Laryngoscopy: Examination, therapy or surgery of the interior of the larynx performed with a specially designed endoscope.Laryngoscopes: Endoscopes for examining the interior of the larynx.Intubation, Intratracheal: A procedure involving placement of a tube into the trachea through the mouth or nose in order to provide a patient with oxygen and anesthesia.Larynx: A tubular organ of VOICE production. It is located in the anterior neck, superior to the TRACHEA and inferior to the tongue and HYOID BONE.Airway Management: Evaluation, planning, and use of a range of procedures and airway devices for the maintenance or restoration of a patient's ventilation.Vocal Cord Paralysis: Congenital or acquired paralysis of one or both VOCAL CORDS. This condition is caused by defects in the CENTRAL NERVOUS SYSTEM, the VAGUS NERVE and branches of LARYNGEAL NERVES. Common symptoms are VOICE DISORDERS including HOARSENESS or APHONIA.Fiber Optic Technology: The technology of transmitting light over long distances through strands of glass or other transparent material.Laryngeal Diseases: Pathological processes involving any part of the LARYNX which coordinates many functions such as voice production, breathing, swallowing, and coughing.Glottis: The vocal apparatus of the larynx, situated in the middle section of the larynx. Glottis consists of the VOCAL FOLDS and an opening (rima glottidis) between the folds.Vocal Cords: A pair of cone-shaped elastic mucous membrane projecting from the laryngeal wall and forming a narrow slit between them. Each contains a thickened free edge (vocal ligament) extending from the THYROID CARTILAGE to the ARYTENOID CARTILAGE, and a VOCAL MUSCLE that shortens or relaxes the vocal cord to control sound production.Anesthesia, General: Procedure in which patients are induced into an unconscious state through use of various medications so that they do not feel pain during surgery.Video Recording: The storing or preserving of video signals for television to be played back later via a transmitter or receiver. Recordings may be made on magnetic tape or discs (VIDEODISC RECORDING).Laryngitis: Inflammation of the LARYNGEAL MUCOSA, including the VOCAL CORDS. Laryngitis is characterized by irritation, edema, and reduced pliability of the mucosa leading to VOICE DISORDERS such as APHONIA and HOARSENESS.Hoarseness: An unnaturally deep or rough quality of voice.Epiglottis: A thin leaf-shaped cartilage that is covered with LARYNGEAL MUCOSA and situated posterior to the root of the tongue and HYOID BONE. During swallowing, the epiglottis folds back over the larynx inlet thus prevents foods from entering the airway.Laryngeal Masks: A type of oropharyngeal airway that provides an alternative to endotracheal intubation and standard mask anesthesia in certain patients. It is introduced into the hypopharynx to form a seal around the larynx thus permitting spontaneous or positive pressure ventilation without penetration of the larynx or esophagus. It is used in place of a facemask in routine anesthesia. The advantages over standard mask anesthesia are better airway control, minimal anesthetic gas leakage, a secure airway during patient transport to the recovery area, and minimal postoperative problems.Retrognathia: A physical misalignment of the upper (maxilla) and lower (mandibular) jaw bones in which either or both recede relative to the frontal plane of the forehead.Anesthesiology: A specialty concerned with the study of anesthetics and anesthesia.Disposable Equipment: Apparatus, devices, or supplies intended for one-time or temporary use.Lingual Nerve Injuries: Traumatic injuries to the LINGUAL NERVE. It may be a complication following dental treatments.Tooth Injuries: Traumatic or other damage to teeth including fractures (TOOTH FRACTURES) or displacements (TOOTH LUXATION).Equipment Design: Methods of creating machines and devices.Laryngeal Edema: Abnormal accumulation of fluid in tissues of any part of the LARYNX, commonly associated with laryngeal injuries and allergic reactions.ManikinsEpiglottitis: Inflammation of the epiglottis.Laryngostenosis: Developmental or acquired stricture or narrowing of the LARYNX. Symptoms of respiratory difficulty depend on the degree of laryngeal narrowing.Arytenoid Cartilage: One of a pair of small pyramidal cartilages that articulate with the lamina of the CRICOID CARTILAGE. The corresponding VOCAL LIGAMENT and several muscles are attached to it.Laryngomalacia: A congenital or acquired condition of underdeveloped or degeneration of CARTILAGE in the LARYNX. This results in a floppy laryngeal wall making patency difficult to maintain.Video-Assisted Surgery: Endoscopic surgical procedures performed with visualization via video transmission. When real-time video is combined interactively with prior CT scans or MRI images, this is called image-guided surgery (see SURGERY, COMPUTER-ASSISTED).Thyroid Cartilage: The largest cartilage of the larynx consisting of two laminae fusing anteriorly at an acute angle in the midline of the neck. The point of fusion forms a subcutaneous projection known as the Adam's apple.Neck: The part of a human or animal body connecting the HEAD to the rest of the body.Tongue DiseasesVoice Quality: That component of SPEECH which gives the primary distinction to a given speaker's VOICE when pitch and loudness are excluded. It involves both phonatory and resonatory characteristics. Some of the descriptions of voice quality are harshness, breathiness and nasality.Speech-Language Pathology: The study of speech or language disorders and their diagnosis and correction.Airway Obstruction: Any hindrance to the passage of air into and out of the lungs.Head: The upper part of the human body, or the front or upper part of the body of an animal, typically separated from the rest of the body by a neck, and containing the brain, mouth, and sense organs.Laryngeal Neoplasms: Cancers or tumors of the LARYNX or any of its parts: the GLOTTIS; EPIGLOTTIS; LARYNGEAL CARTILAGES; LARYNGEAL MUSCLES; and VOCAL CORDS.Preanesthetic Medication: Drugs administered before an anesthetic to decrease a patient's anxiety and control the effects of that anesthetic.Anesthesia, Inhalation: Anesthesia caused by the breathing of anesthetic gases or vapors or by insufflating anesthetic gases or vapors into the respiratory tract.Propofol: An intravenous anesthetic agent which has the advantage of a very rapid onset after infusion or bolus injection plus a very short recovery period of a couple of minutes. (From Smith and Reynard, Textbook of Pharmacology, 1992, 1st ed, p206). Propofol has been used as ANTICONVULSANTS and ANTIEMETICS.Androstanols: Androstanes and androstane derivatives which are substituted in any position with one or more hydroxyl groups.Spinal Injuries: Injuries involving the vertebral column.Anesthetics, Intravenous: Ultrashort-acting anesthetics that are used for induction. Loss of consciousness is rapid and induction is pleasant, but there is no muscle relaxation and reflexes frequently are not reduced adequately. Repeated administration results in accumulation and prolongs the recovery time. Since these agents have little if any analgesic activity, they are seldom used alone except in brief minor procedures. (From AMA Drug Evaluations Annual, 1994, p174)Maxillary Fractures: Fractures of the upper jaw.Dysgeusia: A condition characterized by alterations of the sense of taste which may range from mild to severe, including gross distortions of taste quality.Thiopental: A barbiturate that is administered intravenously for the induction of general anesthesia or for the production of complete anesthesia of short duration.Cervical Vertebrae: The first seven VERTEBRAE of the SPINAL COLUMN, which correspond to the VERTEBRAE of the NECK.Neuromuscular Nondepolarizing Agents: Drugs that interrupt transmission at the skeletal neuromuscular junction without causing depolarization of the motor end plate. They prevent acetylcholine from triggering muscle contraction and are used as muscle relaxants during electroshock treatments, in convulsive states, and as anesthesia adjuvants.Laryngeal Nerve Injuries: Traumatic injuries to the LARYNGEAL NERVE.Immobilization: The restriction of the MOVEMENT of whole or part of the body by physical means (RESTRAINT, PHYSICAL) or chemically by ANALGESIA, or the use of TRANQUILIZING AGENTS or NEUROMUSCULAR NONDEPOLARIZING AGENTS. It includes experimental protocols used to evaluate the physiologic effects of immobility.Alfentanil: A short-acting opioid anesthetic and analgesic derivative of FENTANYL. It produces an early peak analgesic effect and fast recovery of consciousness. Alfentanil is effective as an anesthetic during surgery, for supplementation of analgesia during surgical procedures, and as an analgesic for critically ill patients.Succinylcholine: A quaternary skeletal muscle relaxant usually used in the form of its bromide, chloride, or iodide. It is a depolarizing relaxant, acting in about 30 seconds and with a duration of effect averaging three to five minutes. Succinylcholine is used in surgical, anesthetic, and other procedures in which a brief period of muscle relaxation is called for.Chin: The anatomical frontal portion of the mandible, also known as the mentum, that contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for the passage of blood vessels and a nerve.Laryngopharyngeal Reflux: Back flow of gastric contents to the LARYNGOPHARYNX where it comes in contact with tissues of the upper aerodigestive tract. Laryngopharyngeal reflux is an extraesophageal manifestation of GASTROESOPHAGEAL REFLUX.

Management of laryngeal foreign bodies in children. (1/460)

Foreign body aspiration is one of the leading causes of accidental death in children. Food items are the most common items aspirated in infants and toddlers, whereas older children are more likely to aspirate non-food items. Laryngeal impaction of a foreign body is very rare as most aspirated foreign bodies pass through the laryngeal inlet and get lodged lower down in the airway. Two rare cases of foreign body aspiration with subglottic impaction in very young children (under 2 years of age) are described. In both the cases subglottic impaction occurred consequent to attempted removal of foreign body by blind finger sweeping. The clinical presentation, investigations, and management of these rare cases are discussed.  (+info)

Correlating fibreoptic nasotracheal endoscopy performance and psychomotor aptitude. (2/460)

We have investigated the correlation between the scores attained on computerized psychometric tests, measuring psychomotor and information processing aptitudes, and learning fibreoptic endoscopy with the videoendoscope. Sixteen anaesthetic trainees performed two adaptive tracking tasks (ADTRACK 2 and ADTRACK 3) and one information management task (MAZE) from the MICROPAT testing system. They then embarked on a standardized fibreoptic training programme during which they performed 15 supervised fibreoptic nasotracheal intubations on anaesthetized oral surgery patients. There was a significant correlation between the means of the 15 endoscopy times and both ADTRACK 2 (r = -0.599, P = 0.014) and ADTRACK 3 (r = -0.589, P = 0.016) scores. The correlation between the means of the 15 endoscopy times and MAZE scores was not significant. The ratios of the mean endoscopy time for the last seven endoscopies to the mean endoscopy time for the first seven endoscopies were not significantly correlated with ADTRACK 2, ADTRACK 3 or MAZE scores. Psychomotor abilities appeared to be determinants of trainees' initial proficiency in endoscopy, but did not appear to be determinants of trainees' rates of progress during early fibreoptic training.  (+info)

Perianesthetic dental injuries: frequency, outcomes, and risk factors. (3/460)

BACKGROUND: Dental injury is well-recognized as a potential complication of laryngoscopy and tracheal intubation. However, the frequency, outcomes, and risk factors for this problem have not been documented in a well-defined patient population. METHODS: The authors analyzed the dental injuries of 598,904 consecutive cases performed on patients who required anesthetic services from 1987 through 1997. Dental injuries were defined as perianesthetic events (those occurring within 7 days) that required dental interventions to repair, stabilize, or extract involved dentition or support structures. A 1:3 case-control study of 16 patient and procedural characteristics was performed for cases that occurred during the first 5 yr of the study. Conditional logistic regression was used for data analysis. RESULTS: There were 132 cases (1:4,537 patients) of dental injury. One half of these injuries occurred during laryngoscopy and tracheal intubation. The upper incisors were the most commonly involved teeth, and most injuries were crown fractures and partial dislocations and dislodgements. Multivariate risk factors for dental injury in the case control study included general anesthesia with tracheal intubation (odds ratio [OR] = 89), preexisting poor dentition (OR = 50), and increased difficulty of laryngoscopy and intubation (OR = 11). CONCLUSIONS: Based on these data from a large surgical population at a single training institution, approximately 1:4,500 patients who receive anesthesia services sustain a dental injury that requires repair or extraction. Patients most at risk for perianesthetic dental injury include those with preexisting poor dentition who have one or more risk factors for difficult laryngoscopy and tracheal intubation.  (+info)

Bolus dose remifentanil for control of haemodynamic response to tracheal intubation during rapid sequence induction of anaesthesia. (4/460)

The effect of three bolus doses of remifentanil on the pressor response to laryngoscopy and tracheal intubation during rapid sequence induction of anaesthesia was assessed in a randomized, double-blind, placebo-controlled study in four groups of 20 patients each. After preoxygenation, anaesthesia was induced with thiopental 5-7 mg kg-1 followed immediately by saline (placebo) or remifentanil 0.5, 1.0 or 1.25 micrograms kg-1 given as a bolus over 30 s. Cricoid pressure was applied just after loss of consciousness. Succinylcholine 1 mg kg-1 was given for neuromuscular block. Laryngoscopy and tracheal intubation were performed 1 min later. Arterial pressure and heart rate were recorded at intervals until 5 min after intubation. Remifentanil 0.5 microgram kg-1 was ineffective in controlling the increase in heart rate and arterial pressure after intubation but the 1.0 and 1.25 micrograms kg-1 doses were effective in controlling the response. The use of the 1.25 micrograms kg-1 dose was however, associated with a decrease in systolic arterial pressure to less than 90 mm Hg in seven of 20 patients.  (+info)

Laryngeal movements during the respiratory cycle measured with an endoscopic imaging technique in the conscious horse at rest. (5/460)

A video-laryngoscopic method, implemented with an algorithm for the correction of the deformation inherent in the endoscope optical system, has been used to measure the dorsoventral diameter (Drg) and the cross-sectional area (CSArg) of the rima glottidis in five healthy workhorses during conscious breathing at rest. Simultaneous recording of the respiratory airflow was also obtained in two horses. Drg measured 82.7 +/- 4.5 mm (mean +/- S.D.) independently of the respiratory phase, and did not differ from the measurement in post-mortem anatomical specimens of the same horses. CSArg ranged from 1130 +/- 117 mm2 (mean +/- S.D.) during the inspiratory phase to 640 +/- 242 mm2 during the expiratory phase; being always narrower than tracheal cross-sectional area, which was 1616 +/- 224 mm2, as determined from anatomical specimens. Both inspiratory and expiratory airflow waves displayed a biphasic pattern. Maximal laryngeal opening occurred in phase with the second inspiratory peak, while during expiration CSArg attained a minimum value during the first expiratory peak which was significantly smaller (P < 0.01) than the area subsequently maintained during the rest of the expiratiory phase. These quantitative measurements of equine laryngeal movements substantiate the important role played by the larynx in regulating upper airway respiratory resistance and the expiratory airflow pattern at rest.  (+info)

Intramuscular rocuronium in infants and children: a multicenter study to evaluate tracheal intubating conditions, onset, and duration of action. (6/460)

BACKGROUND: This multicenter, assessor-blinded, randomized study was done to confirm and extend a pilot study showing that intramuscular rocuronium can provide adequate tracheal intubating conditions in infants (2.5 min) and children (3 min) during halothane anesthesia. METHODS: Thirty-eight infants (age range, 3-12 months) and 38 children (age range, 1 to 5 yr) classified as American Society of Anesthesiologists physical status 1 and 2 were evaluated at four investigational sites. Anesthesia was maintained with halothane and oxygen (1% end-tidal concentration if <2.5 yr; 0.80% end-tidal concentration if >2.5 yr) for 5 min. One half of the patients received 0.45 mg/kg intravenous rocuronium. The others received 1 mg/kg (infants) or 1.8 mg/kg (children) of intramuscular rocuronium into the deltoid muscle. Intubating conditions and mechanomyographic responses to ulnar nerve stimulation were assessed. RESULTS: The conditions for tracheal intubation at 2.5 and 3 min in infants and children, respectively, were inadequate in a high percentage of patients in the intramuscular group. Nine of 16 infants and 10 of 17 children had adequate or better intubating conditions at 3.5 and 4 min, respectively, after intramuscular rocuronium. Better-than-adequate intubating conditions were achieved in 14 of 15 infants and 16 of 17 children given intravenous rocuronium. Intramuscular rocuronium provided > or =98% blockade in 7.4+/-3.4 min (in infants) and 8+/-6.3 min (in children). Twenty-five percent recovery occurred in 79+/-26 min (in infants) and in 86+/-22 min (in children). CONCLUSIONS: Intramuscular rocuronium, in the doses and conditions tested, does not consistently provide satisfactory tracheal intubating conditions in infants and children and is not an adequate alternative to intramuscular succinylcholine when rapid intubation is necessary.  (+info)

Clinical assessment of a plastic optical fiber stylet for human tracheal intubation. (7/460)

BACKGROUND: The authors compared the performance of a prototype intubation aid that incorporated plastic illumination and image guides into a stylet with fiberoptic bronchoscopy and direct laryngoscopy for tracheal intubation by novice users. METHODS: In a randomized, nonblinded design, patients were assigned to direct laryngoscopy, fiberoptic bronchoscopy, or imaging stylet intubation groups. The quality of laryngeal view and ease with which it was attained for each intubation was graded by the laryngoscopist. Time to intubation was measured in 1-min increments. A sore-throat severity grade was obtained after operation. RESULTS: There were no differences in demographic, physical examination, or surgical course characteristics among the groups. The laryngoscope produced an adequate laryngeal view more easily than did the imaging stylet or bronchoscope (P = 0.001) but caused the highest incidence of postoperative sore throat (P<0.05). Although the time to intubation for direct laryngoscopy was shorter than for imaging stylet, which was shorter than fiberoptic bronchoscopy (P<0.05), the quality of laryngeal view with the imaging stylet was inferior to both direct laryngoscopy and fiberoptic bronchoscopy techniques (P<0.05). CONCLUSIONS: Novices using the imaging stylet produce fewer cases of sore throat (compared with direct laryngoscopy) and can intubate faster than when using a bronchoscope in anesthetized adult patients. The imaging stylet may be a useful aid for tracheal intubation, especially for those unable to maintain skills with a bronchoscope.  (+info)

Laryngeal mask airway size selection in males and females: ease of insertion, oropharyngeal leak pressure, pharyngeal mucosal pressures and anatomical position. (8/460)

We have compared ease of insertion, oropharyngeal leak pressure, directly measured pharyngeal mucosal pressure and anatomical position (assessed fibreoptically) for the size 4 and size 5 laryngeal mask airway (LMA) in 20 male and 20 female patients. Microchip pressure sensors were attached to the LMA at locations corresponding to the piriform fossa, hypopharynx, base of the tongue, lateral and posterior pharynx, and the oropharynx. Oropharyngeal leak pressure, mucosal pressure and fibreoptic position were recorded during inflation of the cuff from 0 to 30 ml in 10-ml increments. In males, oropharyngeal leak pressure over the inflation range was higher for size 5 (21 vs 17 cm H2O; P = 0.01); mucosal pressure over the inflation range was higher in the posterior pharynx for size 4 (7 vs 2 cm H2O; P = 0.007), and higher in the piriform fossa (8 vs 5 cm H2O; P = 0.003) and hypopharynx (9 vs 5 cm H2O; P = 0.003) for size 5. In females, oropharyngeal leak pressure over the inflation range was the same (21 vs 21 cm H2O), but mucosal pressure over the inflation range was higher in the piriform fossa (21 vs 8 cm H2O; P = 0.003) and posterior pharynx (4 vs 2 cm H2O; P = 0.004) for size 4, and higher in the lateral pharynx (5 vs 1 cm H2O; P = 0.01) and oropharynx (11 vs 5 cm H2O; P = 0.009) for size 5. The distribution of mucosal pressure was different for size 4 between males and females, but not for size 5. For both males and females, fibreoptic position was similar. We conclude that the size 5 LMA is optimal in males, but either size is suitable for females. The shape of the pharynx may be different between males and females.  (+info)

  • If laryngoscopy is essential, it should be done in the controlled setting of an operating room with a person skilled at difficult airway management (including surgical techniques) present. (
  • In a collection of manuscripts, Dr. Hastings has evaluated the effects of equipment and technique on cervical spine movement with laryngoscopy and reviewed the implications of spine injury for airway management. (
  • Below, we'll take a look at laryngoscopy and when you might need one. (
  • There are two types of laryngoscopy, and each uses different equipment. (
  • If the patient does not tolerate this procedure, flexible laryngoscopy should be done. (
  • Laryngoscopy Hospitals Patients can find significant cost savings and shorter waiting times without compromising on quality by traveling from their home country for a major procedure like a Laryngoscopy. (
  • A general health examination will be carried out during the consultation period to assess the level of risk involved if the surgery for Laryngoscopy goes ahead. (
  • It's not meant to cover the whole world of laryngoscopy and we've deliberately avoided chat about videolaryngoscopy as that is it's own topic, but we do hope it will start a bit of chat. (
  • Measurements: Patient BMI, Mallampati airway class, thyromental distance, neck circumference, cervical extension ability, Cormack and Lehane laryngoscopic grade for each laryngoscopy, subjective lifting force required, and need for external laryngeal pressure were recorded. (
  • A nice calm bag-mask ventilation period while familiarising yourself with your most important task (oxygenation, not intubation) sets you up for a stress free and well pre-oxygenated laryngoscopy. (
  • A little more time spent on pre-oxygenation, waiting for drugs to take effect and checking equipment nearly always leads to a smoother attempt at laryngoscopy. (
  • Many hospitals have started offering services designed for Laryngoscopy to make the process smoother for international patients. (
  • The accreditations and certifications of a hospital can help Laryngoscopy patients make a judgement about their level of safety and quality. (
  • On the other hand, the spine movement with laryngoscopy may be dangerous in patients with cervical spine injury because of the possibility of causing new neurologic deficits. (
  • Group 'E', patients were given intravenous Esmolol 1.5 mg/kg 2 minutes before start of laryngoscopy. (
  • In Normotensive patients requiring general anaesthesia with laryngoscopy and intubation, authors conclude that intravenous Esmolol 1.5 mg/kg attenuated Heart rate response but fails to satisfactorily prevent rise in blood pressure. (