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PloS One 2015Neuromuscular block results in the loss of muscular tone in the upper airway, which might contribute to the increased postoperative airway morbidity followed by ProSeal... (Randomized Controlled Trial)
Randomized Controlled Trial
Neuromuscular block results in the loss of muscular tone in the upper airway, which might contribute to the increased postoperative airway morbidity followed by ProSeal laryngeal mask airway (PLMA) insertion. We compared the pharyngolaryngeal discomfort exerted by the PLMA according to the neuromuscular block. One hundred sixty patients undergoing surgery for breast disease or inguinal hernia were anesthetized with propofol and remifentanil by target controlled infusion. Rocuronium 0.6 mg/kg (NMBA group, n = 80) or normal saline (No-NMBA group, n = 80) was administered after the loss of consciousness, and one anesthesiologist inserted the PLMA. Postoperative pharyngolaryngeal discomfort was evaluated at postoperative 1 h. Traumatic event was recorded based on the blood trace on the surface of the PLMA cuff. Insertion time, insertion attempt number, sealing pressure, and fiberoptic brochoscopic grades were evaluated. Patients' characteristics and the PLMA insertion condition (insertion time, successful insertion attempt number, fiberoptic bronchoscopic grade, and sealing pressure) were similar between the two groups. The PLMA can be successfully inserted in non-paralyzed patients with less postoperative pharyngolaryngeal discomfort than when a neuromuscular blocking agent is used (13.8% vs. 30.0%, P = 0.021). The incidence of traumatic events is also reduced when no neuromuscular blocking agent is used (16.3% vs. 32.5%, P = 0.026). Regardless of whether or not a surgical procedure requires muscular relaxation, there is no need to administer neuromuscular blocking agents solely for the purpose of PLMA insertion.
Topics: Bronchoscopy; Female; Humans; Laryngeal Masks; Larynx; Male; Middle Aged; Morbidity; Paralysis; Pharynx; Time Factors; Wounds and Injuries
PubMed: 26252522
DOI: 10.1371/journal.pone.0134130 -
Korean Journal of Anesthesiology Dec 2016Anterior cervical osteophytes are commonly found in elderly patients, but rarely produce symptoms. When symptoms occur, they can range from mild symptoms of dysphagia,...
Anterior cervical osteophytes are commonly found in elderly patients, but rarely produce symptoms. When symptoms occur, they can range from mild symptoms of dysphagia, dysphonia, and foreign body sensation to severe symptoms of airway obstruction due to compression of the pharynx or larynx. We report the case of a 59-year-old man who underwent brain tumor surgery, and developed post-operative respiratory difficulty due to progressive pharyngo-laryngeal edema, requiring urgent endotracheal intubation, secondary to the presence of a previously asymptomatic anterior cervical osteophyte. It is paramount to recognize that asymptomatic anterior cervical osteophytes are a potential cause of life-threatening post-operative respiratory complications that can rapidly progress to life-threatening airway obstruction after surgeries in the prone position, especially in elderly patients.
PubMed: 27924209
DOI: 10.4097/kjae.2016.69.6.640 -
Anaesthesia Oct 2016This study compared two methods of controlling the intracuff pressure in laryngeal mask airways. One hundred and eighty patients were randomly assigned into two groups.... (Comparative Study)
Comparative Study Randomized Controlled Trial
This study compared two methods of controlling the intracuff pressure in laryngeal mask airways. One hundred and eighty patients were randomly assigned into two groups. In the first group (n = 90), after training, the intracuff pressure was controlled using digital palpation of the pilot balloon. In the second group (n = 90), continuous manometry was used to control the intracuff pressure. An upper pressure limit of 60 cmH2 O was set. The median (IQR [range]) intracuff pressure in the palpation group was 130 (125-130 [120-130]) cmH2 O compared with 29 (20-39 [5-60]) cmH2 O in the manometry group (p < 0.001). In the palpation group, 37% of patients experienced pharyngolaryngeal complications vs. 12% in the manometry group (p < 0.001). We conclude that the digital palpation technique is not a suitable alternative to manometry in controlling the intracuff pressure in laryngeal mask airways.
Topics: Double-Blind Method; Female; Humans; Laryngeal Masks; Male; Manometry; Middle Aged; Monitoring, Physiologic; Palpation; Postoperative Complications; Prospective Studies
PubMed: 27501056
DOI: 10.1111/anae.13566 -
British Journal of Anaesthesia Apr 2006Analgesia after pharyngolaryngeal surgery is commonly provided through the i.v. route. The aim of the study was to compare cervical epidural administration of fentanyl... (Comparative Study)
Comparative Study Randomized Controlled Trial
BACKGROUND
Analgesia after pharyngolaryngeal surgery is commonly provided through the i.v. route. The aim of the study was to compare cervical epidural administration of fentanyl with the i.v. route for postoperative analgesia after pharyngolaryngeal surgery.
METHODS
In a randomized double-blind study 42 patients received fentanyl via patient-controlled analgesia (PCA) either through the i.v. route (PCA-IV group, n=22) or through the cervical epidural route (PCA-Epid group, n=20). Identical PCA settings were used in the two groups (bolus dose: 1.5 microg kg(-1), bolus: 25 microg, lockout interval: 10 min, maximum cumulative dose: 400 microg per 4 h). Analgesia at rest and during swallowing was evaluated using a visual analogue scale.
RESULTS
Analgesia at rest was better in the PCA-Epid group than in the PCA-IV group but only 2 and 6 h after surgery (P<0.02). There was no difference in analgesia during swallowing. Cumulative doses of fentanyl were similar {PCA-Epid group: 1412 microg (912), PCA-IV group: 1287 microg (1200) [median (IQR)]}. The Pa(o(2)) showed a significant decrease between the preoperative and postoperative period, but this decrease was identical in the two groups [PCA-IV-group: 11.47 (2.4) kPa vs 8.27 (0.9) kPa; PCA-Epid group: 11.33 (1.9) kPa vs 9.20 (2.4) kPa for preoperative and postoperative period respectively].
CONCLUSIONS
The study results show that cervical epidural analgesia provides marginally better pain relief at rest with no decrease in the fentanyl consumption. The use of the cervical epidural administration of fentanyl is questionable because of the possible complications of the technique.
Topics: Adult; Aged; Aged, 80 and over; Analgesia, Epidural; Analgesia, Patient-Controlled; Analgesics, Opioid; Carbon Dioxide; Deglutition; Double-Blind Method; Drug Administration Schedule; Female; Fentanyl; Humans; Infusions, Intravenous; Laryngeal Neoplasms; Male; Middle Aged; Oxygen; Pain Measurement; Pain, Postoperative; Partial Pressure
PubMed: 16476697
DOI: 10.1093/bja/ael025 -
The Journal of International Medical... 2011Postoperative pharyngolaryngeal complications (PPLC) occur during anaesthesia due to increased cuff pressure following the insertion of laryngeal mask airways. The use... (Randomized Controlled Trial)
Randomized Controlled Trial
Postoperative pharyngolaryngeal complications (PPLC) occur during anaesthesia due to increased cuff pressure following the insertion of laryngeal mask airways. The use of a pressure regulator to prevent PPLC was evaluated in a prospective, randomized study. Sixty patients scheduled to receive general anaesthesia were randomly assigned to two equal groups of 30, either with or without the regulator. The 'just seal' cuff pressure (JSCP), cuff pressure at 5-min intervals during anaesthesia, incidence of pharyngeal sore throat (PST), dysphagia, dysphonia and other complications were evaluated at 1 and 24 h postoperatively. The combined mean ± SD JSCP of both groups was 20.3 ± 3.2 mmHg. In the group with the regulator, cuff pressure was maintained at a constant level during anaesthesia. This study demonstrated that the regulator is a simple, functional device that can reduce the incidence of PST significantly at 1 h postoperatively, following general anaesthesia.
Topics: Adult; Aged; Anesthesia, General; Deglutition Disorders; Dysphonia; Female; Humans; Laryngeal Masks; Male; Middle Aged; Pharyngitis; Postoperative Period; Pressure; Treatment Outcome
PubMed: 22117992
DOI: 10.1177/147323001103900534 -
Breast (Edinburgh, Scotland) Feb 2009
Topics: Breast Neoplasms; Female; Humans; Intubation, Intratracheal; Laryngeal Masks; Pain, Postoperative
PubMed: 19103489
DOI: 10.1016/j.breast.2008.11.001