Nearly 40 years ago, cricoid pressure (CP) was introduced into anesthetic practice based on a single small case series that lacked essential information. No randomized controlled trials have since documented any benefit of CP. In addition, numerous surveys have shown that most anesthetists lack adequate theoretical and practical knowledge regarding all aspects of CP. Despite the lack of evidence of its effectiveness, evidence of numerous deleterious effects (the most important being interference with airway management), and documentation of poor practice of the technique, CP is still considered by most anesthetists as a standard of care during rapid sequence induction. However, by using CP we may well be endangering more lives by causing airway problems than we are saving in the hope of preventing pulmonary aspiration. It is dangerous to consider CP to be an effective and reliable measure in reducing the risk of pulmonary aspiration and to become complacent about the many factors that contribute to regurgitation and aspiration. Ensuring optimal positioning and a rapid onset of anesthesia and muscle relaxation to decrease the risk of coughing, straining or regurgitation during the induction of anesthesia are likely more important in the prevention of pulmonary aspiration than CP. (+info)
Pulmonary arterial medial smooth muscle thickness in sudden infant death syndrome: an analysis of subsets of 73 cases.
[Usefulness of assessment of voice capabilities in female patients with reflux-related dysphonia].
OBJECTIVES: To analyze vocal capabilities in patients diagnosed with reflux related dysphonia versus controls with healthy voice with selection of the most informative discriminating quantitative parameters and to assess voice changes following treatment. MATERIAL AND METHODS: Six parameters of voice range profile (VRP) and five parameters of speech range profile were taken and analyzed from 60 dysphonic outpatient females with laryngopharyngeal reflux (LPR) diagnosed by reflux-related atypical and typical symptoms, videolaryngoscopic findings, upper gastrointestinal endoscopy, and positive response to empiric 3-month omeprazole treatment. Seventy-six females with healthy voice served as controls. RESULTS: All six parameters of voice range profile and three of 5 parameters of speech range profile showed significant differences comparing LPR patients with controls before omeprazole treatment (P<0.05). Logistic regression analysis revealed VRP maximum-minimum intensity range to be the most informative parameter for discrimination between reflux-related dysphonic and healthy voices (overall prediction accuracy, 86.8%). A threshold value of significant parameter was stated using the receiver operating characteristic curve. Treatment with omeprazole significantly improved voice quality showing the greatest changes in the mean scores of majority of voice range profile parameters. CONCLUSIONS: Vocal capabilities, especially evaluated by voice range profile, are restricted in LPR female patients in comparison to subjects with healthy voice. Quantitative voice assessment with voice range profile may add more objective aspect for screening dysphonia and could be used as a criterion of evaluation of treatment efficacy in such patients. (+info)
Laryngopharyngeal reflux: More questions than answers.