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At least 595 records · Page 33Linked to original sources
PubMed1991

Intravenous lignocaine and sympathoadrenal responses to laryngoscopy and intubation. The effect of varying time of injection.

We have studied the effect of varying the timing of a prior dose of intravenous lignocaine 1.5 mg/kg on the cardiovascular and catecholamine responses to tracheal intubation. Forty healthy patients were given an intravenous injection of either placebo or lignocaine 2, 3 or 4 minutes before tracheal intubation. There was a significant increase in heart rate of 21-26% in all groups. There was no significant increase in mean arterial pressure in response to intubation in any group of patients given lignocaine before intubation, but in the placebo group, mean arterial pressure increased by 19.1% compared to baseline values (p less than 0.05).

Adult↗
PubMed2005

Variability in nomenclature of benign laryngeal pathology based on video laryngoscopy with and without stroboscopy.

OBJECTIVES: To assess the extent of interobserver variability in the nomenclature of benign laryngeal pathology based on evaluation of video-endoscopies with and without stroboscopy. DESIGN: Eight video clips of benign laryngeal conditions were viewed by 35 non-voice specialist ENT surgeons. The surgeons viewed the clips in groups of varying sizes with no discussion between them and were asked to make only one diagnosis for each lesion. SETTING: Specialist voice clinic in the department of ENT at The Royal Sussex County Hospital in Brighton, UK. PARTICIPANTS: Participating ENT surgeons were all either registrars or consultants working at different centres in UK, recruited by the author. None were voice specialists. MAIN OUTCOME MEASURE: Interobserver agreement was measured using kappa statistics. RESULTS: Variation was widespread with only two of the eight cases (25%) showing agreement of over 75%. Agreement could be analysed statistically as moderate at best (kappa=0.5 with a 95% confidence interval from 0.5 to 0.6). The seniority of the laryngologist was also analysed with consultants and senior trainees (specialist registrar years 4-6) having better agreement than junior trainees (specialist registrar years 1-3). CONCLUSIONS: The generally accepted optimum treatment for different benign laryngeal pathologies varies substantially. However, our results shows a significant high-level interobserver variability in their diagnosis by non-voice specialists, thus reducing the reliability of outcome data and treatment recommendations. It is therefore important to try and lower this interobserver variability, possibly by widespread use of improved diagnostic technology, stricter/more universally accepted definitions and supervised training of junior doctors in a voice clinic environment.

Clinical Competence↗
PubMed1982

Effect of cardioselective beta-blockers on the heart rate and arterial pressure responses to laryngoscopy.

The effects of the cardioselective beta-blockers practolol (Eraldin, ICI) and metoprolol (Seloken, Hässle) were studied during microlaryngoscopy. I. v. practolol (0.4 mg/kg before and 0.2 mg/kg during anaesthesia) did not protect against increases in arterial pressure, although heart rate was reduced. Oral metoprolol (0.2 g for 4 days) reduced the level of arterial pressure both before and during anaesthesia. Variations in arterial pressure were not attenuated. Very low levels of arterial pressure were seen, and variations in arterial pressures were attenuated when metoprolol was combined with fentanyl.

Adrenergic beta-Antagonists↗
PubMed1990

Methohexital vs midazolam/flumazenil anaesthesia during laryngoscopy under jet ventilation.

In a randomised clinical study, two total intravenous anaesthesia techniques for microlaryngoscopic laser surgery were compared. After an induction dose of 100 mg methohexital, Group I received a maintenance infusion of 10 mg.min-1. In Group II anaesthesia was obtained by 15 mg midazolam followed by 0.1 mg.min-1 continuously and terminated by the injection of flumazenil. For analgesia 5 mg alfentanil were administered. Opiate-induced respiratory depression was antagonised by 0.08 to 0.12 mg naloxone. Prior to, during, and after surgery, adrenergic response was assessed by HPLC-analysis of blood taken from a peripheral vein. Haemodynamic responses to the operation and during the post-operative period were almost identical in both groups. In Group I, the mean recovery period of 14 min was significantly longer than in Group II (9 min), where patients received a mean dose of 0.53 mg (+/- 0.15) flumazenil. Resedation could be observed in all patients receiving flumazenil within 60 min after antagonisation, which was associated with a mean decrease in O2-saturation from 95% to 88%. There was no difference in epinephrine and norepinephrine blood levels between the two groups prior to and during anaesthesia. In all patients, arousal was associated with a significant increase in the epinephrine plasma concentration. While blood levels in Group I decreased during the post-operative period to levels prior to surgery, the concentrations in Group II remained elevated. In one patient who received no naloxone, the reversal of midazolam action induced a 16-fold increase in catecholamine levels (from 50 to 800 ng.l-1) associated with a tachycardia of 170 b.min-1 and hypertension of 160 mmHg.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Attenuating the hypertensive response to laryngoscopy and endotracheal intubation using awake fibreoptic intubation.

Blood pressure and pulse rate measurements were recorded in 35 patients undergoing endotracheal intubation during general anaesthesia (Group A), and 35 patients who had an awake fibreoptic intubation under local anaesthesia (Group B). The mean arterial pressure in Group A rose by a mean of 35 mmHg immediately after intubation, compared with a mean fall of 9 mmHg in Group B. The mean pulse rate in Group A rose by 24 beats per minute (b.p.m.) immediately after intubation, compared with a rise of 3 b.p.m. in Group B. Both these differences were statistically significant (P less than 0.0001 and P less than 0.001 respectively, Mann Whitney U test). Postoperative discomfort was assessed 24 h later by means of linear analogue scales. There was a statistically higher mean score in relation to nose discomfort in Group B (P less than 0.002). Awake fibreoptic intubation successfully reduces the pressor response to endotracheal intubation in normotensive adults. It is suitable for use in those patients who are at risk from the pressor response.

Anesthesia, General↗
PubMed2001

A method of applying Fourier analysis to high-speed laryngoscopy.

A new method for analysis of digital high-speed recordings of vocal-fold vibrations is presented. The method is based on the extraction of light-intensity time sequences from consecutive images, which in turn are Fourier transformed. The spectra thus acquired can be displayed in four different modes, each having its own benefits. When applied to the larynx, the method visualizes oscillations in the entire laryngeal area, not merely the glottal region. The method was applied to two laryngoscopic high-speed image sequences. Among these examples, covibrations in the ventricular folds and in the mucosa covering the arytenoid cartilages were found. In some cases the covibrations occurred at other frequencies than those of the glottis.

Arytenoid Cartilage↗