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Laryngoscopy
Kinds of Laryngoscopy Selected AbstractsMinimal Illumination for Direct Laryngoscopy and Intubation in Different Ambient Light SettingsACADEMIC EMERGENCY MEDICINE, Issue 1 2010FRCPC, Ka Wai Cheung MD Abstract Objectives:, This study sought to investigate the minimal laryngoscope illumination required for proper laryngoscopy and intubation in different ambient light settings as determined by paramedics. Methods:, Paramedics qualified to intubate patients in the field were recruited to intubate a cadaver embalmed with a minimal fixation technique designed to maintain tissue integrity. All paramedic participants intubated the cadaver under three different ambient light settings representing possible out-of-hospital settings: an outdoor night setting, an indoor setting, and an outdoor day setting. Paramedics were asked to determine the minimal illumination required for intubation of the cadaver under each of these settings. Results:, Twenty-three paramedics participated in the study. The mean (±SD) minimal illumination required for intubation was 39.1 (±35.4) lux at the night setting, 92.5 (±57.3) lux at the indoor setting, and 209.7 (±117.4) lux at the day setting. There was a statistically significant difference in minimal illumination required between each of the three light settings (p < 0.0001). Conclusions:, Minimal illumination requirements in the out-of-hospital setting may be lower than previously recommended. Ambient light intensity affects this minimal illumination requirement, with brighter ambient light conditions necessitating more laryngoscope light output. Further studies assessing out-of-hospital laryngoscope illumination should consider ambient light conditions. ACADEMIC EMERGENCY MEDICINE 2010; 17:103,107 © 2010 by the Society for Academic Emergency Medicine [source] Laryngeal histoplasmosis in an immunocompetent patient from a non-endemic region: case reportMYCOSES, Issue 6 2009Teresa C. A. Ferrari Histoplasma capsulatum infection involving the larynx is a rare manifestation, especially in immunocompetent individuals and a high index of suspicion is needed to establish the diagnosis correctly. We report a case of a 50-year-old Brazilian man who presented with progressive hoarseness and throat pain for 4 months. Laryngoscopy showed a supraglottic vegetant lesion, and the biopsies chronic granulomatous inflammation without any specific agent. A second laryngoscopy with biopsies was performed and after 17 days of incubation in specific medium, H. capsulatum was isolated. The patient was successfully treated with amphotericin B. [source] Virtual Laryngoscopy: a Noninvasive Tool for the Assessment of Laryngeal Tumor ExtentTHE LARYNGOSCOPE, Issue 6 2007Yuling Yan PhD Abstract Objectives: Present a clinical application of virtual laryngoscopy (VL) in the assessment of laryngeal tumor and its extent. Study Design: CT data from two subjects are acquired for this preliminary study. One subject is a healthy volunteer and the other is a patient with laryngeal tumor. The laryngeal framework and upper airway are reconstructed using CT data, which allows for computer-aided internal and external anatomical views and interactive fly-through. Methods: These CT data are reconstructed into 0.5 mm slice images, resulting in a total of 200,300 image slices. An advanced commercial visualization software (AMIRA) is used for 3D image segmentation, reconstruction and surface rendering of laryngeal anatomical structures. Results: The 3D laryngeal framework and upper airway are reconstructed for both the tumor patient and the healthy subject. The conventional views of the reconstructed vocal folds are compared with those obtained from fiber-optic laryngoscope. Additionally, unique views of the vocal folds obtained from retrograde visualization and fly-through are presented, which are not possible to obtain using conventional endoscope imaging. The segmented anatomical model and the tumor from the patient's CT images were displayed individually to show the distribution of the tumor and its extent as well as spatial and contextual relationships to the larynx and airway anatomical structures. Conclusions: This study demonstrated the potential application of VL as a noninvasive clinical diagnostic tool for the assessment of laryngeal tumor and its extent. Our preliminary results demonstrated that the VL may provide valuable insights for the diagnosis and treatment planning for laryngeal and airway tumors. The noninvasive VL may complement the invasive laryngoscopic examinations for the staging of tumors and follow-ups on surgical interventions. [source] Prediction and Surgical Management of Difficult LaryngoscopyTHE LARYNGOSCOPE, Issue 4 2004Yayoi Suzuki Kikkawa MD No abstract is available for this article. [source] Suspension Laryngoscopy for Endotracheal Stenting,THE LARYNGOSCOPE, Issue 1 2003Hans Edmund Eckel MD Abstract Objectives/Hypothesis Airway stents have recently been used to establish and maintain patent airways in patients with malignant central airway obstruction, but insertion modalities remain controversial to date. The study seeks to determine the role of suspension laryngoscopy in interdisciplinary airway stenting. Study Design Retrospective, single-institution analysis of a case series treated by a multidisciplinary airway team. Methods Ninety-three consecutive patients with malignant obstruction of the trachea and/or tracheobronchial bifurcation underwent endotracheal stenting through a suspension laryngoscopy approach for the relief of impending respiratory distress. Feasibility, mortality, survival, and complications were analyzed as main outcome measures. Results Stenting through a suspension laryngoscopy approach was feasible 91 of 93 patients (97.8%). Fifteen patients needed repeated stenting, and in all, 121 stents were implanted during the observation period. This approach allowed for the repeated insertion of rigid bronchoscopes of graded sizes to establish an airway and for precise stent positioning. Optical instruments and stent introducer systems could easily be used while adequate ventilation was continuously maintained. Silicone stents of maximal size were inserted without injury of the vocal cords during intubation. Median survival for all patients was 8 months. No intraoperative airway complications were observed, and no patient died secondary to stenting. Conclusions Suspension laryngoscopy and jet ventilation provide an ideal setting for the precise placement of tracheal and bifurcation airway stents. Laryngologists should actively participate in interdisciplinary airway stenting programs. [source] Correlation of Findings on Direct Laryngoscopy and Bronchoscopy With Presence of Extraesophageal Reflux DiseaseTHE LARYNGOSCOPE, Issue 9 2000Michele M. Carr DDS Abstract Objective To determine the correlation between findings at direct laryngoscopy and bronchoscopy and presence of extraesophageal reflux disease (EERD). Study Design Retrospective chart review Methods Operative notes of 155 children undergoing direct laryngoscopy and bronchoscopy between 1996 and 1999 for airway symptoms for whom there was a suspicion of EERD were examined. Gastroesophageal reflux disease (GERD) was considered present if at least one test was positive (including upper GI series, pH probe, gastric scintiscan, or esophageal biopsy). Results A total of 130 (84%) patients had GERD diagnosed. Ninety percent had at least one laryngotracheal abnormality: 83% had an abnormal larynx and 66% had an abnormal trachea. Laryngeal abnormalities in GERD included postglottic edema, 69%; arytenoid edema, 30%; large lingual tonsil, 16%; vocal fold edema, 12%; vocal fold nodule, 12%; ventricular obliteration, 5%; and hypopharyngeal cobblestoning, 3%. Tracheobronchial abnormalities in GERD included tracheal cobblestoning, 33%; blunting of carina, 12.5%; subglottic stenosis, 11%; increased secretions, 11%; and generalized edema or erythema, 5%. The best sensitivity or specificity was obtained by combining postglottic edema, arytenoid edema, and vocal fold edema, resulting in a sensitivity of 75% and a specificity of 67%. Positive predictive value was 100% for the combination of postglottic edema and any vocal fold or ventricular abnormality. Conclusion Laryngoscopy and bronchoscopy can reveal findings with a high positive predictive value for the presence of GERD. Endoscopy of the upper airway in children with clinical signs and symptoms of EERD is a promising tool for diagnosis. [source] Evaluation of the McGrath® Series 5 videolaryngoscope after failed direct laryngoscopy,ANAESTHESIA, Issue 7 2010R. R. Noppens Summary Unanticipated difficulties during tracheal intubation and failure to intubate are among the leading causes of anaesthesia-related morbidity and mortality. Using the technique of video laryngoscopy, the alignment of the oral and pharyngeal axes to facilitate tracheal intubation is unnecessary. In this study we evaluated the McGrath® Series 5 videolaryngoscope for tracheal intubation in 61 patients who exhibited Cormack and Lehane grade 3 or 4 laryngoscopies with a Macintosh laryngoscope. Using the McGrath resulted in an improved glottic view, compared to Macintosh laryngoscope. Laryngoscopy was improved by one grade in 10%, by two grades in 80% and by three grades in 10% of cases (p < 0.0001). The success rate for intubation was 95% with the McGrath. These results suggest that the McGrath videolaryngoscope can be used with a high success rate to facilitate tracheal intubation in difficult intubation situations. [source] Evaluation of the GlideScope® for tracheal intubation in patients with cervical spine immobilisation by a semi-rigid collarANAESTHESIA, Issue 12 2009I. Bathory Summary Application of cervical collars may reduce cervical spine movements but render tracheal intubation with a standard laryngoscope difficult if not impossible. We hypothesised that despite the presence of a Philadelphia Patriot® cervical collar and with the patient's head taped to the trolley, tracheal intubation would be possible in 50 adult patients using the GlideScope® and its dedicated stylet. Laryngoscopy was attempted using a Macintosh laryngoscope with a size 4 blade, and the modified Cormack,Lehane grade was scored. Subsequently, laryngoscopy with the GlideScope was graded and followed by tracheal intubation. All patients' tracheas were successfully intubated with the GlideScope. The median (IQR) intubation time was 50 s (43,61 s). The modified Cormack,Lehane grade was 3 or 4 at direct laryngoscopy. It was significantly reduced with the GlideScope (p < 0.0001), reaching grade 2a in most patients. Tracheal intubation in patients wearing a semi-rigid collar and having their head taped to the trolley is possible with the help of the GlideScope. [source] Laryngoscopy: time to change our viewANAESTHESIA, Issue 10 2009H. Cooke No abstract is available for this article. [source] Laryngoscopy: time to change our viewANAESTHESIA, Issue 4 2009C. M. Frerk First page of article [source] Laryngoscopy force in the sniffing position compared to the extension-extension positionANAESTHESIA, Issue 4 2008L. Lee Summary Laryngoscopy is sometimes easier with the patient's head and neck in the extension-extension position (head extension with the neck extended by the head section of the table bent down at 30°) rather than the classical ,sniffing the morning air' position. We therefore tested the hypothesis that the axial force required for laryngoscopy is less in the extension-extension than the sniffing position. We measured the force axial to the handle of a Macintosh 3 laryngoscope in 20 subjects under general anaesthesia who had been given neuromuscular blocking drugs. Measurement of force was made in the sniffing position and the extension-extension position. The mean (SD) axial force required in the extension-extension position was lower than in the sniffing position (19.6 (7.8) N versus 23.6 (8.6) N, p = 0.04). In the setting of routine tracheal intubation, less force is required when the patient is in the extension-extension position than in the sniffing position. [source] F-18-fluoro-deoxy-glucose positron-emission tomography scanning in detection of local recurrence after radiotherapy for laryngeal/ pharyngeal cancerHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 11 2001Chris H. Terhaard MD Abstract Background The objective of this investigation was to determine whether F18-fluoro-deoxy-glucose (FDG) positron-emission tomography (PET) could differentiate between local recurrence and late radiation effects after radiotherapy for laryngeal/pharyngeal cancer. Methods In a prospective study of 75 patients (67 larynx, eight oro/hypopharynx), 160 laryngoscopies and 109 FDG PET scans were performed on the head and neck region. The mean follow-up time after the first FDG PET scan was 23 months (minimum 1 year). Results Local recurrence was diagnosed in 37 patients: 19 after the first biopsy and 18 after follow-up biopsies. For all of the negative initial FDG scans (27), the biopsies that were taken at the same time were negative and no recurrence was seen for at least 1 year. The first FDG scan was a true positive in 34 of 48 patients. In 12 of the 14 patients with false-positive results, FDG scans were repeated; a decreased FDG uptake was found in 9 of the 12. The sensitivity and specificity of the first scan were respectively 92% and 63%; including subsequent FDG scans, the rates were 97% and 82%, respectively. Conclusions When a local recurrence is suspected after radiotherapy for cancer of the larynx/pharynx, an FDG PET scan should be the first diagnostic step. No biopsy is needed if the scan is negative. If the scan is positive and the biopsy negative, a decreased FDG uptake measured in a follow-up scan indicates that a local recurrence is unlikely. © 2001 John Wiley & Sons, Inc. Head Neck 23: 933,941, 2001. [source] Pediatric Laryngotracheal Obstruction: Current Perspectives on StridorTHE LARYNGOSCOPE, Issue 7 2006John Bent MD Abstract Objectives/Hypothesis: To assess how medical advances have impacted the diagnosis, management, and outcomes of pediatric laryngotracheal obstruction, and to describe the advantages of audio-video documentation of stridorous children. Study Design and Methods: Retrospective. Methods and Materials: 268 patients were referred for suspected laryngotracheal obstruction during the 30 months between September 1, 1995 and March 1, 1998: 173 had 206 flexible fiberoptic laryngoscopies, and 160 had 273 direct laryngoscopies. One hundred and forty-one children were identified with laryngotracheal obstruction, yielding 40 different diagnoses that could be classified into 9 major categories. Thirty-six children (25.5%) had multiple sites of upper airway obstruction. Results: 138 children had follow-up >1 month. Twelve children died (8.7%), leaving 126 survivors (mean follow-up = 21.1 months). Outcomes were classified as resolved (44.2%), improved (37.0%), stable (9.4%), failed (0.7%), or death (8.7%). Better outcomes were seen in more readily treated diagnostic categories, such as tracheobronchial foreign body, chronic laryngitis, and suprastomal granulation tissue; laryngeal stenosis, tracheomalacia, and recurrent respiratory papillomatosis, had less favorable outcomes (P <.001). The former group also showed superior outcome compared to laryngomalacia (P <.001) and vocal cord mobility disorders (P = .004). Ninety-four patients (68.1%) had comorbidities complicating their management. Comorbid conditions were universal among deceased patients and least common in the resolved outcomes category (56.7%), supporting the premise that patients with poor outcomes are more likely to have comorbidities than patients with resolution of laryngotracheal symptoms (P = .034). Conclusions: Audio-video recording of pediatric laryngotracheal obstruction offers numerous advantages. Children classified into an array of diagnostic categories usually have favorable outcomes, but opportunities for continued advances exist, particularly regarding management of comorbidity and chronic obstruction. [source] Evaluation of the McGrath® Series 5 videolaryngoscope after failed direct laryngoscopy,ANAESTHESIA, Issue 7 2010R. R. Noppens Summary Unanticipated difficulties during tracheal intubation and failure to intubate are among the leading causes of anaesthesia-related morbidity and mortality. Using the technique of video laryngoscopy, the alignment of the oral and pharyngeal axes to facilitate tracheal intubation is unnecessary. In this study we evaluated the McGrath® Series 5 videolaryngoscope for tracheal intubation in 61 patients who exhibited Cormack and Lehane grade 3 or 4 laryngoscopies with a Macintosh laryngoscope. Using the McGrath resulted in an improved glottic view, compared to Macintosh laryngoscope. Laryngoscopy was improved by one grade in 10%, by two grades in 80% and by three grades in 10% of cases (p < 0.0001). The success rate for intubation was 95% with the McGrath. These results suggest that the McGrath videolaryngoscope can be used with a high success rate to facilitate tracheal intubation in difficult intubation situations. [source] Unrecognized Misplacement of Endotracheal Tubes in a Mixed Urban to Rural Emergency Medical Services SettingACADEMIC EMERGENCY MEDICINE, Issue 9 2003Michael E. Jemmett MD Abstract Objective: To determine the rate of unrecognized endotracheal tube misplacement when performed by emergency medical services (EMS) personnel in a mixed urban and rural setting. Methods: The authors conducted a prospective, observational analysis of out-of-hospital endotracheal intubations (EIs) performed by EMS personnel serving a mixed urban, suburban, and rural population. From July 1, 1998, to August 30, 1999, emergency physicians assessed and recorded the position of out-of-hospital EIs using auscultation, direct laryngoscopy, infrared CO 2 detectors, esophageal detector devices, and chest x-ray. The state EMS database also was reviewed to determine the number of EIs involving patients transported to the authors' medical center and paramedic assessment of success for these encounters. Results: A total of 167 out-of-hospital EIs were recorded, of which 136 (81%) were deemed successful by EMS personnel. Observational forms were completed for 109 of the 136 patients who arrived intubated to the emergency department. Of the studied patients, 12% (13 of 109) were found to have misplaced endotracheal tubes. For the patients with unrecognized improperly placed tubes, 9% (10 of 109) were in the esophagus, 2% (2 of 109) were in the right main stem, and 1% (1 of 109) were above the cords. Paramedics serving urban and suburban areas did not perform significantly better (p < 0.05) than intermediate-level providers serving areas that are more rural. Conclusions: The incidence of unrecognized misplacement of endotracheal tubes by EMS personnel may be higher than most previous studies, making regular EMS evaluation and the out-of-hospital use of devices to confirm placement imperative. The authors were unable to show a difference in misplacement rates based on provider experience or level of training. [source] Benign parathyroid cyst causing vocal fold paralysis: A case report and review of the literatureHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 6 2006Daniel H. Coelho MD Abstract Background. Parathyroid cysts are uncommon, frequently asymptomatic lesions of the neck and superior mediastinum. Symptomatic parathyroid cysts are very rare, with roughly only 200 cases reported in the literature. Of these, only nine cases have been reported with recurrent laryngeal nerve (RLN) paralysis Methods. We report a case of a 49-year-old man initially seen with a 6-month history of worsening hoarseness. Physical examination revealed a palpable 3-cm, firm, smooth, nontender mass of the right thyroid lobe. Fiberoscopic laryngoscopy showed right vocal cord immobility consistent with RLN paralysis. After CT and fine-needle aspiration of the mass, the patient underwent a right thyroid lobectomy. During surgery, the recurrent laryngeal nerve was found to be stretched and adherent to a right inferior lobe mass. Results. Histologic analysis of the surgical specimen revealed a benign parathyroid adenomatous cyst. Postoperatively, the patient's voice improved markedly. This case represents an extremely rare return of function of the RLN after cyst removal. Conclusion. Parathyroid cysts should be included in the differential diagnosis for vocal fold paralysis. © 2006 Wiley Periodicals, Inc. Head Neck 28:564,566, 2006 [source] Stricture associated with primary tracheoesophageal puncture after pharyngolaryngectomy and free jejunal interpositionHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 3 2006Gurston G. Nyquist MD Abstract Background. Free jejunal interposition has been one of the standard reconstructive options for patients undergoing total laryngopharyngoesophagectomy. Tracheoesophageal puncture (TEP) done primarily is a well-accepted means of voice restoration. The rapid recovery of swallowing and communication in patients who have advanced cancer of the upper aerodigestive tract is a valid goal. The objective of this study was to evaluate the functionality and complications of primary TEP in patients with a free jejunal interposition graft. Methods. Twenty-four consecutive patients who had free jejunal interposition were studied. Thirteen of these patients had a primary TEP. Stricture was assessed through barium swallow, laryngoscopy, and CT scan. Results. A statistically significant greater number of patients had stricture develop after primary TEP (p < .0325). All these patients had stricture develop at the distal anastomosis. These patients also tended to have a poorer quality of diet. Moreover, speech with a TEP prosthesis in patients with a free jejunal interposition was less intelligible and functional than speech with a TEP prosthesis after simple laryngectomy. Conclusions. This article recognizes an increased incidence of stricture formation after primary TEP as compared with non-TEP in patients undergoing pharyngolaryngectomy with free jejunal interposition. The morbidity and possible etiology of this complication are discussed. This clinical data have been translated into a change in clinical practice. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX,XXX, 2005 [source] Video-laryngoscopes in the adult airway management: a topical review of the literatureACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2010P. NIFOROPOULOU The aim of the present paper is to review the literature regarding video-laryngoscopes (Storz V-Mac and C-Mac, Glidescope, McGrath, Pentax-Airway Scope, Airtraq and Bullard) and discuss their clinical role in airway management. Video-laryngoscopes are new intubation devices, which provide an indirect view of the upper airway. In difficult airway management, they improve Cormack,Lehane grade and achieve the same or a higher intubation success rate in less time, compared with direct laryngoscopes. Despite the very good visualization of the glottis, the insertion and advancement of the endotracheal tube with video-laryngoscopes may occasionally fail. Each particular device's features may offer advantages or disadvantages, depending on the situation the anaesthesiologist has to deal with. So far, there is inconclusive evidence indicating that video-laryngoscopy should replace direct laryngoscopy in patients with normal or difficult airways. [source] Evaluation of the Video Intubation Unit in morbid obese patientsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2010I. BATHORY Background: Tracheal intubation may be more difficult in morbidly obese (MO) patients than in the non-obese. The aim of this study was to evaluate clinically if the use of the Video Intubation Unit (VIU), a video-optical intubation stylet, could improve the laryngoscopic view compared with the standard Macintosh laryngoscope in this specific population. Methods: We studied 40 MO patients (body mass index >35 kg/m2) scheduled for bariatric surgery. Each patient had a conventional laryngoscopy and a VIU inspection. The laryngoscopic grades (LG) using the Cormack and Lehane scoring system were noted and compared. Thereafter, the patients were randomised to be intubated with one of the two techniques. In one group, the patients were intubated with the help of the VIU and in the control group, tracheal intubation was performed conventionally. The duration of intubation, as well as the minimal SpO2 achieved during the procedure, were measured. Results: Patient characteristics were similar in both groups. Seventeen patients had a direct LG of 2 or 3 (no patient had a grade of 4). Out of these 17 patients, the LG systematically improved with the VIU and always attained grade 1 (P<0.0001). The intubation time was shorter within the VIU group, but did not attain significance. There was no difference in the SpO2 post-intubation. Conclusion: In MO patients, the use of the VIU significantly improves the visualisation of the larynx, thereby improving the intubation conditions. [source] The GlideScope Ranger® video laryngoscope can be useful in airway management of entrapped patientsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 10 2009A. R. NAKSTAD Background: Airway management of entrapped patients is challenging and alternatives to endotracheal intubation with a Macintosh laryngoscope must be considered. In this study, the GlideScope Ranger® video laryngoscope has been evaluated as an alternative to standard laryngoscopy. Methods: Eight anaesthesiologists from a Helicopter Emergency Medical Service intubated the trachea of a Laerdal SimMan® manikin using the studied laryngoscopes in two scenarios: (A) unrestricted access to the manikin in an ambulance and (B) no access from the head end, simulating an entrapped patient. The time used to secure the airway and the scored level of difficulty were the main variables. Results: In scenario A, all anaesthesiologists managed to secure the airway using both techniques within the 60-s time limit. In scenario B, all secured the airway when using the video laryngoscope, while 50% succeeded with endotracheal intubation using the Macintosh laryngoscope. The difference in the success rate was statististically significant (P=0.025). There were no significant differences in the time spent on endotracheal intubation in the two scenarios or between the devices. All stated that the availability of a video laryngsoscope would make drug-facilitated intubation a realistic alternative when access to patients is limited. The lack of visual control when using the Macintosh laryngoscope excludes this technique in real-life settings. Conclusion: This study suggests that the Glidescope Ranger® may be merited in situations requiring endotracheal intubation by an experienced intubator in patient entrapment. Further studies are required to clarify whether performance in patients mimics that in a manikin. [source] Giant esophageal squamous papilloma: a case reportJOURNAL OF DIGESTIVE DISEASES, Issue 3 2009Sayed Abbas TABATABAEI Esophageal papilloma is a rare disorder that may cause hypopharyngeal symptoms. This patient was a 56-year-old man who presented with cough and choking symptoms. After the initial negative laryngoscopy, a fiberoptic endoscopy revealed a mass originating from the hypopharyngeal area, which was resected surgically and found to be non-malignant. [source] Use of trachlight to assist intubation using left molar approach to laryngoscopyACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2009R. Mahajan No abstract is available for this article. [source] Paediatric airway management: basic aspectsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2009R. J. HOLM-KNUDSEN Paediatric airway management is a great challenge, especially for anaesthesiologists working in departments with a low number of paediatric surgical procedures. The paediatric airway is substantially different from the adult airway and obstruction leads to rapid desaturation in infants and small children. This paper aims at providing the non-paediatric anaesthesiologist with a set of safe and simple principles for basic paediatric airway management. In contrast to adults, most children with difficult airways are recognised before induction of anaesthesia but problems may arise in all children. Airway obstruction can be avoided by paying close attention to the positioning of the head of the child and by keeping the mouth of the child open during mask ventilation. The use of oral and nasopharyngeal airways, laryngeal mask airways, and cuffed endotracheal tubes is discussed with special reference to the circumstances in infants. A slightly different technique during laryngoscopy is suggested. The treatment of airway oedema and laryngospasm is described. [source] Fluoroscopic guidance of Arndt endobronchial blocker placement for single-lung ventilation in small childrenACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2008B. MARCINIAK Background: Thoracoscopic surgery may require single-lung ventilation (SLV) in infants and small children. A variety of balloon-tipped endobronchial blockers exist but the placement is technically challenging if the size of the tracheal tube does not allow the simultaneous passage of the fibreoptic scope and the endobronchial blocker. This report describes a technique for endobronchial blocker insertion using fluoroscopic guidance in children undergoing SLV. Methods: After approval from the local Medical Ethics Committee and parental consent, 18 patients aged 2 years or younger scheduled for thoracic surgery requiring SLV were prospectively included. Following induction of anesthesia, a 5 Fr endobronchial blocker (Cook® Arndt endobronchial blocker) was inserted first into the trachea under direct laryngoscopy. Correct placement in the main bronchus was assessed by fluoroscopy and tracheal intubation next to the endobronchial blocker. Optimal position and balloon inflation was verified using a fibreoptic scope. The duration and number of insertion attempts as well as age, weight and size of the tracheal tube were recorded. Results: Eighteen patients were studied. Median (range) age and weight were 12 (0.2,24) months and 11.2 (4,15) kg, respectively. SLV was successfully achieved in all patients using a 5 Fr endobronchial blocker outside a 3.5,4.5 mm ID tracheal tube within 11.2 (±2.2) min. No side effects were observed during the procedure. Conclusion: Fluoroscopic-guided insertion of extraluminal endobronchial blocker is an effective and reliable tool to place Arndt endobronchial blockers in small children. [source] Minimal Illumination for Direct Laryngoscopy and Intubation in Different Ambient Light SettingsACADEMIC EMERGENCY MEDICINE, Issue 1 2010FRCPC, Ka Wai Cheung MD Abstract Objectives:, This study sought to investigate the minimal laryngoscope illumination required for proper laryngoscopy and intubation in different ambient light settings as determined by paramedics. Methods:, Paramedics qualified to intubate patients in the field were recruited to intubate a cadaver embalmed with a minimal fixation technique designed to maintain tissue integrity. All paramedic participants intubated the cadaver under three different ambient light settings representing possible out-of-hospital settings: an outdoor night setting, an indoor setting, and an outdoor day setting. Paramedics were asked to determine the minimal illumination required for intubation of the cadaver under each of these settings. Results:, Twenty-three paramedics participated in the study. The mean (±SD) minimal illumination required for intubation was 39.1 (±35.4) lux at the night setting, 92.5 (±57.3) lux at the indoor setting, and 209.7 (±117.4) lux at the day setting. There was a statistically significant difference in minimal illumination required between each of the three light settings (p < 0.0001). Conclusions:, Minimal illumination requirements in the out-of-hospital setting may be lower than previously recommended. Ambient light intensity affects this minimal illumination requirement, with brighter ambient light conditions necessitating more laryngoscope light output. Further studies assessing out-of-hospital laryngoscope illumination should consider ambient light conditions. ACADEMIC EMERGENCY MEDICINE 2010; 17:103,107 © 2010 by the Society for Academic Emergency Medicine [source] Tremulous arytenoid movements predict severity of glottic stenosis in multiple system atrophy,MOVEMENT DISORDERS, Issue 10 2010Tetsutaro Ozawa MD Abstract To determine whether tremulous arytenoid movements predict the severity of glottic stenosis in patients with multiple system atrophy (MSA), 28 MSA patients and 14 age-matched controls underwent fiberoptic laryngoscopy with video monitoring during wakefulness and under anesthesia induced by intravenous injection of propofol. Presence or absence of tremulous arytenoid movements was recorded during wakefulness. The ratio of glottic stenosis (%), which represents the extent of airway narrowing under anesthesia, was obtained by measuring the inspiratory glottic angle during wakefulness and under anesthesia. The median ratio of glottic stenosis was significantly higher in patients with MSA (57.5%) than in control subjects (0.5%). Tremulous arytenoid movements were characterized by shaking movements of the arytenoid region including the vocal folds, which are most apparent in the arytenoid cartilage. In this study, tremulous arytenoid movements were observed in 18 (64.2%) of 28 patients with MSA, who displayed a significantly higher median ratio of glottic stenosis (71.2%) than other patients (34.9%). None of the control subjects exhibited tremulous arytenoid movements. A clear correlation existed between the ratio of glottic stenosis and disease duration. Our observations indicate that tremulous arytenoid movements are a marker of the severity of glottic stenosis, which confers an increased risk of upper airway obstruction in patients with MSA. © 2010 Movement Disorder Society [source] Sleep-related stridor due to dystonic vocal cord motion and neurogenic tachypnea/tachycardia in multiple system atrophyMOVEMENT DISORDERS, Issue 5 2007Roberto Vetrugno MD Abstract Sleep-disordered breathing and sleep-related motor phenomena are part of the clinical spectrum of multiple system atrophy (MSA). Stridor has been attributed to denervation of laryngeal muscles or instead to dystonic vocal cord motion. We studied 3 patients with nocturnal stridor in the setting of MSA. All patients underwent nocturnal videopolysomnography (VPSG) with breathing and heart rate, O2 saturation and intra-esophageal pressure recordings, and simultaneous EMG recordings of the posterior cricoarytenoid, cricothyroid, and thyroarytenoid muscles and continuous vocal cord motion evaluation by means of fiberoptic laryngoscopy. VPSG/EMG and fiberoptic laryngoscopy documented normal vocal cord motion without denervation during wake and stridor only during sleep when hyperactivation of vocal cords adductors appeared in the absence of significant O2 desaturation. All patients had tachycardia and tachypnea and paradoxical breathing during sleep, erratic intercostalis and diaphragmatic EMG activity and Rem sleep behavior disorder. One of the patients had restless legs syndrome with periodic limb movement during sleep and excessive fragmentary hypnic myoclonus. In conclusion, our patients with MSA had nocturnal stridor due to sleep-related laryngeal dystonia. Stridor was associated with other abnormal sleep-related respiratory and motor disorders, suggesting an impairment of homeostatic brainstem integration in MSA. © 2007 Movement Disorder Society [source] Laryngeal histoplasmosis in an immunocompetent patient from a non-endemic region: case reportMYCOSES, Issue 6 2009Teresa C. A. Ferrari Histoplasma capsulatum infection involving the larynx is a rare manifestation, especially in immunocompetent individuals and a high index of suspicion is needed to establish the diagnosis correctly. We report a case of a 50-year-old Brazilian man who presented with progressive hoarseness and throat pain for 4 months. Laryngoscopy showed a supraglottic vegetant lesion, and the biopsies chronic granulomatous inflammation without any specific agent. A second laryngoscopy with biopsies was performed and after 17 days of incubation in specific medium, H. capsulatum was isolated. The patient was successfully treated with amphotericin B. [source] Study to assess the laryngeal and pharyngeal spread of topical local anesthetic administered orally during general anesthesia in childrenPEDIATRIC ANESTHESIA, Issue 8 2010FRCA, RICHARD BERINGER BMedSci Summary Background:, Topical local anesthesia of the airway of anaesthetized children has many potential benefits. In our institution, lignocaine is topically instilled blindly into the back of the mouth with the expectation that it will come into contact with the larynx. The volume and method of application varies between clinicians. There is no published evidence to support the plausibility of this technique. Aim:, To determine whether this technique of instillation results in the local anesthetic coming into contact with key laryngeal structures and whether this is influenced by volume or additional physical maneuvers. Methods/Materials:, Sixty-three healthy anaesthetized children between 6 months and 16 years old had lignocaine stained with methylene blue poured into the back of their mouths. The volume and subsequent physical maneuver were determined by randomization. A blinded observer assessed staining of the vocal cords, epiglottis, vallecula and piriform fossae by direct laryngoscopy. Airway complications were recorded. Results:, Fifty-three of the 63 children had complete staining of all four areas. Four children had one area unstained, and all others had at least partial staining of all four structures. Nine children coughed following induction of anesthesia. Coughing was more likely in children with incomplete staining (P = 0.03), low volume lignocaine (P = 0.003) and following a head lift (P = 0.02). Conclusion:, Oral administration of lignocaine without use of a laryngoscope frequently results in widespread coverage of key laryngeal structures and may reduce the risk of coughing. [source] Response to , comments on comparison of Bonfils fiberscope-assisted laryngoscopy with standard direct laryngoscopy in simulated difficult pediatric intubationPEDIATRIC ANESTHESIA, Issue 8 2010Soder Chris No abstract is available for this article. [source] | ||||||||||