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PubMed1995

The use of intranasal nitroglycerin to prevent pressor responses during intubation in general anesthesia--a comparison of various doses.

BACKGROUND: Intranasal nitroglycerin (NTG) was first reported to successfully prevent an increase in arterial blood pressure following laryngoscopy and tracheal intubation by Hill et al. Various different effective dosages of NTG have been reported. Grover et al. indicated 0.75 mg of intranasal NTG to be the most suitable dose. However, no definite conclusion has yet been made. This study was designed to compare the efficacy of four different dosages of intranasal NTG (0.3, 0.5, 0.75, and 1.0 mg) in preventing pressor responses to laryngoscopy and tracheal intubation during the induction of general anesthesia. METHODS: One hundred patients (ASA I or II) scheduled for elective surgery were included. These study subjects were divided into five groups and randomly assigned to four different dosages of intranasal NTG and a placebo. Each group consisted of 20 patients. The NTG solution was administered 1 min before the injection of thiopental. Systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP) and heart rate (HR) were recorded before the induction of anesthesia (T1), before laryngoscopy (T2), and at 0, 3, and 5 min after tracheal intubation (T3, T4, and T5 respectively). RESULTS: In patients who received a placebo (control group), there were significant increases in SAP, MAP, HR and rate-pressure-product (RPP) associated with tracheal intubation. Tachycardia was noted in all experimental groups. The increases in MAP associated with tracheal intubation were significantly less in patients who received NTG of 0.5 mg or more but not 0.3 mg. Although 0.5 mg of NTG did attenuate the increases in SAP after tracheal intubation, the increases in SAP of the other three experimental groups were no less than that of the control group. Rate-pressure-product (RPP) values of the experimental groups were noted to be equal to or higher than those of the control group during the period of study. Contrary to the results of the study conducted by Grover et al., 0.75 mg of NTG did not attenuate the pressor responses. CONCLUSIONS: Intranasal NTG does not attenuate the pressor responses to laryngoscopy and tracheal intubation.

Administration, Intranasal↗
PubMed1996

[Hemodynamic response to intubation with Macintosh and McCoy blades].

INTRODUCTION: The McCoy laryngoscope incorporates a modification of the Macintosh blade designed to facilitate laryngoscopy and difficult intubation. One end is articulated to allow better viewing of the larynx. Use of this blade reduces pressure placed on tissues in the supraglottic area during laryngoscopy. OBJECTIVE: We designed this study to compare the hemodynamic repercussions of laryngoscopy and tracheal intubation (LTI) performed with either a Macintosh or the McCoy blade. PATIENTS AND METHOD: Sixty ASA I-II patients scheduled for elective surgery requiring LTI were randomly assigned to 2 groups of 30 patients each. In both groups anesthetic induction was achieved with 0.04 mg.kg-1 midazolam, 0.002 mg.kg-1 fentanyl, 2 mg.kg-1 propofol and 0.1 mg.kg-1 vecuronium. In group 1 LTI laryngoscopy and intubation were performed using the Macintosh size 3 blade and in group 2 the McCoy size 3 blade was used. Systolic and diastolic arterial pressures and heart rate were recorded in each patient before anesthetic induction (baseline), 1 minute after induction and 5 minutes after start of LTI. RESULTS: We found no significant differences between the 2 groups at any of the recording times. CONCLUSION: The data obtained do not allow us to assert that there is any difference in hemodynamic response to LTI associated to type of blade used.

Adolescent↗
PubMed1996

[Light-guided intubation using Trachlight].

BACKGROUND: A new intubating transilluminated device (Trachlight) has been recently proposed as an alternative to tracheal intubation with direct laryngoscopy. OBJECTIVE: 1) To evaluate Trachlight device in orotracheal intubation and to assess its operation and complications. 2) To compare the time consumption of transillumination intubation in respect to direct laryngoscopy on the same patients. METHODS: The first study was performed on 50 patients undergoing elective surgery and submitted to Trachlight intubation alone; speed of intubation, number of attempts and all complications were recorded and related to Mallampati classes. In the second study 16 patients undergoing to elective surgery were enrolled. Each patient was classified according to both the Mallampati classes and the Cormack classes. Each patient was submitted to two tracheal intubations: the first with the Trachlight and the second with conventional direct laryngoscopy performed by the same anesthesiologist. The time to intubation and the number of attempts were recorded and related to the Mallampati and Cormack classes. RESULTS: In the first study time of intubation with Trachlight was 20.93 +/- 13.02s (mean +/- SD) without statistical differences in respect to the Mallampati classes. In the second study the times to intubation were without any statistical difference independently of the technique of intubation and of the Mallampati or Cormack classes. CONCLUSIONS: Orotracheal intubation using Trachlight appears to be an effective and easy to learn technique, being also easy, safe and fast to carry out. The comparison with direct laryngoscopy showed the same speed and effectiveness even on patients with difficult intubation.

Adolescent↗
PubMedDate not supplied

[Diagnostic approach to acute laryngeal trauma: role of computerized tomography].

Aim of this study was to assess the role of Computed Tomography (CT) in the management of acute laryngeal injuries by reviewing our 5 years' experience. From January, 1991, to November, 1996, sixteen patients with blunt trauma and 2 patients with penetrating injuries of the larynx underwent physical examination, laryngoscopy and CT; 2 of them underwent angiography too. The patients were divided into 3 groups according to Schaefer classification [13], first on the basis of physical examination, CT and laryngoscopy findings. The definitive group and therapy were decided on the basis of final spatial assessment. Physical examination diagnosed the presence and the anatomical level of laryngeal injuries in group I (4 patients); laryngoscopy and CT depicted the type of injury and suggested conservative management in 100% of cases. In group II (10 patients), conservative management was suggested by CT findings in the laryngeal, submucosal soft tissues and fascial plane injuries in 100% of cases. Physical examination findings were correct in 30% of cases, questionable in 30% and incorrect in 30%; the exam was not performed in 10% of cases. Finally, laryngoscopy findings were correct in 60% of cases, incorrect in 20% and not diagnostic in 20%. In group III (2 patients), exposed laryngeal injuries required immediate surgery. In group II, the selective application of CT was useful for assessing the degree of damage in 100% of cases and was helpful in planning conservative management. CT avoided surgery in one patient, showed laryngeal cartilaginous features in 2 patients and 2 pseudoaneurysmal injuries not suspected on the basis of physical examination findings.

Adolescent↗
PubMed1998

The long-term complications of percutaneous dilatational tracheostomy.

Percutaneous dilatational tracheostomy was adopted at our institution, because it was demonstrated to be more cost effective than standard open tracheostomy in critically ill patients. The objective of this study was to evaluate the long-term outcome and complication rate of percutaneous dilatational tracheostomy in critically ill patients. We performed a consecutive case study of all Level I trauma patients from August 1991 to May 1994 who underwent percutaneous dilatational tracheostomy. All patients were prospectively evaluated by a standard questionnaire a minimum of 1 year after the procedure. All symptomatic patients were offered fiberoptic laryngoscopy. Descriptive statistical methods and the Student's T test were used to analyze the data. Of 7054 consecutive trauma admissions, 237 tracheostomies were performed. A total of 143 tracheostomies (60%) were open, and 95 (40%) were percutaneous. Of the 95 patients, 20 were lost to follow-up, 12 died from causes unrelated to the procedure, 6 had severe traumatic brain injuries and were unable to participate, and 2 patients required conversion to an open procedure. This left a study group of 55 patients. At a minimum of 1 year follow-up, 40 patients (73%) were asymptomatic. Of the 15 (27%) symptomatic patients, two patients had acute airway compromise after decannulation secondary to subglottic stenosis. Both were recannulated and subsequently decannulated uneventfully. Six patients declined fiberoptic laryngoscopy, because their symptoms were minimal (minor voice changes in three and intermittent hoarseness in three). Nine patients underwent fiberoptic laryngoscopy, and all examinations were normal. The mean cost of standard open tracheostomy at our institution is $1134 (58%) more than the mean cost of percutaneous dilatational tracheostomy. Of the study group patients undergoing percutaneous dilatational tracheostomy, 27 per cent complained of symptoms a minimum of 1 year posttracheostomy. Of these patients, 60 per cent underwent fiberoptic laryngoscopy, and no subglottic lesions were identified. Our findings suggest that percutaneous dilatational tracheostomy is a safe, cost-effective alternative to standard tracheostomy in critically ill patients.

Adolescent↗
PubMed1998

[Comparison of lidocaine and urapidil for prevention of hemodynamic response to tracheal intubation in patients in general good health].

OBJECTIVE: To compare the efficacy of endovenous administration of 0.5 mg/kg-1 of urapidil to 1 mg/kg-1 of lidocaine for attenuating hemodynamic response to laryngoscopy and tracheal intubation. PATIENTS AND METHODS: Study of 40 ASA I and II patients with normal blood pressure undergoing elective surgery under general anesthesia with orotracheal intubation. The patients were randomly assigned to two groups to receive either 0.5 mg/kg-1 of urapidil or 1 mg/kg-1 five minutes before anesthetic induction. Anesthesia was provided with 0.04 mg/kg-1 of midazolam, 2 micrograms/kg-1 of fentanyl, 2 mg/kg-1 of propofol, 0.1 mg/kg-1 of vecuronium before proceeding to orotracheal intubation, after electromyographic determination of neuromuscular response with T1 less than 5%, and laryngoscopy. Heart rate, systolic, diastolic and mean pressures, and the product of heart rate and mean arterial pressure (HR x MAP) were recorded at the following times: baseline (before administering either lidocaine or urapidil), after induction, after laryngoscopy and intubation, and 3 minutes and 5 minutes after intubation. RESULTS: ASA classification, age, sex and weight were similar in the two groups. Heart rate immediately after intubation, and after 3 and 5 minutes was significantly lower in the lidocaine group. Likewise HR x MAP immediately after intubation and 3 minutes later was significantly lower in the patients who received lidocaine. CONCLUSIONS: In healthy ASA I and II patients with normal blood pressure, a dose of 1 mg/kg-1 of lidocaine provided better protection against the hemodynamic response to laryngoscopy and tracheal intubation than does 0.5 mg/kg-1 of urapidil.

Adult↗
PubMed1997

Blunt laryngotracheal trauma in children.

OBJECTIVES: To demonstrate the diverse causes and manifestations of blunt laryngotracheal trauma in children, and to recommend an appropriate treatment protocol for these patients. DESIGN: A retrospective review of the medical records of patients treated at a tertiary care children's hospital for blunt laryngotracheal trauma during the 12 years before March 1, 1995 was performed. Clinical signs and symptoms, mechanisms of injury, and the results of laryngoscopy were included. PATIENTS: The study included 23 patients ranging from 2 1/2 to 18 1/2 years of age. The medical records of patients who had sustained an injury as a result of penetrating trauma, intubation, or foreign body were excluded. RESULTS: Four patients urgently required tracheotomies; 2 of these patients required subsequent reconstructive airway procedures. One child required a microlaryngoscopy with relocation of the arytenoid cartilage. The remaining 18 patients were treated conservatively with continuous pulse oximetry, cool mist room air, and serial flexible fiberoptic laryngoscopy. The 18 patients were discharged from the hospital after 24 to 48 hours of observation without sequelae. CONCLUSIONS: The signs and symptoms of blunt laryngotracheal trauma in children are not always specific to the extent or type of injury. A prompt diagnosis and treatment plan are needed to prevent potentially catastrophic complications. Patients with obvious airway compromise require immediate intervention. Those without acute airway symptoms often can be treated conservatively, provided that flexible fiberoptic laryngoscopy confirms a safe airway.

Adolescent↗
PubMed1982

Multiple simultaneous tumors in patients with head and neck cancer: a prospective, sequential panendoscopic study.

A prospective panendoscopic study (bronchoscopy, laryngoscopy, esophagoscopy) was carried out in 81 consecutively seen, untreated patients newly diagnosed as having a mucosal neoplasm in the upper aerodigestive tract, to determine how many had a synchronous second primary lesion of the aerodigestive tract. Fourteen patients (17%) proved to have multiple primary lesions (14 second-primary and two third-primary lesions). Three lesions were hypopharyngeal, six esophageal, three pulmonary, two laryngeal, and two oropharyngeal. Two of the additional lesions were found during routine head and neck examination, nine lesions would have been found with a single routine symptom- or roentgenogram-directed endoscopic examination; five, because of their location or small size, would not have been found without panendoscopy, even after chest roentgenography, indirect laryngoscopy, and barium esophagography had been done. The most productive endoscopic examinations for detecting second primary lesions were esophagoscopy and laryngoscopy, the former detecting six lesions, the latter five lesions. The yield of chest roentgenograms was low (1/79). No complications resulted from this prospective panendoscopic protocol study. THese findings should reinforce the belief that head and neck cancer is a panmucosal disease of the aerodigestive tract, that silent second synchronous primary lesions are not uncommon, and that every effort should be made to find all primary sites before treatment of the index tumor is begun.

Bronchoscopy↗
PubMed1999

Double lumen tube placement with the Bullard laryngoscope.

PURPOSE: Placement of double lumen tubes (DLTs) in both normal and difficult airways may be considerably more difficult than standard laryngoscopy and intubation using standard tracheal tubes. Alternative techniques to place DLTs have not been uniformly successful and alternative tracheal tubes do not provide the versatility afforded by the DLT. We intubated the tracheas of patients undergoing thoracic procedures requiring DLTs with the Bullard laryngoscope (BL) to determine its efficacy and outline its shortcomings. METHODS: Twenty nine consecutive patients scheduled for general anesthesia requiring DLT were evaluated. The laryngeal view, time to intubation and the reason for any difficulty with intubation were recorded. Any patient who required a second DLT placement had the second attempt performed via standard laryngoscopy. RESULTS: The time to laryngoscopy was 9+/-5 sec, and the time to intubation was 28+/-10 sec. All patients had Cormack scores of grade of 1 through the BL. The placement of the bronchial lumen of the DLT was found to be in the correct location (left mainstem bronchus) in 9 of 28 patients. CONCLUSION: The BL appears to be effective in the placing DLT into the trachea of patients.

Adult↗
PubMed1996

Esmolol blunts the haemodynamic responses to tracheal intubation in treated hypertensive patients.

PURPOSE: To compare the ability of different bolus doses of esmolol to blunt the haemodynamic effects of laryngoscopy and tracheal intubation in treated hypertensive patients. METHODS: In this randomised, double-blind placebo controlled study, 45 ASA II patients, treated for essential hypertension with drugs other than beta blockers, were divided into three groups of 15 patients each. Patients in different groups either received 20 ml normal saline (Group P), or 100 mg esmolol (Group E100) or 200 mg esmolol (Group E200) as a single bolus intravenous dose before laryngoscopy and intubation. Systolic, diastolic and mean arterial pressure and heart rate were monitored for up to 10 min following intubation and were compared with respective basal readings as well as across groups. RESULTS: Esmolol alone reduced systolic arterial pressure (P < 0.01 in Group E100 and P < 0.001 in Group E200) and heart rate (P < 0.001). Though there was an increase in arterial pressure and heart rate in the control group, esmolol 100 mg maintained arterial pressure and heart rate at levels comparable to basal values throughout the study (P > 0.05). Patients receiving esmolol 200 mg had lower values (P < 0.001) than their basal readings during most of the post-intubation study period. CONCLUSION: Esmolol 100 mg given as bolus, is effective as well as safe in blunting the haemodynamic responses to laryngoscopy and tracheal intubation in treated hypertensive patients.

Adrenergic beta-Antagonists↗
PubMed1999

Assessment of laryngeal view: percentage of glottic opening score vs Cormack and Lehane grading.

PURPOSE: To examine the intra- and inter-rater reliability of two methods that categorize laryngeal view during direct laryngoscopy, the Cormack-Lehane grading system and a new scale, the percentage of glottic opening (POGO) scale. METHODS: Seven anesthesiologists from the University of Pennsylvania Health System viewed 25 identical pairs of slides of laryngeal views during direct laryngoscopy. Each anesthesiologist rated the 50 slides for both Cormack-Lehane grades and POGO scores. The latter CL replaces grades 1 and 2 C-L grades with a percentage of glottic opening: the POGO score. Inter and intra-physician reliability for the Cormack-Lehane grades were determined using the kappa statistic analysis, comparison of POGO scores was performed using the intraclass correlation coefficients (rI). RESULTS: The POGO score had a better inter and intra-physician reliability than the Cormack-Lehane grading system. The intra-physician reliability for the POGO score was very good with an average interclass rI value of 0.88. The inter-physician score was good with a rI of 0.73. The Cormack-Lehane grading system had excellent intra-physician concordance (average kappa = 0.83.) but the inter-physician reliability was poor (kappa = 0.16.) CONCLUSION: The Cormack-Lehane grading system has very poor inter-physician reliability. The lack of inter-physician reliability with Cormack-Lehane grading calls into question the results of previous studies in which different laryngoscopists used this method to assess laryngeal view. The POGO score appears to have good intra and inter-rater reliability. It has several theoretical advantages and may prove to be more useful for research studies in direct laryngoscopy.

Glottis↗
PubMed2000

Difficult airway management: comparison of the Bullard laryngoscope with the video-optical intubation stylet.

PURPOSE: To evaluate, whether the video-optical intubation stylet (VOIS) was more successful for difficult tracheal intubation than the Bullard laryngoscope (BL). METHODS: An intubation mannequin head was modified so that, using a Macintosh blade size 3, only the epiglottis was visible at direct laryngoscopy, representing a grade III laryngoscopic view. Forty anesthesiologists attempted tracheal intubation using each technique. Tracheal intubation with the Bullard laryngoscope was performed using the attached non-malleable intubating stylet preloaded with an endotracheal tube. The video-optical intubation stylet inserted into an endotracheal tube was used with direct laryngoscopy. During conventional laryngoscopy, the video-view from the stylet tip allowed the tracheal tube to be guided behind the epiglottis into the trachea. Ten attempts with each technique were performed by each anesthesiologist in randomized order. Intubation time, and failed intubation (> 60 sec/esophageal intubation) were recorded. The operators assessed the degree of difficulty of each method using a Likert-scale. RESULTS: Mean intubation time (19.2+/-4.5 sec for the BL and 18.8+/-4.6 sec for the VOIS) was almost the identical. The video-optical intubation stylet was associated with fewer failed intubations (8 vs. 41; P<0.005) and had a lower degree of difficulty (1.7+/-0.65 for the VOIS and 2.6+/-0.74 for the BL; P<0.0001). No correlation was found between the anesthesiologist's experience and mean intubation time, estimated degree of difficulty or number of unsuccessful intubation. CONCLUSION: The video-optical intubation stylet was a more effective and simpler intubation device to facilitate difficult tracheal intubation than the Bullard laryngoscope.

Epiglottis↗
PubMed2003

Endotracheal intubation with a lightwand or a laryngoscope results in similar hemodynamic variations in patients with coronary artery disease.

PURPOSE: To asses the cardiovascular changes after either lightwand or conventional laryngoscopic endotracheal intubation (EI) in patients with coronary artery disease. METHODS: Following Institutional approval and informed consent, 80 consecutive patients undergoing elective coronary artery bypass grafting were enrolled in this prospective, controlled, single-blinded study. General anesthesia was induced with fentanyl 5 micro x kg(-1) and thiopental 5 mg x kg(-1) followed by pancuronium 0.1 mg x kg(-1). After loss-of-eyelash reflex the lungs were manually ventilated with 2% isoflurane in oxygen for five minutes. Patients were then randomly allocated to receive either the lightwand (lightwand group, n = 41) or direct-vision laryngoscopy (laryngoscopy group, n = 39). Heart rate (HR) and direct blood pressure were recorded before induction, after induction but before EI, during EI, immediately after EI and at ten-second intervals for the following five minutes. Hemodynamic management during induction was standardized. Hypotension was treated with volume replacement, ephedrine, or phenylephrine as indicated; hypertension was treated with iv nitroglycerin; tachycardia was treated with boluses of esmolol; and, bradycardia was treated with atropine or ephedrine. RESULTS: In both groups, mean arterial blood pressures and HR increased significantly after EI. There was a tendency for the lightwand group to have lower arterial blood pressures and slower HR. However, the differences between the two groups did not reach statistical significance. Requirements for drugs to control HR and mean arterial pressure were similar in both groups. CONCLUSION: In patients with coronary artery disease using a lightwand intubation technique does not modify the hemodynamic response associated with EI as compared with standard direct-vision laryngoscopy.

Aged↗
PubMed2002

Tracheal intubation in children with Morquio syndrome using the angulated video-intubation laryngoscope.

PURPOSE: There are a number of syndromes with proven or suspected instability of the cervical spine especially in pediatric patients. It is a challenge for the anesthesiologist to intubate these patients with as little movement of the cervical spine as possible. A new device to facilitate this task is the angulated video-intubation laryngoscope (AVIL). CLINICAL FEATURES: The AVIL is a curved endoscopic intubation laryngoscope with angulated distal tip. The video-view from the distal blade tip improves glottic visualization during difficult direct laryngoscopy. We report three sisters with Morquio syndrome scheduled for otorhinolaryngology surgery the same day. Two of them had radiologically suspected cervical spine instability. Tracheal intubation was planned with careful direct laryngoscopy under manual in-line stabilization of the neck and head by an assistant. Direct visualization of the larynx using a Miller blade No. 2 was impaired in two of the three children in whom the cervical spine was immobilized. They were both successfully intubated under endoscopic control using the AVIL. CONCLUSION: The AVIL may become a helpful device to aid endotracheal intubation in patients when cervical spine immobilization impairs direct laryngoscopy.

Child↗
PubMed1997

Fixity of vocal cords and laryngocele in acromegaly.

Acromegalic patients have a reduced life expectancy mainly due to cardio-, cerebrovascular and respiratory disorders and increased prevalence of neoplasias. Particularly, the pathogenesis of respiratory disorders in acromegalics is debated. Laryngeal abnormalities are not yet well clarified even if they are frequently involved in the occurrence of respiratory insufficiency. In this study, we report on a 65 year-old acromegalic male suffering from frequent and severe dyspnea attacks and clinical findings of respiratory upperway obstruction, besides the common acromegalic features. At the external examination of the larynx, a bilateral painless and soft mass, located in the laterocervical region under the hyoid bone, was detected. Fiberoptic laryngoscopy, showed bilateral swelling between the aryepiglottic fold and the false vocal cords, whose size increased during the expiration and the phonation, fixity of the vocal cords in paramedian position, with a marked reduction of the respiratory space and increase in arytenoid cartilage size and mucosal edema. Neck and mediastinum CT scan showed the presence of an air containing bilateral swelling, crossing the thyrohyoid membrane. Bilateral cricoarytenoidal joint chondrocalcification, associated to a mixed-type bilateral laryngocele, was diagnosed. Laryngoceles were both surgically removed and a left monolateral arytenoidectomy was performed, using fiberoptic microlaryngoscopy with CO2 laser. The clinical evaluation, one month later, confirmed the complete disappearance of dyspnea and a partial improvement of phonation. Three months later, laryngoscopy showed the bilateral restoration of vocal cords motility and a significant improvement of phonation. This case presents an uncommon and severe respiratory problem in acromegaly such as the fixity of vocal cords associated to laryngocele. Circulating GH and IGF-I hypersecretion caused edema and laxity of laryngeal mucosa as well as bilateral ankylosis of cricoarytenoidal joints. The use of CO2 laser technique via micro-laryngoscopy successfully resolved laryngeal abnormalities.

Acromegaly↗
PubMed1998

[The difficult intubation. The value of BURP and 3 predictive tests of difficult intubation].

UNLABELLED: The value of BURP (= backwards-upwards-rightwards-pressure of the larynx) was tested as a improvement of the visualisation of the larynx. Simultaneously we wanted to assess the value of different predictive tests of a difficult intubation, which are easy to perform as bedside tests. PATIENTS AND MATERIAL: 1993 patients of all different surgical clinics in a tertiary care hospital in Switzerland were tested, the complete anaesthesiological staff was involved. We registered the original Mallampati classes, the thyromental distances of Patil and Frerk and the difference of the jugulomental distances in maximally reclined and neutral head position according to Chow. Every anaesthetist also noted his personal, subjective opinion of a possible difficult intubation. Under optimal conditions for intubation we assessed the grade of laryngoscopy according to Wilson and applied BURP if the grade was 3 or higher. Both laryngoscopic grades and the difficulty of intubation were noted. RESULTS: In our study we found 12.5% awkward (Wilson G3-G5) and 4.7% difficult (Wilson G4-G5) laryngoscopies. These could be changed with BURP into 5.0% and 1.9% respectively. With BURP we found 1.8% of difficult intubations. During our study we did not find any patients, whom we could not intubate either with a mandrin inside the tube or with help of the fiberoptic. The relation between sensitivity and specificity was in all single predictors and in two combinations very low. Our personal subjective predictions proofed to be better, but the rate of false negatives was too high for clinical use. CONCLUSION: BURP is a valuable method for rendering the majority of difficult laryngoscopies into easy ones. It is very easy to learn and does not need any additional equipment. Three commonly used and recommended predictive tests of the difficult intubation proofed to be of little use in clinical practice.

Adolescent↗
PubMed2003

The role of 70-degree telescopic examination during direct laryngoscopic evaluation of laryngeal cancers.

Endoscopy has currently been an indispensable method in many areas of otorhinolaryngology, especially in paranasal sinus surgery. Telescopic evaluation of the larynx has not drawn much attention. In this study, a 70-degree angled rigid telescope was used along with computerized tomography (CT), indirect and direct laryngoscopy in the evaluation of laryngeal cancer. The critical areas such as the anterior commissure, subglottic region and ventricles were investigated specifically. Nineteen patients were collected in the study. We found the sensitivity for indirect laryngoscopy to be 20-25% and for direct laryngoscopy to be 50-70%. The scores for CT and 70-degree telescopy were 70-100%. In the subglottic region telescopy was superior to CT. We believe that, when it is used in association with CT, telescopy provides better insight when deciding between partial or total laryngectomy and a healthier evaluation of the resection margin.

Adult↗
PubMed1994

Omeprazole for the treatment of posterior laryngitis.

PURPOSE: To determine whether the patients with refractory posterior laryngitis respond to treatment with omeprazole. PATIENTS AND METHODS: Sixteen consecutive patients with persistent posterior laryngitis despite prior therapy with H2 blockers were recruited from outpatient university otolaryngology and gastroenterology practices. Patients received 6 to 24 weeks of omeprazole 40 mg qhs, which was increased to 40 mg twice a day for 6 weeks in four patients with continuing symptoms. Laryngoscopy, esophagoscopy, and esophageal/laryngeal symptom questionnaire were completed at entry to the study. Laryngoscopy and the questionnaire were repeated at the conclusion of the study. A follow-up questionnaire was completed at 6 weeks. RESULTS: Laryngoscopy scores improved from 4.44 to 1.94 (nonblinded otolaryngologist) and 4.31 to 1.88 (blinded otolaryngologist) (P < 0.05). Laryngeal and esophageal symptom indices improved from 13.94 and 9.00 to 3.00 and 0.38, respectively (P < 0.05). Symptom indices increased to 7.00 and 7.33, respectively, after the discontinuation of therapy (P < 0.05 compared with the conclusion of the study). One patient intolerant of omeprazole underwent fundoplication and was asymptomatic 6 weeks after surgery. Only 3 patients had esophagitis at entry. CONCLUSIONS: The signs and symptoms of posterior laryngitis improve with the administration of omeprazole and symptoms recur after discontinuation of therapy, suggesting that reflux is the underlying etiology. Patients with refractory symptoms, but intolerant of omeprazole, may benefit from antireflux surgery. Laryngoscopic findings of posterior laryngitis are often subtle, and many patients with posterior laryngitis do not have esophagitis.

Adult↗