phenylephrine-hydrochloride and Laryngismus

The purpose of the study was to assess the suitability and safety of the flexible reinforced laryngeal mask airway (FRLMA) for intranasal surgery (INS) anesthesia. A secondary objective was to compare the incidence of complications of removal of the FRLMA with tracheal extubation in awake and anesthetized patients. One hundred fourteen ASA physical status I and II patients requiring INS were randomly assigned into three groups: Group I = FRLMA, Group II = endotracheal tube (ET) extubated awake, and Group II = ET extubated deeply anesthetized. In Group I, the incidence of coughing and oxyhemoglobin desaturation at removal was significantly reduced compared with that in Groups II and III (P < 0.05). There were no episodes of postremoval laryngospasm in Group I; in Group III, the incidence was 19% (P < 0.05), whereas in Group II, it was 6% (not significantly different). The number of patients with oxyhemoglobin desaturation < or = 92% on admission to the postanesthesia care unit was 0% in Group I, 26% in Group II (P < 0.05), and 16% in Group III (not significantly different). At bronchoscopy, the incidence of blood visible in the airway was low and similar among the three groups (3%, 6%, and 3%, respectively). There were no significant differences in the incidence of airway complications between Groups II and III.. We compared airway management for intranasal surgery anesthesia using a new device, the flexible reinforced laryngeal mask airway, with the current standard of tracheal intubation. The study demonstrates that the flexible reinforced laryngeal mask airway can provide a safe, protected airway with a smoother emergence from anesthesia than tracheal intubation.

Topics: Adult; Anesthesia Recovery Period; Anesthesia, General; Bronchoscopy; Cough; Equipment Design; Female; Follow-Up Studies; Hoarseness; Humans; Incidence; Intubation, Intratracheal; Laryngeal Masks; Laryngismus; Male; Nose; Oxyhemoglobins; Pharyngitis; Pliability; Postoperative Hemorrhage; Respiration; Respiration, Artificial; Safety; Wakefulness

Intralaryngeal injections of botulinum toxin (Botox), under electromyographic guidance, have emerged as an effective treatment for adductor spasmodic dysphonia. To remain effective, these injections must be repeated every 3 to 9 months as the symptoms recur. One drawback to the current method is the need for electromyographic confirmation of needle placement into the thyroarytenoid muscle. This report describes an anatomic approach to Botox injection that requires only flexible nasopharyngeal endoscopy and careful evaluation of the anatomic landmarks. This technique has been used successfully on 13 patients, and objective pretreatment and posttreatment measures are reported.

Topics: Adult; Aged; Botulinum Toxins; Electromyography; Endoscopy; Female; Humans; Injections, Intramuscular; Laryngeal Muscles; Laryngismus; Male; Middle Aged; Nose; Pharynx; Speech; Voice Disorders

Acute epiglottitis is a potentially fatal upper respiratory tract infection. In this paper, we describe the use of flexible nasoendoscopy, both in establishing the diagnosis and during the subsequent airway management of adults with acute epiglottitis.

Topics: Acute Disease; Adult; Endoscopes; Epiglottitis; Humans; Laryngismus; Laryngitis; Nose

Topics: Acoustics; Adult; Female; Head; Humans; Laryngismus; Nose; Respiration; Voice