induced with propofol, fentanyl, and cis-atracurium. Measurements of systolic and diastolic blood pressures, heart rate, rate pressure product, and ST segment changes were made at baseline, preintubation, and every minute for the first 5 min following intubation. The number of intubation attempts, the duration of intubation, and airway complications were recorded. RESULTS: The intubation time was shorter in the conventional laryngoscopy group than in the intubating laryngeal mask airway group (16.33 ± 10.8 vs. 43.04±19.8 s, respectively) (p<0.001). The systolic and diastolic blood pressures in the intubating laryngeal mask airway group were higher than those in the conventional laryngoscopy group at 1 and 2 min following intubation (p<0.05). The rate pressure product values (heart rate x systolic blood pressure) at 1 and 2 min following intubation in the intubating laryngeal mask airway group (15970.90 ± 3750 and 13936.76 ± 2729, respectively) were higher than those in the conventional laryngoscopy group (13237.61 ± 3413 and 11937.52 ± 3160, respectively) (p<0.05). There were no differences in ST depression or elevation between the groups. The maximum ST changes compared with baseline values were not significant between the groups (conventional laryngoscopy group: 0.328 mm versus intubating laryngeal mask airway group: 0.357 mm; p = 0.754). The number and type of airway complications were similar between the groups. CONCLUSION: The intense and repeated oropharyngeal and tracheal stimulation resulting from intubating laryngeal mask airway induces greater pressor responses than does stimulation resulting from conventional laryngoscopy in hypertensive patients. As ST changes and upper airway morbidity are similar between the two techniques, conventional laryngoscopy, which is rapid and safe to perform, may be preferred in hypertensive patients with normal airways.

comparability of second dose thiopental with lidocaine in the attenuation of cardiovascular reponse to endotracheal intubation

This study was carried out to appraise the usefulness of second dose thiopental for hemodynamic response to laryngoscopy and intubation. The present study comprised 120 patients aged 15 to 65 years who were divided into four groups each of 30 patients. Patients in each group were given 2 microg/kg fentanyl IV, 4 mg/kg thiopental for induction of anesthesia, followed by 0.5 mg/kg atracurium for muscle relaxation and a second dose of thiopental [1mg/kg in group I, 2mg/kg in group II] immediately prior to laryngoscopy and intubation, lidocaine 1.5 mg/kg [group III] or normal saline 5 ml [group IV] 2 minutes prior to larygoscopy and intubation. The heart rate [HR], systolic arterial pressure [SAP], diastolic arterial pressure [DAP], mean arterial pressure [MAP], and rate pressure product [RPP] were determined before induction of anaesthesia and laryngoscopy [baseline], and at 1min [T1], 3min [T3], 5min [T5], and 10min [T10] after laryngoscopy and intubation. Our findings demonstrated similar effects of lidocaine and second dose thiopental 2mg/kg on attenuation of DAP, MAP, RPP, and HR changes at 1, 3, and 5 min after endotracheal intubation [EI]. Second dose thiopental can be employed as a substitute for lidocaine in attenuation of cardiovascular response to intubation in patients devoid of ischemic heart disease

effect of intravenous nitroglycerine on blood pressure during intubation

Hypertension is one of the most frequent complication during laryngoscopy and intubation; thus in the premedication or induction stages, many drugs have been used to control this hypertension. Nitroglycerine is one of the drugs thought to be effective and the purpose of this study is to appraise this deliberation. 150 patients of 20-50 years of age were enrolled in this randomized double blind clinical trial. They were randomly divided into two group, one received 2 micro g/kg nitroglycerine while the other group did not received any drug. Blood pressure was checked in 3 different stages and compared. In both groups, pre and post intubation systolic pressure had a significant difference; whereas this relation could not be found for the diastolic pressure. These variables did not have a statistically significant relation prior to intubation; whilst after intubation, a significant relation was elicited. Injection of 2 micro g/kg nitroglycerine immediately after anesthetic induction is effective in preventing the unwanted increase in the blood pressure, and as a result, complications following this response in patients with ischemic heart disease would be reduced

hemodynamic effects and complications of tracheal intubation with intubating laryngeal mask airway: a comparison with direct laryngoscopy

The intubating laryngeal mask airway [ILMA] is designed to facilitate blind tracheal intubation. Direct laryngoscopy, to facilitate tracheal intubation, produces a marked pressor response. This randomized, controlled study -was undertaken to compare the complications of insertion and hemodynamic effects following tracheal intubation through intubating laryngeal mask airway [ILMA] with that of conventional Macintosh laryngoscope. One hundred adult patients undergoing elective surgery were randomly allocated into two equal-sized groups. All patients received general anesthesia using a standard balanced anesthesia technique. Tracheal intubation was performed using either intubating laryngeal mask airway or Macintosh laryngoscope. The intubation time, number of attempts required for successful intubation, the problems encountered during intubation, hemodynamic changes and postoperative pharyngolaryngeal complications were recorded. Time to intubation was comparatively longer in ILM.4 group than laryngoscopy group [58.6 +/- 8.2 sec. versus 29.2 +/- 5.6 sec. p <0.001]. The overall intubation success rate was comparable among the two study groups. The changes-in mean blood pressure were significantly less in ILMA group as compared to laryngoscope group [p <0.05]. The incidence of postoperative sore throat and hoarseness of voice was comparable among groups. Our results suggest that ILMA offers advantage over laryngoscope in minimizing the hemodynamic effects to intubation. Therefore, it can be used as a suitable alternative to laryngoscopy for tracheal intubation

Complicações extralaríngeas das cirurgias por laringoscopia direta de suspensão / Extra-laryngeal complications of suspension laryngoscopy

Apesar do uso rotineiro da laringoscopia de suspensão (LS) na microcirurgia de laringe, poucos são os estudos na literatura que tratam das complicações deste procedimento. OBJETIVO: Avaliar as complicações extralaríngeas após a laringoscopia de suspensão e relacioná-las com o tempo de cirurgia. MATERIAL E MÉTODO: Trinta e sete procedimentos consecutivos foram analisados prospectivamente enfocando as lesões relacionadas à LS. A pesquisa incluiu análise pré e pós-operatória dos pacientes quanto aos critérios estudados. RESULTADO: O tempo cirúrgico foi menor de trinta minutos em quatorze casos, entre trinta e sessenta minutos em dezesseis casos e maior de uma hora em sete casos. Vinte e sete apresentaram lesão relacionada à LS, sendo mais comuns as lesões da mucosa oral. Lesão temporária dos nervos foi encontrada em cinco casos, e trauma dentário em um caso. Houve relação estatística entre o tempo de cirurgia e o índice de lesões de mucosa oral menores de 1 centímetro, confirmando que procedimentos mais longos apresentam maior risco para esta complicação. CONCLUSÃO: Esses achados demonstram que a LS não é um procedimento inócuo, produzindo complicações freqüentes. Ainda que não representem grande morbidade aos pacientes, tais danos são evitáveis desde que técnicas mais apuradas sejam utilizadas.

Although suspension laryngoscopy is routinely used in laryngeal surgery, there are only few studies on the complications of this procedure. AIM: to evaluate the complications outside the larynx following suspension laryngoscopy and analyze their relation with surgery duration. MATERIALS AND METHODS: Thirty-seven procedures were prospectively analyzed for intervention-related complications. The study included patient preoperative and postoperative assessment, focusing on dental, mucosal and nerve status (hypoglossal and lingual nerves). RESULTS: Most procedures (27/37) were associated to some kind of complication, and mucosal injuries were the most common; temporary nerve lesions were observed in five cases and dental injuries in one case. Statistic significance was found between surgery duration and mucosal injury (lesions smaller than 1 centimeter), showing that longer procedure pose higher risks for these complications. CONCLUSION: These findings suggest that suspension laryngoscopy is frequently associated with complications outside the larynx. Although these injuries represent a low risk of significant morbidity, they can be avoided if more accurate techniques are used.

An assessment of the ratio of height to thyromental distance compared to thyromental distance as a predictive test for prediction of difficult tracheal intubation in Thai patients.

BACKGROUND AND RATIONALE: Preoperative evaluation is important in the detection of patients at risk for difficult tracheal intubation. Thyromental distance (TMD) is often used for these purposes, but its value as an indicator for difficult intubation is questionable, as it varies with patient size and body proportions. The purpose of the present study was to evaluate and compare the accuracies of the ratio of patient's height to TMD (ratio of height to TMD = RHTMD) and TMD alone in the prediction of difficult tracheal intubation in Thai patients. MATERIAL AND METHODS: The authors collected data on 382 consecutive patients scheduled to receive general anesthesia requiring endotracheal intubation for elective surgery. Thyromental distance and RHTMD were evaluated preoperatively. Difficult intubation was defined in the present study by Cormack and Lehane grade 3 or 4. The optimal predictive value was chosen using a receiver operating characteristic (ROC) curve. The areas under the ROC curves (AUC) of TMD and RHTMD were compared to determine the performance of the different predictive tests used. The sensitivity, specificity, and positive and negative predictive values of each of the predictive tests were calculated according to standard formulae. RESULTS: Difficult intubation occurred in 42 patients (10.9 %). The predictive advantage of RHTMD has a similar specificity with improved sensitivity in comparison with TMD. The AUC of RHTMD was significantly greater than the AUC of TMD (p = 0.00). The authors concluded that RHTMD had better accuracy in predicting difficult intubation than TMD.

Comparison of nalbuphine and midazolam on the cardiovascular response to laryngoscopy and intubation

To compare the effects of nalbuphine and midazolam on cardiovascular response to laryngoscopy and intubation -during induction of anaesthesia. Ninety adult male patients of ASA I or II status were included and divided into three equal g roups. Group I was control in which 3ml of saline was given. Group II received nalbuphine 75 ug/kg and Group III received midazolam 30 ug/kg. The cardiovascular response was evaluated at laryngoscopy and every minute after intubation for three minutes.The results were analysed statistically by ANOVA.p<0.05 was taken significant. A decrease in HR, SBP, DBP, MAP was seen after three minutes in Group II and III but the decrease was more pronounced in Group II.[p<0.05] Premedication with nalbuphine 75gg/kg is more effective than midazolam in blunting the haemodynamic response to laryngoscopy and intubation

A comparative study on the close reduction of arytenoid dislocation under indirect and direct laryngoscope / 华中科技大学学报（医学）（英德文版）

To assess the curative effects of different reduction techniques on the dislocation of cricoarytenoid joint caused by intubation, indirect laryngoscope (IL) and direct laryngoscope (DL) were utilized for the closed reduction of the displaced arytenoid under local anesthesia. 23 patients who underwent the reduction for dislocated arytenoid under IL or DL from January 1991 to June 2001 were reviewed. The data were collected on the duration of the laryngeal injury, times of receiving reduction, side-effects after the treatment and the period for voice to return to normal. The relationship between the duration of the laryngeal lesion and the period of the voice rehabilitation was examined. 13 patients received the reduction under IL and 10 patients under DL. Except the times of the reduction, which showed significant difference, no differences were found between IL group and DL group in the course and the period of voice rehabilitation, as well as sore throat after the manipulation. The patients' voice recovery was positively related to their course of disease in both IL and DL group. It is concluded that the recovery of normal voice is obviously affected by the duration of arytenoid dislocation. The reduction under IL is as effective as under DL in the treatment of arytenoid dislocation. Reduction by DL is better suit the patients with long time course of disease.

Direct laryngoscopy: a prospective study

Prospective clinical analysis of direct laryngoscopic procedures performed in Mosul Teaching Hospital Iraq. Patients and 100 direct laryngoscopic procedures performed in the period from September 1996 to June 1997. There were 55 males and 45 females. The average age was 42.8 years. The most common surgical indications were hoarseness [77%] and tumor-like mass detected on indirect laryngoscopy [38%]. Laryngeal squamous cell carcinoma [SCC] was the most common final diagnosis in the malignant cases. Chronic nonspecific laryngitis was the most common benign diagnosis. The diagnostic accuracy of indirect mirror laryngoscopy compared to direct laryngoscopy was 61%. The diagnostic accuracy of direct laryngoscopic findings and histological diagnosis was 87%. Direct laryngoscopy was difficult in 3 patients, those with short and muscular neck structure. The incidence of major complications was at least 4%. Minor complications occurred in 7% of the patients. Laryngospasm was significantly higher in patients who underwent direct laryngoscopy along with other procedures than in those who underwent direct laryngoscopy alone. Conclusions: Direct laryngoscopy was performed most often indicated for chronic hoarseness and tumor-like masses detected on indirect laryngoscopy. Laryngeal SCC was the most common malignancy and chronic nonspecific laryngitis was the most common non-malignant finding. The incidence of major complications was 4%. Laryngospasm was significantly higher in patients who had undergone procedures in addition to direct laryngoscopy. It is felt that patients who undergo direct laryngoscopy are most safely managed as in patients for 24 hours

Ingestión accidental del foco del laringoscopio durante la reanimación neonatal / Accidental ingestion of a laryngoscope ligh bulb during neonatal resuscitation

Introducción. La ingestión de cuerpos extraños en neonatos es rara.Caso clínico. Recién nacido masculino que nace bañado en meconio, por lo que ameritó laringoscopia directa, la cual fue negativa, deglutiendo el foco del laringoscopio probablemente al estar flojo, tomándose radiografía simple de abdomen, encontrándose en estómago, siendo evacuado a las 36 horas de vida extrauterina sin complicaciones.Conclusiones. Se revisa la literatura encontrándose dos casos similares, los cuales se resolvieron sin complicaciones y se insiste al médico pediatra o a la enfermera encargada de reanimación de revisar el equipo, no solo el funcionamiento de las pilas y la hoja adecuada, sino también que el foco del laringoscopio este bien atornillado.

Utilidad de la aspiración e intubación traqueal en la prevención del síndrome de aspiración meconial / Utility of tracheal aspiration and endotracheal intubation in the prevention of meconium aspiration syndrome

Objetivo. Determinar la utilidad de la intubación endotraqueal y aspiración directa a tráquea para disminuir la incidencia de síndrome de aspiración meconial en recién nacidos sanos y vigorosos nacidos con líquido amniótico meconial y conocer las complicaciones del procedimiento. Diseño. Estudio de cohortes concurrentes sin asignación aleatoria. Unidades de estudio. Ciento cincuenta y uno recién nacidos con peso igual o mayor de 2,500 g, nacidos con líquido amniótico meconial de cualquier densidad, con Apgar igual o mayor de 7 al minuto de vida y clínicamente sanos. Mediciones y resultados. Se dividieron a los pacientes en dos grupos. A todos los pacientes se les realizó aspiración nasofaríngea al momento de nacer la cabeza y antes del nacimiento completo. Al grupo 1 (n=88) no se realizó ningún procedimiento y al grupo 2 (n=63) se realizó laringoscopia para la visualización y aspiración directa a tráquea posterior al nacimiento. No se presentó ningún caso de SAM. ningún paciente del grupo 1 presentó complicaciones y dos pacientes del grupo dos presentaron complicaciones pulmonares. Conclusiones. Las maniobras de laringoscopia y aspiración traqueal no están indicadas como procedimiento de rutina en pacientes sanos y vigorosos con líquido amniótico meconial, ya que existe mayor riesgo de complicación

Predicción de la laringoscopia directa difícil

En una forma prospectiva se observaron 90 pacientes, con el objeto de llegar a una fórmula de predicción del grado de dificultad para la intubación endotraqueal, durante la laringoscopia directa, previa a la colocación del laringoscopio de microcirugía laríngea y al paso de un broncoscopio rígido. Se establecieron tres parámetros: 1. Inspección oral tratando de observar: a)la epiglotis b)la úvula c)el borde libre del paladar blando y d)solamente el paladar blando. 2. Observación del punto de cruce de la línea anterior del cuello con la rama horizontal del maxilar inferior. 3. La capacidad de propulsión del occipucio con relación al hombro