Seguridad y efectividad de la ventilación a chorro con frecuencias ventilatorias convencionales para microcirugía laríngea electiva / Safety and effectiveness of jet ventilation with conventional ventilatory frequencies for elective microlaryngeal surgery

Introducción: La ventilación al paciente durante la microcirugía laríngea confronta varios problemas. La ventilación a chorro tipo jet con frecuencias ventilatorias convencionales permite usar catéteres endotraqueales de pequeño diámetro para aportar volúmenes adecuados de oxígeno y proporciona mejores condiciones operatorias que el método tradicional. Objetivo: Evaluar la seguridad y efectividad de la ventilación jet con frecuencias ventilatorias convencionales para microcirugía laríngea electiva en comparación con la ventilación convencional. Métodos: Se realizó un estudio comparativo, a simple ciego, aleatorizado y paralelo. Se trabajó con un prototipo de dispositivo de ventilación jet con permiso de uso excepcional en seres humanos (autorización excepcional No: 004/17 para realización de estudio piloto, con fecha 2 de agosto de 2017, conferido por el CECMED). Se utilizó un grupo estudio de 45 pacientes (grupo E) y se comparó con un grupo control (grupo C) de 15 pacientes ventilados mediante el método tradicional. Resultados: La oxigenación resultó superior dentro del grupo E. El grupo C requirió eventualmente de extubación, apnea transitoria y reintubación, lo que repercutió en contra de la integridad anatomofisiológica de los pacientes, del campo operatorio y la docencia. Fue evidente una mayor estabilidad hemodinámica entre los sujetos del grupo E. Las presiones intrapulmonares producidas por la ventilación jet no provocaron lesiones ni repercusión clínica evidentes. Conclusiones: Aplicar la ventilación a chorro con frecuencias ventilatorias convencionales fue seguro y efectivo. Por primera vez se obtienen experiencias de utilización de un método de ventilación jet en el país. El grupo en el que se aplicó la ventilación convencional sufrió complicaciones más frecuentes y peligrosas. Es necesario asimilar las tecnologías de ventilación jet para elevar la calidad de la atención médica en tiempos de paz, de guerra o desastres, en contextos electivos, o emergentes como el desafío de una vía respiratoria difícil(AU)

Introduction: Ventilation to the patient during microlaryngeal surgery confronts several problems. Jet ventilation with conventional ventilatory frequencies allows the use of small diameter endotracheal catheters to provide adequate oxygen volumes and provide better operating conditions than the traditional method. Objective: To evaluate the safety and effectiveness of jet ventilation with conventional ventilatory frequencies for elective microlaryngeal surgery in comparison to conventional ventilation. Methods: A comparative, single-blind, randomized and parallel study was performed. It was used a prototype of jet ventilation device with an exceptional use permit in humans (exceptional authorization No: 004/17 for conducting a pilot study, dated August 2, 2017, conferred by the CECMED). A study group of 45 patients (group E) was used and compared with a control group (group C) of 15 patients using the traditional ventilation method. Results: Oxygenation was higher in group E. Group C eventually required extubation, transitory apnea and reintubation, which impacted against the anatomophysiological integrity of patients, the operative field and teaching. A greater hemodynamic stability was evident among the subjects of group E. The intrapulmonary pressures produced by jet ventilation did not cause obvious injuries or clinical repercussions. Conclusions: Applying jet ventilation with conventional ventilatory frequencies was safe and effective. For the first time, experiences of using a jet ventilation method in the country were obtained. The group in which conventional ventilation was applied suffered more frequent and dangerous complications. It is necessary to assimilate jet ventilation´s technologies to raise the quality of medical attention in times of peace, war or disasters, in elective or emerging contexts as the challenge of a difficult airway(AU)

A Case of Bradycardia due to Vagal Reflex during Laryngeal Microsurgery / 대한이비인후과학회지

Laryngeal microsurgery has been used popularly for phonosurgery. Sometimes, this procedure is complicated by cardiovascular changes due to insertion of laryngosope. Tachycardia and elevation of blood pressure are common but bradycardia induced by vagal reflex is very rare. The authors report the case of severe bradycardia induced by vagal reflex experienced during laryngeal microsurgery with a review of the literature.

Laryngeal Tiririt (Bridge): For microlaryngeal surgery shake

Objective: To design an instrument for steadying instrument handling during microlaryngeal surgery using an operating laryngoscope. Method: Our device design takes its cue (pun intended) from professional billiards players like our very own Efren "Bata" Reyes. The laryngeal tiririt (bridge or rake) draws inspiration from the billiards bridge (locally known as tiririt) used to extend the player's reach when the cue ball is too far to make an accurate shot. Setting: The laryngeal tiririt was used and tested by senior residents in microlaryngeal surgeries done in our institution. Result: The laryngeal tiririt greatly improved the accuracy required in laryngeal surgeries without adding up huge set up or expensive equipment. (Author)

The Effects of Preoperative Sprayed 10% Lidocaine on the Hemodynamic Response during Suspension Microlaryngeal Surgery / 영남의대학술지

PURPOSE: It is well known that suspension microlaryngeal surgery produces marked increases in arterial blood pressure and heart rate. In this study, we evaluated the effects of 10% lidocaine preoperatively sprayed for attenuation of the perioperative hemodynamic response during suspension microlaryngeal surgery. MATERIALS AND METHODS: Fifty American Society of Anesthesiologists (ASA) class 1 patients scheduled for excision of a vocal polyp by suspension laryngoscopy were randomly divided into two groups (n=25 for each group). They were intubated without 10% lidocaine spray (control group) or given 1.5 mg/kg of 10% lidocaine sprayed onto the pharyngolaryngeal and intratracheal sites 90 sec prior to intubation (10% lidocaine group). Anesthesia was maintained using desflurane in O2/N2O 50%. The arterial blood pressure and heart rate were measured at preinduction (T0), 1 min (T1), 3 min (T2), 5 min (T3) after tracheal intubation, and 1 min (T4), 3 min (T5), 5 min (T6) and 10 min (T7) after the suspension laryngoscopy. RESULTS: In the 10% lidocaine group, the arterial blood pressure and heart rate at 1 (T1), 3 (T2) min after tracheal intubation and 1 (T4), and 3 (T5) min after suspension laryngoscopy were lower than the same measurements in the control group. CONCLUSION: 10% lidocaine sprayed onto the pharyngolaryngeal and intratracheal sites before intubation was an effective method for attenuation of the perioperative hemodynamic response during suspension microlaryngeal surgery.

Microlaryngeal surgery for removing the fibrous noduls of the vocal cord

It is a radical technique. With delicate modified instruments, this technique can improve considerably the function because of the advances in technology that emphasize mucosal preservation

Vocal Dynamic Studies before and after Laryngeal Microsurgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Perceptual acoustic measures are most often used to judge the outcomes and the objective analysis of phonosurgical results before and after the microlaryngeal surgery. However, they have rarely been reported in this country. The purpose of this study is to analyze aerodynamic and acoustic results before and after microlaryngeal surgery and to analyze the differences of the prognosis of various benign vocal cord lesions. MATERIALS AND METHODS: At Inha University Hospital, from June 1996 to August 1998, 245 microlaryngeal surgeries were done. Malignant lesions were excluded. And 118 (54 females and 64 males) out of 245 patients were followed up after the surgery: the acoustic and the aerodynamic studies before and 8 weeks after microlaryngeal surgery for benign lesions: vocal polyp, vocal nodule, Reinke's edema, intracordal cyst and hyperkeratosis. Seven measurements were performed: fundamental frequency, jitter, shimmer, noise to harmonic ratio as the acoustic analysis, maximal phonation time, mean flow rate and subglottal pressure as the aerodynamic analyses. RESULTS: Postoperative acoustic and aerodynamic data of vocal polyp, vocal nodule, Reinke's edema and intracordal cyst were improved, but those of hyperkeratosis were not improved. CONCLUSION: By comparing the acoustic and aerodynamic data before and after the microlaryngeal surgery, postoperative vocal function was defined more accurately and objectively. Jitter, shimmer, and MFR might be meaningful parameters accessing the quantitative changes in vocal quality before and after the microlaryngeal surgery.

Acoustic Analysis of Benign Vocal Cord Lesions: Before and after Microlaryngeal Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Benign vocal cord lesions that are not responsive to medical and/or speech therapy are often treated by microlaryngeal surgery. The purpose of this study is to measure selected acoustic parameters to document quantitative changes in vocal quality before and after microlaryngeal surgery and to analyze differences of prognosis for various benign vocal cord lesions, such as vocal cord polyp, vocal cord nodule, and Reinke's edema. MATERIALS AND METHODS: The authors used a computerized acoustic analysis program (CSL-MDVP) to measure mean fundamental frequency (Fo), jitter, shimmer, and noise to harmonics ratio (NHR) from voice samples of selected patients who had benign vocal cord lesions before and after at least 10 weeks of surgery. RESULTS: The values of Fo and NHR showed no significant difference in all three groups. There was significant improvement in nodule regarding jitter. Also, there was significant improvement in the vocal cord polyp regarding jitter and shimmer. CONCLUSION: Jitter and shimmer will be effective acoustic parameters in documenting the quantitative changes in vocal quality before and after microlaryngeal surgery.