Phonomyography as a Novel Method to Determine Meeting Abstracts at the Laryngeal Adductor Muscles

2003 ◽  
Vol 98 (2) ◽  
pp. 359-363 ◽  
Author(s):  
Thomas M. Hemmerling ◽  
Denis Babin ◽  
François Donati
Keyword(s):  
Endotracheal Tube ◽  
Neuromuscular Blockade ◽  
Cuff Pressure ◽  
Maximum Effect ◽  
Vocal Cords ◽  
Pressure Method ◽  
Single Twitch ◽  
Adductor Muscles ◽  
Significant Difference ◽  
Train Of Four

Background Neuromuscular blockade at the laryngeal adductor muscles may be measured using the cuff of a endotracheal tube placed between the vocal cords. Phonomyography is an alternative method of neuromuscular monitoring. In this study, phonomyography is applied to determine blockade at the larynx and compared with the cuff pressure method. Methods After the authors obtained approval from the ethics committee and informed consent, 28 patients were entered in the study. After induction of anesthesia, a endotracheal tube was inserted. Its cuff was placed in the trachea in routine fashion (n = 14) or between the vocal cords (n = 14). In all patients, a small condenser microphone was placed in the vestibular fold, just lateral to the tube, next to the laryngeal adductor muscles. The recurrent laryngeal nerve was stimulated supramaximally with single twitch stimulation (0.1 Hz) for onset, and train-of-four stimulation every 12 s during offset of neuromuscular blockade was produced by 0.1 mg/kg mivacurium. Onset and recovery of neuromuscular blockade measured by the two methods were compared using the test (P < 0.05), and a Bland-Altman test was performed to define agreement between the two methods. Onset and recovery of neuromuscular blockade measured by phonomyography with the cuff placed between the vocal cords or in the trachea were compared using the test (P < 0.05). Results Mean onset, maximum effect, and time to reach 25% and 75% of control twitch response for phonomyography cuff pressure method were 145 s (SD, 25) 156 s (SD, 33), 89% (SD, 4) 91% (SD, 4), 9 min (SD, 4) 10 min (SD, 3), and 27 min (SD, 4) 29 min (SD, 4), respectively, without being significantly different. Mean bias was -2%, with limits of agreement of -20 and +18% for all signals (cuff method minus phonomyography). There was no significant difference in onset and offset of neuromuscular blockade measured using phonomyography with the cuff placed between the vocal cords or in the trachea. Conclusions Both methods can be used interchangeably to determine neuromuscular blockade of the laryngeal adductor muscles. Phonomyography allows measurement of laryngeal blockade with the endotracheal tube in the normal position.

Prehospital Intubations Are Associated with Elevated Endotracheal Tube Cuff Pressures: A Cross-Sectional Study Characterizing ETT Cuff Pressures at a Tertiary Care Emergency Department

2021 ◽  
pp. 1-4
Author(s):  
Ruo S. Chen ◽  
Laurel O’Connor ◽  
Matthew R. Rebesco ◽  
Kara L. LaBarge ◽  
Edgar J. Remotti ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Cuff Pressure ◽  
Care Center ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Endotracheal Tube Cuff ◽  
Cross Sectional ◽  
Tube Cuff ◽  
Respiratory Therapists ◽  
Significant Difference

Abstract Introduction: Emergency Medical Services (EMS) providers are trained to place endotracheal tubes (ETTs) in the prehospital setting when indicated. Endotracheal tube cuffs are traditionally inflated with 10cc of air to provide adequate seal against the tracheal lumen. There is literature suggesting that many ETTs are inflated well beyond the accepted safe pressures of 20-30cmH2O, leading to potential complications including ischemia, necrosis, scarring, and stenosis of the tracheal wall. Currently, EMS providers do not routinely check ETT cuff pressures. It was hypothesized that the average ETT cuff pressure of patients arriving at the study site who were intubated by EMS exceeds the safe pressure range of 20-30cmH2O. Objectives: While ETT cuff inflation is necessary to close the respiratory system, thus preventing air leaks and aspiration, there is evidence to suggest that over-inflated ETT cuffs can cause long-term complications. The purpose of this study is to characterize the cuff pressures of ETTs placed by EMS providers. Methods: This project was a single center, prospective observational study. Endotracheal tube cuff pressures were measured and recorded for adult patients intubated by EMS providers prior to arrival at a large, urban, tertiary care center over a nine-month period. All data were collected by respiratory therapists utilizing a cuff pressure measurement device which had a detectable range of 0-100cmH2O and was designed as a syringe. Results including basic patient demographics, cuff pressure, tube size, and EMS service were recorded. Results: In total, 45 measurements from six EMS services were included with ETT sizes ranging from 6.5-8.0mm. Mean patient age was 52.2 years (67.7% male). Mean cuff pressure was 81.8cmH2O with a range of 15 to 100 and a median of 100. The mode was 100cmH2O; 40 out of 45 (88.9%) cuff pressures were above 30cmH2O. Linear regression showed no correlation between age and ETT cuff pressure or between ETT size and cuff pressure. Two-tailed T tests did not show a significant difference in the mean cuff pressure between female versus male patients. Conclusion: An overwhelming majority of prehospital intubations are associated with elevated cuff pressures, and cuff pressure monitoring education is indicated to address this phenomenon.

scholarly journals Effect of Nutritional Status on Vecuronium Induced Neuromuscular Blockade

1998 ◽  
Vol 26 (4) ◽  
pp. 392-395 ◽  
Author(s):  
S. Sinha ◽  
A. K. Jain ◽  
A. Bhattacharya
Keyword(s):  
Nutritional Status ◽  
Neuromuscular Blockade ◽  
Marked Effect ◽  
Elective Surgery ◽  
Severe Malnutrition ◽  
Onset Of Action ◽  
Duration Of Action ◽  
Significant Difference ◽  
Train Of Four ◽  
Time To Onset

Based on simple clinical and biochemical parameters of nutritional status, seventy adult patients scheduled for elective surgery under general anaesthesia were categorized as having normal nutrition, mild, moderate or severe malnutrition or obesity Under anaesthesia, evoked responses on train-of-four nerve stimulation were recorded every 15 seconds on a mechanomyograph. Vecuronium 0.1 mg.kg-1 was used to achieve neuromuscular blockade. Compared with patients having normal nutrition, the time to onset of action was significant& prolonged in the moderate and severely malnourished groups; the time to no response on train-of-four stimulation was delayed only in severely malnourished groups (P<0.001). The duration of action of the initial dose was shorter in the moderate and severely malnourished groups. The obese group had an earlier onset of action and a longer duration of action compared with patients of normal nutrition (P<0.001). No significant difference in recovery time to a train-of-four ratio of 0.70 was observed between the malnourished and patients with normal nutrition. Malnutrition hus a marked effect on vecuronium-induced neuromuscular blockade.

scholarly journals Quantitative Relationships between Pulmonary Function and Residual Neuromuscular Blockade

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
ShuYing Fu ◽  
WenDong Lin ◽  
XiNing Zhao ◽  
ShengJin Ge ◽  
ZhangGang Xue
Keyword(s):  
Pulmonary Function ◽  
Neuromuscular Blockade ◽  
Demographic Data ◽  
Preoperative Evaluation ◽  
Tracheal Extubation ◽  
Postanesthesia Care Unit ◽  
Predictive Values ◽  
Residual Neuromuscular Blockade ◽  
Significant Difference ◽  
Train Of Four

Background. Neuromuscular blockade is a risk factor for postoperative respiratory weakness during the immediate postoperative period. The quantitative relationships between postoperative pulmonary-function impairment and residual neuromuscular blockade are unknown. Methods. 113 patients who underwent elective laparoscopic cholecystectomy were enrolled in this study. They all had a pulmonary-function test (PFT) during the preoperative evaluation. Predictive values based on demographic data were also recorded. The train-of-four ratio (TOFR) was recorded at the same time as the PFT and at every 5 minutes in the qualified 98 patients in the postanesthesia care unit (PACU). We analyzed the degree of PFT recovery when the TOFR had recovered to different degrees. Results. There was a significant difference (P<0.05) between the preoperative baseline value and the postoperative forced vital capacity at each TOFR point, except at a TOFR value of 1.1. There was also a significant difference (P<0.05) between the preoperative baseline value and the postoperative peak expiratory flow at each TOFR point. Conclusions. Postoperative residual neuromuscular blockade was common (75.51%) after tracheal extubation, and pulmonary function could not recover to an acceptable level (85% of baseline value), even if TOFR had recovered to 0.90. Trial Registration. Chinese Clinical Trial Register is ChiCTR-OOC-15005838.

scholarly journals Evaluating the effect of calcium chloride in combination with neostagmine and atropine against residual neuromuscular blockade at the end of general anesthesia

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M M Marzouk ◽  
R A Shoukry ◽  
S A Refaat ◽  
A M Fathi
Keyword(s):  
General Anesthesia ◽  
Endotracheal Tube ◽  
Calcium Chloride ◽  
Neuromuscular Blockade ◽  
P Value ◽  
Double Blind ◽  
Residual Neuromuscular Blockade ◽  
Significant Difference ◽  
Group A ◽  
Group B

Abstract Background Muscle relaxants used in general anesthesia during the insertion of an endotracheal tube (ETT) to relax the muscles of the neck and throat, which reduces the risk of injury. They also are used to relax the chest muscles when an endotracheal tube is used to aid mechanical ventilation. Objective The aim of this study has been to evaluate the effect of calcium chloride coadministered with neostigmine and atropine on neuromuscular blockade recovery time at the end of general anesthesia. And compare it’s effect against usual neuromuscular reverse of neostigmine and atropine. Patients and Methods In this present study we use Double blind prospective randomized Clinical trial study, 30 patients were enrolled. They were divided in two groups each of which contains 15 patients: Group (A): received 5 mg/kg of calcium chloride coadministered with 25 μg/kg of neostigmine and 15 μg/kg of atropine at the end of surgery. Group (B): received the same volume of normal saline coadministered with 25 μg kg of neostigmine and 15 μg / kg of atropine at the end of surgery. Results Comparison between calcium and neostigmine groups according TOF at 5 minutes and 10 minutes using Independent t-test, P- value was less than 0.01 which means that there is high significant difference between 2 groups. On the other hand, TOF at 20 minutes in calcium and neostigmine groups shows no difference at all. Conclusion So Calcium chloride elevate serum calcium level, calcium has antineuromuscular blockade effect, therefore calcium chloride increase TOF and enhance neuromuscular recovery and decrease the PORC after neostigmine administration.

scholarly journals The Effect of Adjustment of Endotracheal Tube Cuff Pressure during Scarless Remote Access Endoscopic and Robotic Thyroidectomy on Laryngo-Pharyngeal Complications: Prospective Randomized and Controlled Trial

2019 ◽  
Vol 8 (11) ◽  
pp. 1787 ◽  
Author(s):  
Chang-Hoon Koo ◽  
Hye-Min Sohn ◽  
Eun-Su Choi ◽  
June-Yong Choi ◽  
Ah-Young Oh ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Cuff Pressure ◽  
Controlled Trial ◽  
Robotic Thyroidectomy ◽  
Remote Access ◽  
Control Group ◽  
Endotracheal Tube Cuff ◽  
Tube Cuff ◽  
Significant Difference ◽  
Endotracheal Tube Cuff Pressure

Scarless remote access endoscopic and robotic thyroidectomy has been recently performed as a safe and feasible method. However, little is known about the laryngo-pharyngeal complications after surgery and the effect of adjusting the endotracheal tube cuff pressure during surgery on laryngo-pharyngeal complications. Patients were randomized into two groups: the control group (n = 52) and adjusted group (n = 52). The initial cuff pressure was set to 25 mmHg and then monitored without adjustment (control group) or with adjustment at approximately 25 mmHg (adjusted group) throughout surgery. The incidences and severity of postoperative sore throat (POST), hoarseness, dysphagia, and cough were recorded at 1, 6, 24, and 48 h after surgery. Cuff pressures of the control group changed significantly over time and were higher than those of the adjusted group. The incidence of POST was lower in the adjusted group at 24 h postoperatively (p = 0.035), and there was a significant difference in the severity of POST at 6 and 24 h postoperatively between the two groups. There were no differences in the incidence of hoarseness, dysphagia, and cough between the two groups, except dysphagia and cough at 6 h postoperatively. Therefore, intraoperative monitoring and adjustment of the cuff pressure can reduce the incidence of laryngo-pharyngeal complications.

scholarly journals The change of endotracheal tube cuff pressure during laparoscopic surgery

Open Medicine ◽  
2019 ◽  
Vol 14 (1) ◽  
pp. 431-436 ◽  
Author(s):  
Youngsuk Kwon ◽  
Ji Su Jang ◽  
Sung Mi Hwang ◽  
Jae Jun Lee ◽  
Seok Jun Hong ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Laparoscopic Surgery ◽  
Endotracheal Tube ◽  
Cuff Pressure ◽  
Control Group ◽  
Study Group ◽  
Endotracheal Tube Cuff ◽  
Tube Cuff ◽  
Significant Difference ◽  
Endotracheal Tube Cuff Pressure

AbstractBackgroundWe evaluated the endotracheal tube cuff pressure (Pcuff) changes during pneumoperitoneum for laparoscopic cholecystectomy and the correlations between body mass index (BMI), pneumoperitoneum time, and Pcuff changes.MethodsTotal 60 patients undergoing laparoscopic cholecystectomy were allocated to either a study group (BMI ≥ 25 kg/m2) or a control group (BMI < 25 kg/m2). The endotracheal intubation was performed with a high-volume low-pressure cuffed oral endotracheal tube. A manometer was connected to the pilot balloon using a 3-way stopcock and the cuff was inflated. The change in Pcuff was defined as the difference between the pressure just before intra-abdominal CO2 insufflation and the pressure before CO2 desufflation.ResultsPcuff increased to 5.3 ± 3.6 cmH2O in the study group and 5.7 ± 5.4 cmH2O in the control group. There was no significant difference between two groups. While BMI was not correlated with change in Pcuff (r = 0.022, p = 0.867), there was a significant correlation between change in Pcuff and the duration of pneumoperitoneum (r = 0.309, p = 0.016).ConclusionThe change in Pcuff was not affected by BMI and was significantly correlated with pneumoperitoneum time. We recommend regular measurement and adjustment of Pcuff during laparoscopic surgery.

New Ultrathin-walled Endotracheal Tube with a Novel Laryngeal Seal Design

1996 ◽  
Vol 84 (1) ◽  
pp. 162-172 ◽  
Author(s):  
Chiara Reali-Forster ◽  
Theodor Kolobow ◽  
Matteo Giacomini ◽  
Tomayoshi Hayashi ◽  
Koji Horiba ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
The Novel ◽  
Air Leak ◽  
Vocal Cords ◽  
Mechanically Ventilated ◽  
Seal Design ◽  
Significant Difference ◽  
Short And Long Term ◽  
Indicator Dye ◽  
Pressure Seal

Background A new endotracheal tube (ETT) was fabricated and tested in sheep. It had no tracheal cuff; airway seal was achieved at the level of the glottis through a no-pressure seal made of "gills"; the laryngeal portion was oval-shaped; and the wall thickness was reduced to 0.2 mm. Methods Sheep were tracheally intubated either with a standard tube or with the new tube, and their lungs were mechanically ventilated for 1 or 3 days. Air leak was recorded at different peak inspiratory pressures (PIPs). Liquid seepage into the trachea was assessed using an indicator dye. Tracheolaryngeal lesions were scored grossly and histologically. Results There was no air leak up to 40 cmH2O of PIP, in either group, in short- and long-term studies. Methylene blue leaked across the cuff in two sheep with standard ETTs. No dye leaked across the gills with the new ETTs. In the new ETT group, the trachea appeared better preserved, grossly and histologically, than in the standard ETT group at both 1 and 3 days (P &lt; 0.05). At day 1, the larynx and vocal cords appeared grossly less injured in the new ETT group (P &lt; 0.05), whereas there was no difference at day 3. Histology did not show significant difference on vocal cords, epiglottis, and larynx between the two groups at any time. Conclusions The novel, no-pressure seal design of the new ETT is highly effective in preventing air leak and aspiration. It causes no significant tracheal injury.

scholarly journals LOW FLOW ANESTHESIA

2016 ◽  
Vol 23 (12) ◽  
pp. 1522-1526
Author(s):  
Hamid Raza ◽  
Bashir Ahmed ◽  
Mr Kamlaish
Keyword(s):  
Laryngeal Mask Airway ◽  
Endotracheal Tube ◽  
Cuff Pressure ◽  
Tertiary Care ◽  
Laryngeal Mask ◽  
Low Flow ◽  
Care Hospital ◽  
Asa Classification ◽  
Significant Difference ◽  
Low Flow Anesthesia

Objectives: The aim of our study is to determine the incidence of complicationswhen using Laryngeal mask airway and compare it with endotracheal tube intubation, duringadministration of low flow anesthesia. Study Design: A randomized control trial. Period: 3months from February 2015 to April 2015. Setting: Tertiary Care Hospital in Karachi Pakistan.Materials and Methods: The study population consisted of n= 100 patients who underwentelective operative procedures of the eye. Patients who belonged to the ASA classification typeI and II were allocated into two groups using a random number generator. Group A consistedof all the patients on whom endotracheal tube was used as airway and group B included all thepatients on whom Laryngeal mask airway was used. The complications were noted on a predesignedproforma. Data was analyzed using SPSS version 23. Results: The study populationconsisted of n= 100 patients out of which n= 43 were males and n= 57 were females, 42%of the patients belonged to ASA classification I and 58% belonged to the ASA classificationII. Leakage of air was observed in 7% of the patients, postoperative shivering was observedin 20%, sore throat was observed in n= 22 patients, of which n= 18 patients belonged to theETT group and n= 4 patients belonged to the LMA group. Endotracheal carbon dioxide levelsdid not show any significant difference. Conclusion: According to the results of our study,Laryngeal mask airway has a lower incidence of post-operative complications, provided that itspositioning and cuff pressure are noted and maintained regularly, and it can be used as a safealternative to endotracheal intubation when using low flow controlled anesthesia respectively.

Mivacurium Neuromuscular Block at the Adductor Muscles of the Larynx and Adductor Pollicis in Humans

1996 ◽  
Vol 85 (1) ◽  
pp. 77-81 ◽  
Author(s):  
Benoit Plaud ◽  
Bertrand Debaene ◽  
Frank Lequeau ◽  
Claude Meistelman ◽  
Francois Donati
Keyword(s):  
Neuromuscular Block ◽  
Onset Time ◽  
Pressure Change ◽  
Peak Effect ◽  
Adductor Pollicis ◽  
Vocal Cords ◽  
Laryngeal Muscles ◽  
Time To Peak ◽  
Adductor Muscles ◽  
Train Of Four

Background Laryngeal muscles must be paralyzed for tracheal intubation. Time to peak effect (onset time) is shorter and intensity of blockade is less at laryngeal muscles compared with the adductor pollicis. The authors' aim in this study was to determine the neuromuscular effects of mivacurium at the laryngeal adductor muscles and the adductor pollicis. Methods In 22 adults, anesthesia was induced and maintained with propofol and alfentanil. The force of contraction of the adductor pollicis was recorded, and the laryngeal response was evaluated by measuring the pressure change in the cuff of a tracheal tube positioned between the vocal cords after train-of-four stimulation. Mivacurium (0.07 mg.kg-1 or 0.14 mg.kg-1) was given intravenously (10s). Results With 0.07 mg.kg-1 mivacurium, onset time was 151 +/- 40 s(mean +/- SD) at the larynx and 241 +/- 79 s at the adductor pollicis, respectively (P &lt; 0.005). Maximum block was 78 +/- 18% and 95 +/- 8%, respectively (P &lt; 0.002), and time to 90% recovery was 11.1 +/- 2.9 min and 23.3 +/- 7.6 min, respectively (P &lt; 0.001). With 0.14 mg.kg-1 mivacurium, onset time also was more rapid at the vocal cords (137 +/- 20 s) than at the adductor pollicis (201 +/- 59 s, P &lt; 0.01). Maximum block was 90 +/- 7% and 99 +/- 1% (P &lt; 0.005), and time to 90% recovery was 16.4 +/- 4.9 min and 27.4 +/- 7.8 min, respectively (P &lt; 0.01). Conclusions With mivacurium, onset and recovery are faster at the laryngeal muscles, but block is less intense than at the adductor pollicis. A dose greater than 0.14 mg.kg-1 mivacurium is necessary to ensure complete relaxation at the vocal cords.

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