Evaluation of the time to desensitization of the larynx of cats following topical lidocaine application

2020 ◽  
pp. 1098612X2096788
Author(s):  
Teela L Jones ◽  
Kyrissa Boyer ◽  
Kelly Chapman ◽  
Brea Craigen ◽  
Anderson da Cunha ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Endotracheal Tube ◽  
Direct Laryngoscopy ◽  
Respiratory Complications ◽  
Vocal Cords ◽  
Topical Lidocaine ◽  
Mixed Breed ◽  
Significant Difference ◽  
Stimulation Of ◽  
Reactivity Score

Objectives The objective of this study was to evaluate the time to decreased reactivity of the arytenoid cartilages in cats after application of topical lidocaine. Methods One hundred and ten mixed-breed cats were randomly assigned to one of five groups based on the time between application of lidocaine and stimulation of the larynx: 5 (T5), 15 (T15), 30 (T30), 45 (T45) or 60 (T60) s. Cats were premedicated with dexmedetomidine, ketamine and buprenorphine. Anesthesia was induced with propofol to effect. Lidocaine 2% (2 mg/kg) was applied topically to the vocal cords using a catheter attached to a syringe under direct laryngoscopy. After lidocaine application, the designated time elapsed and the vocal cords were stimulated with the patient end of an endotracheal tube. Severity of reaction was reported as none, mild, moderate or severe. All cats were intubated after the reactivity score was recorded. Anesthesia was maintained with isoflurane and 100% oxygen while cats were spayed or neutered. Cats were monitored in recovery for signs of respiratory complications and pain. Results There was a significant difference in overall reactivity score between T5 and T45 ( P = 0.0038). Also, there was a significant difference in the number of cats with no reaction compared with cats with any reaction between T5 and T30 ( P = 0.03), as well as between T5 and T45 ( P = 0.0028). No cat had a severe reactivity score at T45 or T60. All cats were successfully intubated. There were no complications during intubation, maintenance of anesthesia or recovery. Conclusions and relevance As the lowest overall reactivity score occurred at T45, it is recommended to wait at least 45 s after application of topical lidocaine before attempting tracheal intubation.

Comparison of Various Methods of Electromyographic Monitoring of the Recurrent Laryngeal Nerve in Thyroid Surgery

2002 ◽  
Vol 111 (9) ◽  
pp. 811-816 ◽  
Author(s):  
Kurt P. Tschopp ◽  
Christine Gottardo
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Endotracheal Tube ◽  
Direct Laryngoscopy ◽  
Thyroid Surgery ◽  
Laryngeal Nerve ◽  
Vocal Cords ◽  
Surface Electrodes ◽  
Advantages And Disadvantages ◽  
The Mean ◽  
Stimulation Of

In the present study, 3 types of electrodes for recurrent laryngeal nerve (RLN) monitoring are compared: 1) intralaryngeal surface electrodes attached to a conventional endotracheal tube, 2) monopolar needle electrodes placed on the vocal cords by direct laryngoscopy, and 3) bipolar needle electrodes inserted intraoperatively through the cricothyroid ligament. Data were collected from stimulation of 21 RLNs in 16 patients undergoing thyroid surgery. The reliability in terms of distinct electromyographic (EMG) potentials following stimulation of the RLN was 100% with monopolar and bipolar needle electrodes and 76% with intralaryngeal surface electrodes. The mean (±SD) amplitudes of the EMG potentials were 1.61 ± 1.6 mV, 2.37 ± 1.8 mV, and 0.35 ± 0.4 mV for the monopolar endolaryngeal, bipolar transligament, and intralaryngeal surface electrodes, respectively. The advantages and disadvantages of each type of electrode are discussed.

scholarly journals A Case Report of Female Patient with Laryngeal Granuloma

2017 ◽  
Vol 18 (2) ◽  
pp. 175-177
Author(s):  
Sladjana Simovic ◽  
Tatjana Sarenac Vulovic ◽  
Jasmina Stojanovic ◽  
Sandra Zivanovic ◽  
Mladen Koravovic
Keyword(s):  
Early Childhood ◽  
Case Report ◽  
Tracheal Intubation ◽  
General Anesthesia ◽  
Female Patient ◽  
Direct Laryngoscopy ◽  
Potential Complication ◽  
Patient Case ◽  
Vocal Cords ◽  
Laryngeal Granuloma

AbstractThe aim of this case report is to present the laryngeal granuloma in 23 year old female patient. Case outline: The 23 year old female was admitted for examination, because of long lasting, progressive hoarseness. In anamnesis, we found that she has undergone general anesthesia for 8 times, in the early childhood. We performing direct laryngoscopy with complete otorhinolaryngologic examination, rigid endovideostroboscopy and the large granuloma of the larynx was found. Conclusions: Laryngeal granuloma of vocal cords affected mainly men, except for cases associated with laryngeal intubation. We should keep in mind that postintubation laryngeal granuloma might develop after tracheal intubation, so care must be taken to avoid the potential complication.

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 < 0.05). At day 1, the larynx and vocal cords appeared grossly less injured in the new ETT group (P < 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.

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.

Tracheal Intubation: Direct Laryngoscopy

2020 ◽  
pp. 122-129
Author(s):  
Keith Greenland ◽  
Richard Levitan
Keyword(s):  
Tracheal Intubation ◽  
Direct Laryngoscopy
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