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At least 73 records · Page 4Linked to original sources
PubMed2005

Comparison of the anaesthetic requirement with target-controlled infusion of propofol to insert the laryngeal tube vs. the laryngeal mask.

BACKGROUND AND OBJECTIVE: The target effect-site concentration of propofol to insert a laryngeal mask airway was recently reported as almost 5 microg mL(-1). The present study aimed to determine the target effect-site concentration with target-controlled infusion of propofol to place classical larnygeal mask airway or current laryngeal tube in adult patients. METHODS: We included 40 patients scheduled for short gynaecological and radiological procedures under general anaesthesia in a randomized, double-blind manner using the Dixon's up-and-down statistical method. Monitoring included standard cardiorespiratory monitors, and bispectral index monitoring was used for all patients. Anaesthesia was conducted with a target-controlled infusion system: Diprifusor. The initial target plasma concentration of propofol was 5 microg mL(-1), and was changed stepwise by 0.5 microg mL(-1) increments according to Dixon's up-and-down method. Criteria for acceptable insertion were: Muzi's score < or = 2, and mean arterial blood pressure, heart rate or bispectral index variation <20% the baseline values. RESULTS: Target effect-site concentration of propofol required to insert laryngeal tube was 6.3 +/- 0.3 microg mL(-1) with Dixon method and ED50 was 6.1 microg mL(-1) (5.9-6.4) with logistic regression method. In the case of larnygeal mask airway they were 7.3 +/- 0.2 microg mL(-1) (Dixon method) and 7.3 microg mL(-1) (7.1-7.5; with logistic regression) respectively (P < 0.05). ED95 (logistic regression) was 6.8 microg mL(-1) (5.9-7.6) for laryngeal tube and 7.7 microg mL(-1) (7.3-8.0) for larnygeal mask airway (P < 0.05). Haemodynamic incidents were 55% in the larnygeal mask airway group vs. 30% in the laryngeal tube group (P < 0.05). CONCLUSIONS: The target effect-site concentration of propofol for insertion of laryngeal tube was lower than for larnygeal mask airway (P < 0.05), with a consequent reduction of the propofol induced haemodynamic side-effects.

Adolescent↗
PubMed2002

A comparison of the laryngeal tube with the laryngeal mask airway during routine surgical procedures.

UNLABELLED: The laryngeal mask airway (LMA; Laryngeal Mask Company, Henley-on-Thames, UK) is an established airway device, whereas the laryngeal tube (LT) is relatively new and therefore not as well investigated. Therefore, the purpose of the present prospective, randomized, controlled trial was to compare the LT with the LMA in routine clinical practice. In 50 patients undergoing general anesthesia for minor routine surgery, standardized anesthesia was induced and maintained with alfentanil and propofol. Patients were randomized to controlled ventilation (fraction of inspired oxygen = 0.4; fraction of inspired nitrous oxide = 0.6; tidal volume = 7 mL/kg; respiratory rate = 10 breaths/min) with the LT (n = 25) or the LMA (n = 25). Oxygen saturation was recorded before the induction of anesthesia and after the administration of oxygen. After 2 and 10 min of ventilation with the LT or LMA, oxygen saturation, end-expiratory carbon dioxide, expiratory tidal volume, and peak airway pressure were recorded. Capillary blood gas samples were taken before the induction of anesthesia and after 10 min of ventilation. Time of insertion and airway leak pressure of each device were measured. The time of insertion was comparable with both devices (LT versus LMA, median 21 s versus 19 s; P = not significant). Blood gas samples and ventilation variables revealed sufficient ventilation and oxygenation with either device (P = not significant). Peak airway pressure (LT, 17 +/- 3 cm H(2)O; LMA, 15 +/- 3 cm H(2)O) and airway leak pressure (LT, 36 +/- 3 cm H(2)O; LMA, 22 +/- 3 cm H(2)O) were significantly (P < 0.05) higher when using the LT compared with the LMA. In conclusion, using the LT and LMA resulted in comparable ventilation and oxygenation variables in this model of ASA physical status I and II patients undergoing routine surgical procedures. The newly developed LT may be a simple alternative device to secure the airway. IMPLICATIONS: The laryngeal tube, a newly developed airway device, and the laryngeal mask airway were used to ventilate patients in the operating room. Both airway devices proved to be effective and safe; however, the laryngeal tube allowed greater airway pressure during ventilation.

Adolescent↗
PubMed2006

Salvage conservation laryngeal surgery after irradiation failure for early laryngeal cancer.

OBJECTIVES: One third of recurrences after radiotherapy for early laryngeal cancer remain localized. Salvage conservation laryngeal surgery, with total laryngectomy held as reserve, is a surgical management option that is arguably underused. The aim of this review is to report the oncologic and functional results of salvage conservation laryngeal surgery, using the external or the endolaryngeal laser approach. STUDY DESIGN: Review article. METHODS: A computerized literature search of the Medline database from 1985 to 2005 was performed using the following search strategy: laryngeal neoplasm/AND salvage therapy/. Studies with a sample size less than 10 and an average follow-up of less than 24 months were excluded from analysis. The oncologic outcome, functional outcome, length of hospitalization, and the frequency of complications were recorded. RESULTS: The average reported local control rate for recurrent early glottic cancer after radiotherapy salvaged by using the external or the endolaryngeal laser approach is 77% and 65%, respectively. The average reported overall local control rate, including cases that subsequently required total laryngectomy, is 90% and 83%, respectively. The endolaryngeal approach when compared with the extralaryngeal approach does have the advantage of reduced complications, lesser requirement for tracheostomy and nasogastric feeding, and shortened hospitalization time. CONCLUSIONS: Conservation laryngeal surgery is a safe and effective treatment for recurrent localized disease after radiotherapy for early stage glottic cancer. Local control may be achieved without the sacrifice of laryngeal function, and total laryngectomy may be held in reserve as the ultimate option for salvage without compromising ultimate survival significantly.

Humans↗
PubMed2006

Neck management in patients undergoing postradiotherapy salvage laryngeal surgery for recurrent/persistent laryngeal cancer.

OBJECTIVE: To determine a plan for the management of cervical lymph nodes in patients undergoing salvage laryngeal surgery (SLS) for recurrent/persistent laryngeal cancer after primary radiotherapy (RT). STUDY DESIGN: : Retrospective chart review. METHODS: Charts of 51 consecutive patients who had salvage total or supracricoid laryngectomy with or without neck dissection for recurrent/persistent laryngeal squamous cell carcinoma after primary RT from 1988 to 2005 in our institution were reviewed. No patients received concomitant or neo-adjuvant chemotherapy. Thirty-four patients underwent SLS along with unilateral or bilateral neck dissection, whereas 17 patients underwent the SLS without neck dissection. Reports of preRT and preSLS staging of the primary tumor and the neck, recorded using the TNM system, were reviewed. Reports of the final histopathologic examination for the excised laryngeal cancer and cervical lymph nodes were reviewed. RESULTS: Thirty-four patients underwent SLS with unilateral or bilateral neck dissection. The preRT staging of the primary tumor for those 34 patients showed that 32 (94%) were staged T-1 (14) and T-2 (18), whereas the preSLS staging of the primary tumor for those 34 patients showed that 29 (85%) were staged T-3 and T-4. The postSLS final histopathologic examination of the excised lymph nodes in those 34 patients demonstrated that 30 (88%) did not have any evidence of nodal metastasis. On comparing patients with and without nodal metastasis (on their postSLS final histopathology), we found that the preSLS neck staging, based on computed tomographic (CT) scanning of the neck, was significantly associated with the negative/positive postSLS status of nodal metastasis (P = .006). Of 29 patients staged preSLS as N-0, 28 (97%) patients did not have nodal metastasis on their postSLS final pathology (negative predictive value = 97%, confidence interval, 82.2-99.9). PreRT neck staging, preRT and preSLS staging of the primary tumor, along with laryngeal subsite involvement (supraglottis, glottis, subglottis) did not significantly correlate with the status of neck metastasis on final postSLS histopathology (P = .68, 0.78, 0.49, and 0.42, respectively). None of the 34 patients had any neck tumor recurrence in the postSLS follow-up period (median, 3 yr). In addition, all 17 patients who underwent SLS without neck dissection were staged N-0 both before RT as well as preSLS, and none developed neck disease in the postSLS follow-up period (median, 2.5 yr). CONCLUSION: Management of the neck in patients undergoing salvage total or supracricoid laryngectomy for laryngeal cancer recurrence/persistence after primary RT should be based on the preSLS CT staging of the neck. Patients staged N-0 preSLS are not likely to harbor occult nodal metastasis and therefore may not require elective neck dissection.

Adult↗
PubMedDate not supplied

Observations on laryngeal disease, laryngeal behavior and voice.

This discussion accepted the hypothesis that every laryngeal sound is produced by its unique type of vocal cord vibration. The production of vocal sound is not capricious, it follows certain laws many of which are not known. Research into the behavior of the larynx has produced some interesting and perhaps, useful findings. It was the intention of this paper to describe some of the features of laryngeal behavior as they relate to both phonation and laryngeal disorders in the belief that such knowledge lends itself to the more efficient management of certain vocal and laryngeal problems. The central theme has been that it is laryngeal behavior and not laryngeal disease itself that determines vocal deviation.

Female↗
PubMed1994

The incendiary characteristics of the laryngeal and reinforced laryngeal mask airway to CO2 laser strike--a comparison with two polyvinyl chloride tracheal tubes.

The incendiary characteristics of the laryngeal and reinforced laryngeal mask airway to the CO2 laser have been compared with two polyvinyl chloride tracheal tubes. Three different power densities (2.35, 4.7 and 9.8 x 10(3) watt/cm2) were used, with either oxygen or a 30% oxygen/70% nitrous oxide mixture flowing down the tube. The laryngeal mask airway (and reinforced model) was shown to be more resistant than the polyvinyl chloride tracheal tubes. The laryngeal mask tube could not be ignited at a power density of 2.25 x 10(3) watt/cm2 after five minutes, although penetration occurred in 20-30 seconds. A layer of silica ash built up at the impact site and protected the underlying tube. The laryngeal mask airway cuff was penetrated at 3 to 5 seconds. At this power density the polyvinyl chloride tube ignited in 2 to 8 seconds and the cuff was penetrated in 0.1 seconds. At the highest power density the tubes of all airways ignited within 0.2 seconds. The possibilities for improving the incendiary characteristics of the laryngeal mask airway are discussed.

Carbon Dioxide↗
PubMed1997

Bronchopulmonary changes after laryngeal cancer treatment--differentiation between metastatic laryngeal and second primary cancer.

The survivors of laryngeal cancer have an increased risk of second primary cancer, especially in the lung. Therefore, the authors were interested, if there is an increase of precancerous lesions or malignancies in bronchopulmonary biopsies of the patients after laryngeal cancer treatment. There were 70 (38 transbronchial and 32 bronchial) of 5,097 bronchopulmonary biopsies in 58 patients (55 men and 3 women) with history of laryngeal carcinoma. The age of the patients ranged from 39 to 81 years (mean value 62.5 years). The biopsies were performed from 1 month to 23 years after surgical treatment and/or radiation therapy due to squamous laryngeal carcinoma. The frequency of metaplastic, dysplastic and tumorous lesions was contrary to expectation a bit lower than in routine bronchial biopsies. But in contrast with the latter, metastases were 10 times more common among tumorous lesions. In 19 of 58 patients malignancies appeared from 1 month up to 276 months after laryngectomy. Four patients had definitively, and another 5 very probably second primary carcinoma. Ten patients presented with metastases from laryngeal cancer. The possibilities to differentiate metastatic laryngeal and second primary carcinoma are discussed.

Biopsy↗
PubMed1993

[Expression of human papillomavirus (HPV) gene in HPV-positive laryngeal tumors and activity of the HPV long control region in cultured normal laryngeal epithelial cells].

Expression of the human papillomavirus (HPV) gene was examined in HPV-positive laryngeal tumors. Moreover, the activity of the HPV long control region (LCR) was tested in cultured laryngeal epithelial cells. HPV-11 early genes were heterogeneously expressed in adult laryngeal papillomas. We found one laryngeal carcinoma case in whom the HPV-16 transforming genes, E6 and E7, were expressed. Both HPV-11 and -16 LCRs were active in cultured laryngeal epithelial cells from vocal cords. These results suggest that laryngeal epithelial and tumor cells are target cells for HPV gene expression.

Adult↗
PubMed2000

[Usefulness of laryngeal mask for difficult intubation in a child with congenital laryngeal webs].

We report a case of difficult intubation with congenital laryngeal web. An 11-year-old boy was scheduled for urinary surgery. After anesthetic induction, the anesthesiologist encountered resistance at the vocal cord preventing satisfactory intubation. A size 3 laryngeal mask was immediately inserted, and an adequate airway was obtained. We found a laryngeal web at the vocal cord by bronchoscope inserted thorough the laryngeal mask. The peroperative course was uneventful. Immediately after removal of the laryngeal mask, the patient developed airway obstruction due to sputum and/or laryngeal spasm. The obstruction was relieved through application of positive pressure ventilation and aspiration of the sputum.

Airway Obstruction↗
PubMed2002

[Surgical management of laryngeal cancer and preservation of laryngeal function].

OBJECTIVE: To explore the surgical methods for laryngeal cancer and long-term effects of larygectomy. METHODS: 625 cases of laryngeal cancer at different stages, including 182 cases of supraglottic cancer, 429 cases of glottic cancer, and 14 cases of subglottic cancer, underwent operation of different kinds from 1979 to 1999. Radiotherapy was given to those with poorly differentiated squamous carcinoma or with metastasis of cervical lymph nodes postoperatively. The effects of operation, especially that on the preservation of laryngeal function was analyzed. RESULTS: Partial laryngectomy was performed on 521 of the 625 cases (83.4%) and 203 of the 305 cases at stages III and IV (66.6%). The decannulation rate was 84.07% in the cases undergoing partial laryngectomy. The nasal feeding tube was removed and peroral feeding was recovered in all patients. All cases undergoing partial laryngectomy succeeded in phonation. The overall 3-year survival rate was 89.63% and the overall 5-year survival rate was 77.36%. For the cases with laryngeal cancer at stages III and IV, the 3-year survival rate among those undergoing partial laryngectomy was 84.9%, not significantly different from that among those cases undergoing total laryngectomy (87.7%, P > 0.05); the 5-year survival rate was 66.6% among those undergoing partial laryngectomy and was 69.7% among those undergoing totals laryngectomy (P > 0.05). CONCLUSION: The rate of partial laryngectomy is rather high in this group. It is possible to preserve the laryngeal function without compromising the remote survival rate. The prerequisite for the preservation of laryngeal function is to master and choose the proper renovation methods.

Adult↗
PubMed1992

[Selective laryngeal re-innervations in the dog by nervous microsutures of branches of the recurrent laryngeal nerve].

INTRODUCTION: This work has been carried out to investigate in an animal model, the possibility of surgical selective reinnervation of the larynx following destruction of the laryngeal branch of the vagus nerve. MATERIAL AND METHODS: In ten dogs, on the right side of the neck only, the recurrent laryngeal nerve was identified, cut and section of the nerve removed. Following this the hemi-larynx on the operated side was reinnervated in the following manner. Using a microsurgical suture (described in the text) the motor nerves from extra-laryngeal muscles were anastomosed onto the nerves supplying the intrinsic abductors and adductors of the larynx. The nerve to sterno-thyroid was anastomosed onto the nerve supplying the posterior crico-arytenoid muscle (vocal cord abductor). Similarly the nerve supplying thyrohyoid was anastomosed onto the cut distal end of the adductor division of the recurrent laryngeal nerve. Clinical, electromyographical and histological evaluations have been used to prove the reinnervation. RESULTS: In the nine surviving animals successful re-innervations, as defined by the return of normal function, has been achieved for posterior crico-arytenoid and 7 adductor muscles. CONCLUSION: This study has demonstrated the feasibility of laryngeal reinnervation after surgical section of the recurrent laryngeal nerve, and give some cause for optimism for its ultimate application in man.

Anastomosis, Surgical↗
PubMed1997

Bilateral recurrent laryngeal neurectomy as a model for the study of idiopathic canine laryngeal paralysis.

The purposes of this study were to develop an experimental model of canine laryngeal paralysis that mimicked the naturally occurring disease and to document the upper airway changes produced, both clinically and with pulmonary function testing. Ten dogs had bilateral recurrent laryngeal neurectomy performed and were recovered from anesthesia. Tidal breathing flow-volume loop analysis and upper airway resistance measurements were taken before and after the development of clinical laryngeal paralysis while dogs breathed room air and after the individual administration of 2 respiratory stimulants. Clinical signs of laryngeal paralysis developed 38 days (median) following denervation. Although some variations were present, tidal breathing flow-volume loop analyses on room air, following denervation, were similar to those reported in naturally occurring cases. Upper airway resistance increased following denervation and was significantly increased with both respiratory stimulants. We concluded that bilateral recurrent laryngeal neurectomy resulted in clinical signs and respiratory changes similar to those of idiopathic canine laryngeal paralysis.

Animals↗
PubMed1996

[The detection of laryngeal carcinoma-associated antigens in tissue and serum using three mixed monoclonal antibodies against laryngeal cancer].

Laryngeal carcinoma-associated antigens in tissue and serum of patients with laryngeal carcinoma and normal adults were detected by using ABC and ELISA methods. The results showed that the positive rate rised from 80-86.6% to 97.7% by applying mixed monoclonal antibodies compared with single monoclonal antibody against laryngeal cancer. It was also found that the level of laryngeal carcinoma-associated antigens was much higher in serum of laryngeal carcinoma group than that of control group. The statistic difference was very significant (P < 0.01). The level was different with clinical types, stages and increased in line with the tumor growth. So it was suggested that the mixed monoclonal antibodies were sensitive and specific, which was considered as a useful tumor marker for diagnosis, monitoring clinial course and judging prognosis of patient with laryngeal carcinoma.

Adult↗
PubMed2005

Effect of deficits in laryngeal sensation on laryngeal muscle biochemistry.

Swallowing deficits in elderly people are significant clinical problems and may be associated with impaired pharyngolaryngeal sensation. However, the extent to which sensory innervation affects the motor system is unclear. Our purpose was to examine differences in biochemical properties of laryngeal muscles following sensory nerve ablation. We used sodium dodecyl sulfate-polyacrylamide gel electrophoresis to evaluate laryngeal muscles of young and old Fischer 344/Brown Norway rats, and rats that underwent sensory ablation via bilateral section of the superior laryngeal nerve, internal branch (SLNi), or mixed sensory-motor nerve ablation via left-sided recurrent laryngeal nerve (RLN) section. In lateral thyroarytenoid muscle, a reduction was found in the proportion of the most rapidly contracting myosin heavy chain isoform (type 2B) with SLNi section, RLN section, and aging. Section of the SLNi did not alter the proportion of any myosin heavy chain isoform within the lateral cricoarytenoid or posterior cricoarytenoid muscles, but RLN section resulted in a reduction in the proportion of type 2B. Accordingly, alteration in biochemical properties of the lateral thyroarytenoid muscle alone was demonstrated following sensory ablation. We conclude that sensory changes may affect properties of laryngeal muscles, and may thus have an impact on motor control during critical functions, such as airway protection during swallowing.

Animals↗
PubMed2005

Neuroimmunological activation of the afferent laryngeal neural circuit in experimentally induced laryngeal inflammation.

CONCLUSIONS: These results show that laryngeal inflammatory reactions may induce the expression of proinflammatory cytokines along the afferent laryngeal circuit and in nuclei associated with the HPA axis. Local laryngeal inflammation may induce functional and physiologic alterations in the laryngeal neural system via neuroimmunologic reactions. OBJECTIVE: Idiopathic laryngeal disorders associated with various neurologic conditions such as spasmodic dysphonia, idiopathic vocal fold paralysis and sudden infant death syndrome are causally related to upper respiratory tract infections, and it can be speculated that these disorders result in neurophysiologic alterations. The goal of this study was to identify the neurophysiologic effect on the central nervous system of local inflammatory alterations in the larynx. MATERIAL AND METHODS: The expression of c-fos and IL-1beta was identified after injecting saline solution, 10 microg of lipopolysaccharide or 100 microg of lipopolysaccharide into the larynx of 12 rats. RESULTS: The inflammatory cytokine IL-1beta was mainly expressed in the inferior olivary nucleus and raphe nucleus, which are associated with the hypothalamic-pituitary-adrenal (HPA) axis. IL-1beta expression was also found in the nuclei of afferent nervous pathways of the superior laryngeal nerve, such as the nucleus tractus solitarius, nucleus ambiguus, lateral reticular nucleus, magnocellular reticular nucleus and paragigantocellular reticular nucleus.

Animals↗
PubMed1993

Cricopharyngeal-laryngeal dysplasia in a horse with sudden clinical onset idiopathic laryngeal hemiparesis.

A 7-year-old Thoroughbred racehorse developed loud exercise-related respiratory noises and exercise intolerance over a short period. Examination showed congenital cricopharyngeal-laryngeal dysplasia (rostral displacement of the palatopharyngeal arch) and also left sided idiopathic laryngeal hemiparesis, the latter appearing to be of recent clinical onset. The animal developed colic some months after laryngeal surgery and a nephrosplenic entrapment was surgically corrected. Aerophagia and regurgitation worsened after surgery and, after developing inhalation pneumonia, the animal was destroyed. Post-mortem examination confirmed the presence of idiopathic laryngeal hemiparesis and of cricopharyngeal-laryngeal dysplasia which had some previously undescribed laryngeal muscle abnormalities.

Journal Article↗
PubMed2006

Diagnosis of unilateral recurrent laryngeal nerve paralysis: laryngeal electromyography, subjective rating scales, acoustic and aerodynamic measures.

OBJECTIVE/HYPOTHESIS: To determine whether specific laryngeal electromyography (LEMG) patterns in patients with unilateral vocal fold paralysis/paresis (UVFP) are related to etiology of injury, time from onset of injury, patient perception of symptom severity, acoustic measures, and laryngeal aerodynamic measures. STUDY DESIGN: This is a retrospective review of 75 patients. METHODS: Each patient received LEMG, acoustic and aerodynamic testing, and a subjective rating scale assessment (the Glottal Closure Index). Statistical analysis by groups were performed using both chi and single-factor analysis of variance testing. RESULTS: An iatrogenic etiology was associated with poor tone on LEMG (P = .05). Those individuals evaluated after 3 months after onset demonstrated more nascent units, a sign of reinnervation, compared with individuals evaluated before 3 months (P < .02). Individuals with fewer normal motor units on LEMG had significantly higher mean translaryngeal air flows (P = .044). Individuals with poor recruitment had significantly shorter maximum phonation times (P = .034) and higher mean flows (P = .044). Individuals with better laryngeal tone as noted on LEMG had significantly lower mean flows (P = .06). CONCLUSIONS: Specific LEMG patterns are related to the etiology of the UVFP and time course since recurrent laryngeal nerve injury. LEMG appears to reflect vocal fold muscle tone as seen on laryngeal function studies. In combination, these studies provide a cohesive assessment of laryngeal function in patients with UVFP.

Adult↗