[Drug-induced sleep endoscopy]. / Medikamentös induzierte Schlafendoskopie.

Drug-induced sleep endoscopy (DISE) is a procedure for the assessment of the upper airways in patients with obstructive sleep apnea (OSA) and was first described by Croft and Pringle in 1991 1. So far, it has not been clarified to what extent the DISE can be compared to natural sleep. Eastwood and colleagues ultimately described a correlation in terms of the tendency to collapse in sedation and during natural sleep. It was shown, that DISE is useful in individual therapeutic descisions 2. In recent years, efforts to standardize the procedure have been made in order to make the results more comparable and reproducible. With the introduction and increasing use of stimulation therapy of the hypoglossal nerve, DISE has been used more and more in hospitals in recent years. This article is intended to present the procedure based on the European position paper on DISE 3 4.

Glottic visibility for laryngeal surgery: Tritube vs. microlaryngeal tube: A randomised controlled trial.

BACKGROUND: Good visibility is essential for successful laryngeal surgery. A Tritube with outer diameter 4.4 mm, combined with flow-controlled ventilation (FCV), enables ventilation by active expiration with a sealed trachea and may improve laryngeal visibility. OBJECTIVES: We hypothesised that a Tritube with FCV would provide better laryngeal visibility and surgical conditions for laryngeal surgery than a conventional microlaryngeal tube (MLT) with volume-controlled ventilation (VCV). DESIGN: Randomised, controlled trial. SETTING: University Medical Centre. PATIENTS: A total of 55 consecutive patients (>18 years) undergoing elective laryngeal surgery were assessed for participation, providing 40 evaluable data sets with 20 per group. INTERVENTIONS: Random allocation to intubation with Tritube and ventilation with FCV (Tritube-FCV group) or intubation with MLT 6.0 and ventilation with VCV (MLT-VCV) as control. Tidal volumes of 7 ml kg predicted body weight, and positive end-expiratory pressure of 7 cmH2O were standardised between groups. MAIN OUTCOME MEASURES: Primary endpoint was the tube-related concealment of laryngeal structures, measured on videolaryngoscopic photographs by appropriate software. Secondary endpoints were surgical conditions (categorical four-point rating scale), respiratory variables and change of end-expiratory lung volume from atmospheric airway pressure to ventilation with positive end-expiratory pressure. Data are presented as median [IQR]. RESULTS: There was less concealment of laryngeal structures with the Tritube than with the MLT; 7 [6 to 9] vs. 22 [18 to 27] %, (P < 0.001). Surgical conditions were rated comparably (P = 0.06). A subgroup of residents in training perceived surgical conditions to be better with the Tritube compared with the MLT (P = 0.006). Respiratory system compliance with the Tritube was higher at 61 [52 to 71] vs. 46 [41 to 51] ml cmH2O (P < 0.001), plateau pressure was lower at 14 [13 to 15] vs. 17 [16 to 18] cmH2O (P < 0.001), and change of end-expiratory lung volume was higher at 681 [463 to 849] vs. 414 [194 to 604] ml, (P = 0.023) for Tritube-FCV compared with MLT-VCV. CONCLUSION: During laryngeal surgery a Tritube improves visibility of the surgical site but not surgical conditions when compared with a MLT 6.0. FCV improves lung aeration and respiratory system compliance compared with VCV. TRIAL REGISTRY NUMBER: DRKS00013097.