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PubMed1981

[Hundred cases of general anesthesia for laryngoscopy and/or bronchoscopy, in children under five years age (author's transl)].

The authors describe an anesthetic technique used for endoscopies (laryngo-tracheo-bronchoscopies) in 100 children under five years age. Three different apparatus for jet ventilation are used: manual injection, automatic injection and high frequency positive pressure ventilation. The first apparatus is home made. It allows control of insufflation of O2 by manual compression of a gun type injector. With the second one (Wolf injectomat), injection of O2 or O2/N2O is automatic. The aga bronchovent is used for high frequency positive ventilation with O2.

Anesthesia, General↗
PubMed1981

Etomidate infusion for laryngoscopy.

Reporting our experience with etomidate infusion in 37 cases of endoscopic examinations of the larynx, we recommend a method of general anesthesia ensuring easy examination conditions and rapid recovery. After premedication with atropine, IV Thalamonal is administered till obtention of somnolence. A dose of 0.25 mg/kg of etomidate is used for induction and an infusion at a rate of 25 mcg/kg/min for maintenance of anesthesia. Succinylcholine is used for intubation and whenever complementary muscular relaxation is required. Ventilation is ensured by the jet mixing technique with a manual injector. Fentanyl is given when reactions of tachycardia or arterial hypertension due to nociceptive stimuli are observed. The method described is safe, provides good conditions of anesthesia with complete amnesia and rapid recovery.

Adjuvants, Anesthesia↗
PubMed1993

[Unilateral paralysis of the vocal fold: correlation between laryngoscopy and electromyography].

From a clinical point of view, unilateral vocal fold paresis means that one of the vocal folds shows reduced mobility. Etiology may be mechanical or supranuclear, but in most cases it is a partial peripheral neurogenic lesion in the muscles innervated by one of the recurrent laryngeal nerves. On the one hand, a retrospective analysis was made of 71 cases with laryngoscopically reduced mobility of one vocal fold: 58 patients had electromyographic signs of partial denervation; 13 had normal electromyographic activity. Possible explanations are mechanical factors, paradoxical reinnervation, or central neurological pathology. On the other hand we reviewed 179 cases with an electromyographic diagnosis of unilateral partial peripheral neurogenic lesion in the muscles innervated by one of the recurrent laryngeal nerves: 119 patients showed a clinically immobile vocal fold, 2 a normally moving vocal fold and 58 a paretic vocal fold. A lot of immobile vocal folds are thus partial denervations. Insufficient amount of functional motor units and paradoxical reinnervation provide possible explanations.

Electromyography↗
PubMed1995

[Comparative study of clonidine and lidocaine on the attenuation of the intraocular pressure increase associated with laryngoscopy and endotracheal intubation].

OBJECTIVE: To verify and compare the efficacy of clonidine and lidocaine for attenuating the ocular hypertensive response generated by manipulation of the laryngoscope and endotracheal intubation (EIT). PATIENTS AND METHODS: In this prospective double blind study 45 patients undergoing non-ocular surgery were divided into 3 groups according to pretreatment protocol: A, approximately 3 micrograms/kg clonidine orally 90-120 min before surgery; B, 1.5 mg/kg intravenous lidocaine 1 min before EIT and C, control group. On all patients we recorded intraocular pressure (IOP), mean arterial pressure and heart rate at the following times: basal, just before EIT, immediately after EIT, 5 minutes later and 10 minutes later. RESULTS: The patients pretreated with clonidine had significantly lower IOP levels than did the control group at all measurements times; patients pretreated with lidocaine had lower IOP after induction and after intubation. IOP was significantly lower in patients who received lidocaine than in control group patients after EIT, although IOP levels with lidocaine were higher than with clonidine. CONCLUSIONS: Pretreatment with oral clonidine is an effective method for preventing increases in IOP after EIT, is more effective than pretreatment with lidocaine, and should therefore be used for that end. Intravenous lidocaine represents a valid alternative in emergency cases when the approximate wait time of 2 hours is contraindicated.

Adult↗